Department of Biochemistry and Molecular Biology, Loyola University Chicago, Maywood, Illinois.
Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois.
Gastroenterology. 2022 Nov;163(5):1321-1333. doi: 10.1053/j.gastro.2022.07.064. Epub 2022 Aug 7.
BACKGROUND & AIMS: There is debate whether atypical enteropathogenic Escherichia coli (aEPEC) causes disease in adults. aEPEC is commonly detected in symptomatic and asymptomatic individuals. aEPEC, in contrast to typical EPEC, lacks bundle-forming pili, altering its pathogenicity. Here, we define for the first time the clinical manifestations of sporadic aEPEC infection in United States children and adults and determine whether EPEC load correlates with disease.
This is a retrospective case-control study of 380 inpatients/outpatients of all ages. EPEC load in stools was determined by quantitative polymerase chain reaction.
Diarrhea, vomiting, abdominal pain, and fever were more prevalent in EPEC-positive cases than in EPEC-negative controls. aEPEC infection caused mostly acute, mild diarrhea lasting for 6 to 13 days. However, some had severe diarrhea with 10 to 40 bowel movements per day or had persistent/chronic diarrhea. Fever, vomiting, and abnormal serum sodium levels were more common in children. Adults more often reported abdominal pain and longer duration of diarrhea. Symptomatic aEPEC infection was associated with leukocytosis in 24% of patients. EPEC load >0.1% was associated with symptomatic infection; however, loads varied greatly. Co-infecting pathogens did not alter diarrhea severity or EPEC load. Longitudinal data reveal that some are colonized for months to years or are repeatedly infected.
aEPEC is associated with a wide array of symptoms in adults, ranging from asymptomatic carriage to severe diarrhea. Higher EPEC loads are associated with presence of symptoms, but bacterial load does not predict disease or severity. Future studies are needed to understand bacterial and host factors that contribute to aEPEC pathogenicity to improve diagnostic tools and clinical care.
是否非典型肠致病性大肠杆菌（aEPEC）会导致成人发病仍存在争议。aEPEC 在有症状和无症状个体中均普遍存在。与典型 EPEC 不同，aEPEC 缺乏束状形成的菌毛，从而改变了其致病性。在此，我们首次定义了美国儿童和成人散发的 aEPEC 感染的临床表现，并确定了 EPEC 负荷是否与疾病相关。
这是一项回顾性病例对照研究，纳入了所有年龄段的 380 例住院/门诊患者。通过定量聚合酶链反应来确定粪便中的 EPEC 负荷。
与 EPEC 阴性对照组相比，EPEC 阳性病例更常出现腹泻、呕吐、腹痛和发热。aEPEC 感染主要引起急性、轻度腹泻，持续 6-13 天。然而，一些患者出现严重腹泻，每天排便 10-40 次，或出现持续性/慢性腹泻。发热、呕吐和异常血清钠水平在儿童中更为常见。成年人更常报告腹痛和腹泻持续时间更长。有症状的 aEPEC 感染与 24%患者的白细胞增多有关。EPEC 负荷>0.1%与有症状感染相关；然而，负荷差异很大。合并感染的病原体并未改变腹泻严重程度或 EPEC 负荷。纵向数据显示，一些患者会被定植数月至数年，或反复感染。
aEPEC 与成人的各种症状相关，从无症状定植到严重腹泻不等。较高的 EPEC 负荷与症状存在相关，但细菌负荷不能预测疾病或严重程度。未来需要研究细菌和宿主因素，以了解其对 aEPEC 致病性的贡献，从而改善诊断工具和临床治疗。
