Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya.
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2023 Apr 19;76(76 Suppl1):S77-S86. doi: 10.1093/cid/ciad035.
To address knowledge gaps regarding diarrheagenic Escherichia coli (DEC) in Africa, we assessed the clinical and epidemiological features of enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), and Shiga toxin-producing E. coli (STEC) positive children with moderate-to-severe diarrhea (MSD) in Mali, The Gambia, and Kenya.
Between May 2015 and July 2018, children aged 0-59 months with medically attended MSD and matched controls without diarrhea were enrolled. Stools were tested conventionally using culture and multiplex polymerase chain reaction (PCR), and by quantitative PCR (qPCR). We assessed DEC detection by site, age, clinical characteristics, and enteric coinfection.
Among 4840 children with MSD and 6213 matched controls enrolled, 4836 cases and 1 control per case were tested using qPCR. Of the DEC detected with TAC, 61.1% were EAEC, 25.3% atypical EPEC (aEPEC), 22.4% typical EPEC (tEPEC), and 7.2% STEC. Detection was higher in controls than in MSD cases for EAEC (63.9% vs 58.3%, P < .01), aEPEC (27.3% vs 23.3%, P < .01), and STEC (9.3% vs 5.1%, P < .01). EAEC and tEPEC were more frequent in children aged <23 months, aEPEC was similar across age strata, and STEC increased with age. No association between nutritional status at follow-up and DEC pathotypes was found. DEC coinfection with Shigella/enteroinvasive E. coli was more common among cases (P < .01).
No significant association was detected between EAEC, tEPEC, aEPEC, or STEC and MSD using either conventional assay or TAC. Genomic analysis may provide a better definition of the virulence factors associated with diarrheal disease.
为了解决非洲肠致病性大肠杆菌（DEC）方面的知识空白，我们评估了在马里、冈比亚和肯尼亚，患有中度至重度腹泻（MSD）的婴幼儿中肠聚集性大肠杆菌（EAEC）、肠致病性大肠杆菌（EPEC）和产志贺毒素大肠杆菌（STEC）的临床和流行病学特征。
在 2015 年 5 月至 2018 年 7 月期间，我们招募了年龄在 0-59 个月、因医疗原因出现 MSD 且与无腹泻的匹配对照的儿童。使用常规培养和多重聚合酶链反应（PCR）以及定量 PCR（qPCR）对粪便进行检测。我们评估了 DEC 在不同地点、年龄、临床特征和肠道合并感染中的检出情况。
在 4840 名患有 MSD 的儿童和 6213 名匹配对照中，对 4836 例病例和 1 例对照进行了 qPCR 检测。在使用 TAC 检测到的 DEC 中，61.1%为 EAEC，25.3%为非典型 EPEC（aEPEC），22.4%为典型 EPEC（tEPEC），7.2%为 STEC。与 MSD 病例相比，对照中 EAEC（63.9%比 58.3%，P<.01）、aEPEC（27.3%比 23.3%，P<.01）和 STEC（9.3%比 5.1%，P<.01）的检出率更高。EAEC 和 tEPEC 在年龄<23 个月的儿童中更为常见，aEPEC 在各年龄组中相似，而 STEC 则随年龄增加而增加。在随访时，营养状况与 DEC 病原体类型之间没有关联。DEC 与志贺菌/侵袭性大肠杆菌的合并感染在病例中更为常见（P<.01）。
使用常规检测或 TAC 均未发现 EAEC、tEPEC、aEPEC 或 STEC 与 MSD 之间存在显著相关性。基因组分析可能会更好地定义与腹泻病相关的毒力因子。
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