Gorbach S L, Banwell J G, Chatterjee B D, Jacobs B, Sack R B
J Clin Invest. 1971 Apr;50(4):881-9. doi: 10.1172/JCI106560.
The microflora of the small and large intestine was determined in 17 adults with acute undifferentiated diarrhea in Calcutta, India. On the basis of bacteriologic findings, the patients could be divided into two groups: those with a predominant flora of Escherichia coli (eight patients) and those with a mixed coliform flora (nine patients). In the former group, E. coli were distributed throughout the small and large bowel. Broth filtrates of these isolates contained an enterotoxin which caused fluid accumulation in the rabbit intestinal loop model. Toxigenic E. coli were cleared rapidly from the small bowel during the acute period; some patients only had the "hot" strains in their fecal effluent. During convalescence, the serotypes of E. coli changed and the new strains did not elaborate enterotoxin. Only one of the eight patients had a serotype previously associated with diarrhea. Acute undifferentiated diarrhea in the remaining cases was apparently caused by untypable E. coli or by typable strains not generally considered pathogenic. Small bowel and fecal cultures from the mixed flora group revealed a heterogeneous mixture of Gram-negative enteric bacilli and a distinct pattern could not be discerned. Further study will be needed to elucidate the cause of diarrhea in these cases.
对印度加尔各答17名患有急性未分化型腹泻的成年人的小肠和大肠微生物群进行了测定。根据细菌学检查结果，患者可分为两组：以大肠杆菌为主的菌群（8例患者）和混合大肠菌群（9例患者）。在前一组中，大肠杆菌分布于整个小肠和大肠。这些分离株的肉汤滤液含有一种肠毒素，可在兔肠襻模型中引起液体蓄积。产毒素大肠杆菌在急性期从小肠中迅速清除；一些患者的粪便中仅含有“热”菌株。在恢复期，大肠杆菌的血清型发生变化，新菌株不再产生肠毒素。8例患者中只有1例的血清型先前与腹泻有关。其余病例的急性未分化型腹泻显然是由无法分型的大肠杆菌或通常不被认为具有致病性的可分型菌株引起的。混合菌群组的小肠和粪便培养显示革兰氏阴性肠道杆菌的异质性混合物，无法辨别出明显的模式。需要进一步研究以阐明这些病例中腹泻的原因。
