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Enteropathogenic Escherichia coli infection: History and clinical aspects

British Journal of Biomedical Science, 2002 by Clarke, S C, Haigh, R D, Freestone, P P E, Williams, P H

ABSTRACT

Diarrhoeagenic Escherichia coli remains an important cause of diarrhoea) disease worldwide. In terms of global public health, enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli are the most important. However, enterohaemorrhagic E. coli has emerged as a cause of disease in developed countries in recent years, and a number of large outbreaks have been reported. Therefore, the importance of research into diarrhoeagenic E. coli remains an important issue. EPEC is the most widespread of the diarrhoeagenic E. coli and provides a good virulence model for other E. coli infections, as well as other pathogenic bacteria. Although the virulence mechanisms of E. coli are now better understood, there remains much to be learned before effective treatments can be developed. Type III secretion mechanisms, the locus of enterocyte effacement and various toxins are all involved in the pathogenesis of the various diarrhoeagenic E. coli and may provide targets for future therapies. This review aims to provide an update on the worldwide problem of diarrhoeagenic E. coli by focusing on EPEC, and describes the history of the organism, its incidence and the clinical aspects of infection.

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KEY WORDS: Diarrhea. Escherichia coli.

Introduction

Diarrhoeal illness continues to be a major public health burden worldwide. Despite the fact that most children are now immunised against all the major childhood infectious diseases, the World Health Organisation (WHO) reports1 that more than 10 million die each year before their fifth birthday. This amounts to almost half the total number of deaths before the age of 50. However, the figures were higher - the total mortality has been reduced successfully from around 21 million in 1995. Even so, more than 50 million deaths occurred in 1997, 40 million of which were in developing countries and approximately one-third were due to infectious and parasitic diseases. A large proportion of these deaths were due to diarrhoeal diseases, one of the most common being Escherichia coli infection.

Currently, there are seven recognised diarrhoeagenic E. coli: enteropathogenic E. coli, enterohaemorrhagic E. coli, enteroinvasive E. coli, enterotoxigenic E. coli, enteroaggregative E. coli, diffuse-adherent E. coli and cytolethal distending toxin-producing E. coli. In terms of global infection, enteropathogenic E. coli (EPEC) is the most important. This review provides a general background to the history of the EPEC bacterium and focuses on its worldwide incidence and the clinical aspects surrounding infection.

Enteropathogenic Escherichia coff - historical overview

'Infantile diarrhoea was the term used to describe the symptoms of an infection that had been noted for a number of centuries. Over the past four centuries, infantile diarrhoea has had a number of synonyms including the terms 'griping in the guts, cholera infantum, 'summer diarrhoea' and `gastro-enteritis'.2 Up to and including the early part of the last century, infantile diarrhoea was a major problem worldwide, with high morbidity and mortality.

From 1920, diarrhoea-associated mortality in infants decreased in developed countries, resulting in a decline of interest in determining the aetiology of infantile diarrhoea;3 however, during the 1930s, a number of severe nosocomial outbreaks of neonatal enteritis occurred in New York, USA, each of which was associated with high mortality.4 In 23 outbreaks in 15 hospitals a total of 711 cases of infantile diarrhoea occurred in hospitalised infants, and the average morbidity and mortality rates were 15.5% and 73%, respectively (ranging from 4% to 49% and 0% to 21.5%, respectively). This led to a renewed interest in the aetiology of infantile diarrhoea.

Bray5 reported the isolation of diarrhoeagenic E. coli from cases of infantile summer diarrhoea although the intestinal pathogenicity of E. coli had already been noted as early as 1889(6) and 1897.(7) Lesage(7) suggested that there were pathogenic and non-pathogenic strains of E. coli because convalescent serum from a patient with diarrhoea agglutinated bacteria from other patients with diarrhoea during an epidemic. The same serum did not agglutinate bacteria from healthy individuals.7

Early epidemiological investigations used carbohydrate fermentation5 or slide agglutination tests8 to identify diarrhoeagenic E. coli. In 1947, Kauffman9 published a serotyping scheme based on somatic (0), flagellar (H) and capsular (K) antigens, providing a reliable method of typing diarrhoeagenic E. coli that is still used today for the serotyping of E. coli and other members of the Enterobacteriaceae. In the UK in the first half of the last century, epidemiological studies to determine the source of diarrhoeagenic E. coli mostly were unsuccessful. In the mid 1950s, however, E. coli serogroups associated with infantile diarrhoea were isolated from cows' milk.2 It is unlikely that they could be isolated from commercially-prepared milk today because of stringent bacteriological testing and pasteurisation, but some raw milks sold on farms could contain diarrhoeagenic E. coli.

Health Care Industry

Enteropathogenic Escherichia coli infection: History and clinical aspects

British Journal of Biomedical Science, 2002 by Clarke, S C, Haigh, R D, Freestone, P P E, Williams, P H

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