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Fecal leukocytes in children infected with diarrheagenic Escherichia coli

Erik H Mercado1, Theresa J Ochoa, Lucie Ecker

  • 1Universidad Peruana Cayetano Heredia, Lima, Peru.

Journal of Clinical Microbiology
|February 18, 2011
PubMed

Insights

Diarrheagenic Escherichia coli infections in young children are linked to elevated fecal leukocytes, indicating an inflammatory response. Enterotoxigenic E. coli (ETEC) showed a significant association with these inflammatory markers.

Area of Science:

  • Pediatric Infectious Diseases
  • Gastroenterology
  • Microbiology

Background:

  • Diarrheagenic *Escherichia coli* is a significant cause of childhood diarrhea.
  • Assessing the host inflammatory response, such as fecal leukocytes, can help understand disease severity.
  • Previous studies have not fully elucidated the inflammatory markers associated with specific diarrheagenic *E. coli* pathotypes in young children.

Purpose of the Study:

  • To quantify fecal leukocytes in children with diarrheagenic *E. coli* infections.
  • To compare fecal leukocyte levels between diarrheal episodes and healthy controls.
  • To investigate the association between specific diarrheagenic *E. coli* pathotypes and fecal leukocyte presence.

Main Methods:

  • Analysis of 1,474 stool samples from 935 diarrhea episodes and 539 controls in children under 2 years in Lima, Peru.
  • Multiplex real-time PCR for detecting diarrheagenic *E. coli* and other enteric pathogens.
  • Methylene blue staining of stool smears to quantify fecal leukocytes (polymorphonuclear leukocytes per high-power field, L/hpf) by a blinded observer.

Main Results:

  • Fecal leukocytes (>10 L/hpf) were significantly higher in diarrheal episodes (11.8%) compared to controls (1.1%) (P < 0.001).
  • Among samples with *E. coli* as the sole pathogen, fecal leukocytes were elevated in diarrhea (8.5%) versus controls (1.3%) (P < 0.01).
  • Enterotoxigenic *E. coli* (ETEC) as a single pathogen was strongly associated with fecal leukocytes (OR 4.1, P < 0.05), even after adjusting for confounding factors.

Conclusions:

  • Diarrheagenic *E. coli* infections are associated with an increased presence of fecal leukocytes in young children.
  • ETEC, as a single pathogen, demonstrates a significant association with a heightened inflammatory response.
  • While generally eliciting a mild inflammatory response, diarrheagenic *E. coli* infections trigger a measurable increase in fecal leukocytes during symptomatic illness.

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