Diagnosisand Investigation of Diarrheagenic Escherichia coli

Although most Escherichia coli are harmless commensals of the human intestine, certain specific, highly-adapted E. coli strains are capable of causing urinary tract, systemic or enteric/diarrheagenic infection. Diarrheagenic E coli are divided into six distinct categories, or pathotypes, each with a distinct pathogenic scheme (Table 1). Combined, diarrheagenic E coli have emerged as perhaps the most important enteric pathogens of man. In the developing world, the E coli categories account for more cases of gastroenteiltis among infants than any other cause (1) In addition, E coli are also the most common cause of traveller's diarrhea, which afflicts more than one million travellers to the developing world annually (1). Enterohemorrhagic E coli (EHEC) are the cause of hemolytic uremic syndrome (HUS), which has become a major foodborne threat in many parts of the developed world (2). Table 1 Categories of Diarrheagenic E. coli Category Toxins Invasion Virulence plasmid Adhesin Clinical syndrome ETEC LT, ST - Many CFA/I, CFA/II, CFA/IV, others Watery diarrhea EPEC - + 60 MDa Bundle-forming pilus Watery diarrhea of infants EHEC SLT-1, SLT-2 - 60 MDa( a ) Intimin, Fimbriae( a ) Hemorrhagic colitis, HUS EAEC EAST1( a ) ? 65 MDa( a ) AAF/I, AAF/I Watery, persistent diarrhea EIEC EIET( a ) +++ 140 MDa Ipa's(?) Watery diarrhea, dysentery DAEC ? ? ? F1845( a ) Watery diarrhea ( a )Role in pathogenesis unproven.