Impact of Aeromonas and diarrheagenic Escherichia coli screening in patients with diarrhea in Paraná, southern Brazil

Introduction: A wide diversity of bacterial agents may cause diarrhea, presenting challenges to clinical laboratories to define a diagnosis. Considering that most stool cultures are negative, we screened stool samples from patients with diarrhea for the presence of 14 bacterial enteropathogens, aiming to establish which of them should be included in routine stool analysis. Methodology: Stool samples from 400 patients with diarrhea were analyzed for the presence of Salmonella, Shigella, Campylobacter, Aeromonas, Plesiomonas shigelloides, Vibrio, Yersinia enterocolitica, and diarrheagenic Escherichia coli using conventional microbiological methods and PCR. Two distinct samples were studied; one included predominantly patients involved in outbreaks, and the other patients of low socioeconomic status presenting sporadic cases of diarrhea. Results: In total, 86 cultures (21.5%) were positive. Mixed infections were found in five patients, leading to recovery of 91 strains of enteropathogenic bacteria: Salmonella Enteritidis (9.2%), Aeromonas (7.2%), diarrheagenic E. coli (5.2%), and C. jejuni (1%). However, Salmonella predominated, with 11.5% frequency in diarrhea outbreaks, while Aeromonas predominated among patients of low socioeconomic status, with 14.6% frequency. Conclusion: Aeromonas and diarrheagenic E. coli, which are not routinely screened for, deserve to be included in laboratory screening panels.

Download Full-text

Molecular Epidemiology of Extended-Spectrum β-Lactamase–Producing Escherichia coli Pathotypes in Diarrheal Children from Low Socioeconomic Status Communities in Bihar, India: Emergence of the CTX-M Type

Infectious Diseases Research and Treatment ◽

10.1177/1178633617739018 ◽

2017 ◽

Vol 10 ◽

pp. 117863361773901 ◽

Cited By ~ 6

Author(s):

Abhishek Mandal ◽

Abhishek Sengupta ◽

Ajay Kumar ◽

Utpal K Singh ◽

Anil K Jaiswal ◽

...

Keyword(s):

Escherichia Coli ◽

Low Socioeconomic Status ◽

Antimicrobial Activities ◽

Control Measures ◽

Resistance Pattern ◽

Age Group ◽

Low Socioeconomic ◽

E Coli ◽

Extended Spectrum ◽

Stool Samples

Background: Childhood diarrheal diseases remain highly endemic in India, but the emergence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli among children with diarrhea in Bihar remains elusive. In this study, we determine and characterize ESBL-producing E coli pathotypes among hospitalized diarrheal preschool children living in low socioeconomic level communities in Bihar, India. Materials and methods: The stool samples were collected everyday throughout the year for 2 consecutive years. In our study, we collected stool samples randomly from every fifth patient. Stool samples were collected from a total of 633 randomly selected diarrheal children (age: 0-60 months) belonging to 17 communities and screened for identification of virulent diarrheagenic E coli (DEC) pathotype (viz, enteropathogenic E coli [EPEC], enteroaggregative E coli [EAEC], enterotoxigenic E coli [ETEC], enteroinvasive E coli [EIEC], and enterohemorrhagic E coli [EHEC]) by a multiplex polymerase chain reaction (PCR) assay. Furthermore, ESBLs were screened by conventional antibiotic resistance pattern testing and later characterized for the presence of β-lactamase ( bla) genes by PCR and DNA sequencing. Results: Diarrheagenic E coli was detected in 191 cases (30.2%) of the total 633 diarrheic children. Maximum occurrence of DEC was found in ≤12 months age group (72.7%) with prevalence of the EAEC pathotype. Most isolates were resistant to ampicillin, ciprofloxacin, piperacillin, levofloxacin, ceftazidime, cefotaxime, ceftriaxone, and gentamicin, whereas over 96% of them were sensitive to amikacin. About 37.6% of total 191 DEC isolates were ESBL producers (n = 72), being prevalent among ETEC (n = 35; 18.32%), followed by EPEC (n = 21; 10.9%), EAEC (n = 13; 6.8%), and EIEC (n = 3; 1.57%). Interestingly, the commonest β-lactamase was CTX-M type ( blaCTX-M) in 86.1% (n = 62) of the ESBL isolates, followed by blaSHV (n = 49; 68%), blaTEM (n = 37; 51.8%), and blaOXA (n = 21; 29.1%) determinants. Resistance of ESBL isolates was mostly related to ampicillin (100%), ceftriaxone (98.1%), cefotaxime (92.4%), gentamicin (74.1%), and levofloxacin (73.2%), whereas best antimicrobial activities were observed for piperacillin-tazobactam, amikacin, meropenem, and imipenem. Conclusions: This study revealed that EAEC (72.1%) is the predominant pathotype in Bihar, significantly high in ≤12 months age group children ( P = .04). Moreover, the widespread prevalence of ESBLs in children, especially the CTX-M type, is of great concern, which requires monitoring of infection control measures through efficient antimicrobial management and detection of ESBL-producing isolates.

Download Full-text

Molecular Detection of Diarrheagenic Escherichia coli from Children with Acute Diarrhea in Tertiary Care Hospitals of Dhaka, Bangladesh.

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i2.8576 ◽

2013 ◽

Vol 5 (2) ◽

pp. 59-66 ◽

Cited By ~ 1

Author(s):

Sushmita Roy ◽

SM Shamsuzzaman ◽

Kazi Z Mamun

Keyword(s):

Escherichia Coli ◽

Multiplex Pcr ◽

Acute Diarrhea ◽

Tertiary Care ◽

Medical Science ◽

Pcr Assay ◽

E Coli ◽

Diarrheagenic Escherichia Coli ◽

Multiplex Pcr Assay ◽

Stool Samples

Objective: Multiplex PCR assay was used for diagnosis of diarrheagenic Escherichia coli (DEC) in stool samples of children (under 5 years) with acute diarrhea. Methods: Samples were collected from January 2011 to December 2011, from Dhaka Medical College Hospital and Dhaka Shishu Hospital. Multiplex PCR with five specific primer pairs to detect enteropathogenic E. coli (eae, bfp), enterotoxigenic E. coli (lt, st) and enteroaggregative E. coli (aat) were used. However, enteroinvasive E. coli, enterohemorrhagicE. coli and diffusely adhererentE. coli were not sought. Result: In total, 135 (67.5%) E. coli were isolated from 200 stool samples. The prevalence of DEC was 68 (34%). Among DEC, most frequently isolated pathotype was EPEC 40 (58.82%), followed by ETEC 24 (35.29%) and EAggEC 18 (26.47%). Among the EPEC, 5 (12.5%) were typical EPEC. Among the 68 DEC positive cases, 22 samples contained more than one pathogenic gene in various combinations. Among the combination of DEC, EPEC+ETEC combination was 6 (27.27%) followed by ETEC+EAggEC 4 (18.18%), EPEC+EAggEC and ETEC+EPEC+EAggEC were both in 3 (13.6%). Conclusion:This study shows that DEC is a common cause of childhood diarrhea in Dhaka city of Bangladesh. By using multiplex PCR assay, DEC can be diagnosed in one PCR reaction that makes a conclusive diagnosis of diarrhea. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8576 Asian Journal of Medical Science, Volume-5(2) 2014: 59-66

Download Full-text

Diarrheagenic Escherichia coli and Acute and Persistent Diarrhea in Returned Travelers

Journal of Clinical Microbiology ◽

10.1128/jcm.38.10.3550-3554.2000 ◽

2000 ◽

Vol 38 (10) ◽

pp. 3550-3554 ◽

Cited By ~ 34

Author(s):

C. Schultsz ◽

J. van den Ende ◽

F. Cobelens ◽

T. Vervoort ◽

A. van Gompel ◽

...

Keyword(s):

Escherichia Coli ◽

Multivariate Analysis ◽

Acute Diarrhea ◽

Case Control Study ◽

Persistent Diarrhea ◽

E Coli ◽

Diarrheagenic Escherichia Coli ◽

Stool Samples ◽

Control Study

To determine the role of diarrheagenic Escherichia coliin acute and persistent diarrhea in returned travelers, a case control study was performed. Enterotoxigenic E. coli (ETEC) was detected in stool samples from 18 (10.7%) of 169 patients and 4 (3.7%) of 108 controls. Enteroaggregative E. coli (EAggEC) was detected in 16 (9.5%) patients and 7 (6.5%) controls. Diffuse adherent E. coli strains were commonly present in both patients (13%) and controls (13.9). Campylobacter andShigella species were the other bacterial enteropathogens most commonly isolated (10% of patients, 2% of controls). Multivariate analysis showed that the presence of ETEC was associated with acute diarrhea (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.5 to 29.1; P = 0.005), but not with persistent diarrhea (OR, 1.6; 95% CI, 0.4 to 7.4). EAggEC was significantly more often present in patients with acute diarrhea than in controls (P = 0.009), but no significant association remained after multivariate analysis. ETEC and EAggEC are frequently detected in returned travelers with diarrhea. The presence of ETEC strains is associated with acute but not with persistent diarrhea.

Download Full-text

The impact of socioeconomic status on foodborne illness in high-income countries: a systematic review

Epidemiology and Infection ◽

10.1017/s0950268814003847 ◽

2015 ◽

Vol 143 (12) ◽

pp. 2473-2485 ◽

Cited By ~ 38

Author(s):

K. L. NEWMAN ◽

J. S. LEON ◽

P. A. REBOLLEDO ◽

E. SCALLAN

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Foodborne Pathogens ◽

Developed Countries ◽

Foodborne Illness ◽

Low Socioeconomic ◽

E Coli ◽

Developed Nations ◽

The Impact

SUMMARYFoodborne illness is a major cause of morbidity and loss of productivity in developed nations. Although low socioeconomic status (SES) is generally associated with negative health outcomes, its impact on foodborne illness is poorly understood. We conducted a systematic review to examine the association between SES and laboratory-confirmed illness caused by eight important foodborne pathogens. We completed this systematic review using PubMed for all papers published between 1 January 1980 and 1 January 2013 that measured the association between foodborne illness and SES in highly developed countries and identified 16 studies covering four pathogens. The effect of SES varied across pathogens: the majority of identified studies for Campylobacter, salmonellosis, and E. coli infection showed an association between high SES and illness. The single study of listeriosis showed illness was associated with low SES. A reporting bias by SES could not be excluded. SES should be considered when targeting consumer-level public health interventions for foodborne pathogens.

Download Full-text

Prevalence of Diarrheagenic Escherichia coli in Finns with or without Diarrhea during a Round-the-World Trip

Journal of Clinical Microbiology ◽

10.1128/jcm.38.12.4425-4429.2000 ◽

2000 ◽

Vol 38 (12) ◽

pp. 4425-4429 ◽

Cited By ~ 37

Author(s):

Markku Keskimäki ◽

Leena Mattila ◽

Heikki Peltola ◽

Anja Siitonen

Keyword(s):

Escherichia Coli ◽

Primary Culture ◽

Shiga Toxin ◽

Clinical Picture ◽

Salmonella Enterica ◽

Bacterial Pathogens ◽

E Coli ◽

Diarrheagenic Escherichia Coli ◽

Enteropathogenic Bacteria ◽

The World

The incidence of diarrhea and the prevalence of bacterial enteropathogens, viruses, and parasites in feces of subjects with and without diarrhea were evaluated in 204 Finns traveling round the world (from Finland to China, Malaysia, Australia, Fiji, Chile, and Brazil and back to Finland). Special emphasis was placed on the finding of diarrheagenic Escherichia coli (enterotoxigenic, enteropathogenic, Shiga toxin-producing, and enteroaggregative strains) by PCR from growth on primary culture plates. From the PCR-positive samples, corresponding strains were isolated, confirmed as E. coli, and O serotyped. Of all the subjects, 37% experienced a total of 90 episodes of diarrhea. No adenoviruses or rotaviruses were detected, and findings of parasites were insignificant. In contrast, enteropathogenic bacteria were present in 62% of the 65 diarrheal and in 33% of the 127 nondiarrheal samples (P < 0.001); diarrheagenic E. coli strains were found in 35 and 26% of these, respectively (not statistically significant). As a single pathogen, E. coli was found in 20 and 24% of samples (not significant). Of all diarrheagenic E. coli strains, enteropathogenic strains were the most commonly found independently of the clinical picture of the subjects, whereas Salmonella enterica as a single pathogen was the most common non-E. coli organism found in diarrheal samples. Multiple bacterial pathogens were found 10 times more commonly in diarrheal than in nondiarrheal samples (20 versus 2%; P < 0.001).

Download Full-text

Antimicrobial Susceptibility Pattern of Klebsiella pneumonia and Escherichia coli Isolated from Stool Samples of Patients in Two Tertiary Hospitals in Rivers State, Nigeria

South Asian Journal of Research in Microbiology ◽

10.9734/sajrm/2020/v6i130143 ◽

2020 ◽

pp. 44-49

Author(s):

S. I. Douglas ◽

N. P. Akani ◽

N. C. Kamani

Keyword(s):

Escherichia Coli ◽

Public Health Problem ◽

Multi Drug Resistance ◽

Klebsiella Pneumonia ◽

Susceptibility Pattern ◽

E Coli ◽

Microbiological Methods ◽

Tertiary Hospitals ◽

Stool Samples ◽

Rivers State

Reduced susceptibility of antibiotics against Enterobacterial strains have emerged as an important public health problem worldwide. Infections caused by Escherichia coli and Klebsiella pneumonia can affect severely ill patients, and their colonization of human gut, endangers population at large in communities, and in hospitals. This research is aimed at determining the susceptibility pattern of Escherichia coli and Klebsiella pneumonia from stool of patients in two tertiary hospitals in Rivers State, Nigeria. A total of 114 stool samples were collected from patients. Stool samples were collected in sterile biological specimen bottles and were sent to the laboratory immediately after collection. Stool samples were inoculated by streaking on Eosin methylene blue and MacConkey agar plates. Isolates were characterized using standard microbiological methods and were stored and used for further tests. The result showed that nineteen isolates of E. coli were 100% resistant to Cefuroxime and Augmentin, while 78.9%, 68.4% and 42.1% were resistant to cefixime, Ceftazidime and Nitrofurantoin, respectively. The result for the susceptibility pattern of the Klebsiella isolates showed 100% resistance to cefuroxime and Augmentin. Resistance to ceftazidime, cefixime and nitrofurantoin were observed to be 70%, 60% and 45%, respectively. Isolates of E. coli and Klebsiella were highly susceptible to Meropenem and ofloxacin. The isolates of E. coli and Klebsiella showed multi-drug resistance to the different antibiotics. Although the meropenem, ofloxacin and ciprofloxacin antibiotics showed high level of sensitivity to these isolates, there were still some level of resistance recorded.

Download Full-text

Phenotypic and Genotypic Antibiotic Resistant diarrheagenic Escherichia coli pathotypes isolated from Children with Diarrhea in Nairobi City, Kenya

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i6.5 ◽

2020 ◽

Vol 30 (6) ◽

Author(s):

Mark Kilongosi Webale ◽

Bernard Guyah ◽

Christine Wanjala ◽

Peter Lokamar Nyanga ◽

Sella K. Webale ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Agents ◽

Cross Sectional Study ◽

Genotypic Resistance ◽

Cross Sectional ◽

Antibiotic Resistant ◽

E Coli ◽

Diarrheagenic Escherichia Coli ◽

Resistant Genes ◽

Stool Samples

BACKGROUND፡ The marked genome plasticity of diarrheagenic Escherichia coli promotes emergence of pathotypes displaying unique phenotypic and genotypic resistance. This study examined phenotypic and genotypic antibiotic resistant diarrheagenic Escherichia coli pathotypes among children in Nairobi City, Kenya.METHODS: In a cross-sectional study, diarrheagenic Escherichia coli pathotypes were isolated from stool samples and their phenotypic and genotypic resistance against eight antimicrobial agents assayed.RESULTS: Diarrheagenic Escherichia coli was detected in 136(36.4%) children. Most of diarrheagenic Escherichia coli that were resistant to ampicillin, ceftriaxone, streptomycin, gentamycin, ciprofloxacin, chloramphenicol, erythromycin and tetracycline, harbored citm, bla CMY, aadA1, aac(3)-IV, qnr, catA, ere(A) and tet(A) corresponding resistant genes.CONCLUSION: Antimicrobial-resistant genes are highly prevalent among phenotypic resistant ETEC pathotypes indicating a possibility of horizontal gene transfer in spreading antibiotic resistant genes among E. coli pathotypes.

Download Full-text