Diarrheagenic <em>Escherichia coli</em>
Abstract
Escherichia coli is the predominant nonpathogenic facultative flora of the human intestine. Some E. coli strains, however, have developed the ability to cause disease of the gastrointestinal, urinary, or central nervous system in even the most robust human hosts. Diarrheagenic strains of E. coli can be divided into at least six different categories with corresponding distinct pathogenic schemes. Taken together, these organisms probably represent the most common cause of pediatric diarrhea worldwide. Several distinct clinical syndromes accompany infection with diarrheagenic E. coli categories, including traveler’s diarrhea (enterotoxigenic E. coli), hemorrhagic colitis and hemolytic-uremic syndrome (enterohemorrhagic E. coli), persistent diarrhea (enteroaggregative E. coli), and watery diarrhea of infants (enteropathogenic E. coli). This review discusses the current level of understanding of the pathogenesis of the diarrheagenic E. coli strains and describes how their pathogenic schemes underlie the clinical manifestations, diagnostic approach, and epidemiologic investigation of these important pathogens.
Escherichia coli is the predominant facultative anaerobe of the human colonic flora. The organism typically colonizes the infant gastrointestinal tract within hours of life, and, thereafter, E. coli and the host derive mutual benefit (169). E. coli usually remains harmlessly confined to the intestinal lumen; however, in the debilitated or immunosuppressed host, or when gastrointestinal barriers are violated, even normal “nonpathogenic” strains of E. coli can cause infection. Moreover, even the most robust members of our species may be susceptible to infection by one of several highly adapted E. coli clones which together have evolved the ability to cause a broad spectrum of human diseases. Infections due to pathogenic E. coli may be limited to the mucosal surfaces or can disseminate throughout the body. Three general clinical syndromes result from infection with inherently pathogenic E. coli strains: (i) urinary tract infection, (ii) sepsis/meningitis, and (iii) enteric/diarrheal disease. This article will review the diarrheagenic E. coli strains, which include several emerging pathogens of worldwide public health importance, and will specifically focus on pathogens afflicting humans. We will particularly concentrate on the E. coli strains whose study has advanced most over the last decade, i.e., enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroaggregative E. coli (EAEC). Since the categories of diarrheagenic E. coli are differentiated on the basis of pathogenic features, emphasis will be placed on the mechanisms of disease and the development of diagnostic techniques based on virulence factors.
ACKNOWLEDGMENTS
This work was supported by Public Health Service grants AI-33096 to J.P.N. and AI-21657 and AI-41325 to J.B.K.
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