NUTRITIONAL IMPACT AND ULTRASTRUCTURAL INTESTINAL ALTERATIONS IN SEVERE INFECTIONS DUE TO ENTEROPATHOGENIC ESCHERICHIA-COLI STRAINS IN INFANTS

Objective: Enteropathogenic Escherichia coli (EPEC) strains are able t o adhere to human intestinal tissue inducing a typical lesion causing dissolution of the brush border membrane and loss of microvillus struc ture at sites of bacterial attachment. The presence of these lesions c an provoke perpetuation of diarrhea associated with malabsorption of t he nutrients and nutritional aggravation. In this paper we report the nutritional impact of severe EPEC gastroenteritis in infants in a smal l bowel ultrastructural study. Methods and Results: Two infants aged 3 months and one 4 month old infant with profuse watery diarrhea lastin g less than 6 days were studied. After rehydration therapy, the patien ts were fed a cow's milk formula and since food intolerance was diagno sed, a protein-hydrolisate, lactose-free formula was introduced. This dietary modification was successful, diarrhea ceased, the patients wer e discharged and followed up for 30 days. The following EPEC strains w ere identified in the stools and in the jejunal secretion: O111ab:H2, O119:H6 and O18ab:H14. A small bowel biopsy was performed and the elec tron microscopic study revealed bacteria tightly adhered to the apical portion of the enterocyte and effacement of the microvilli. These les ions were more prominent in the areas where bacteria were present. Con clusion: The patients underwent an acute nutritional aggravation due t o food intolerance, but the introduction of a protein-hydrolisate, lac tose-free formula, allowed prompt cessation of diarrhea and nutritiona l recovery.