CONTROLLED-STUDY OF ESCHERICHIA-COLI DIARRHEAL INFECTIONS IN BANGLADESHI CHILDREN

Diarrheal diseases are highly prevalent in Bangladesh. However, the re lative contribution of diarrheagenic Escherichia coli organisms-those that are enterotoxigenic (ETEC), enteropathogenic (EPEC), enteroinvasi ve, enterohemorrhagic, enteroaggregative, and diffuse adherent-to diar rhea in Bangladeshi populations is not known. With DNA probes specific for these diarrheagenic E. coli strains, we analyzed fecal E. coli fr om 451 children up to 5 years of age with acute diarrhea seeking treat ment at a Dhaka hospital and from 602 matched control children without diarrhea from July 1991 to May 1992. Enteroinvasive E. coli was not i solated from any children; enterohemorrhagic E. coli was not isolated from any diarrheal children but was isolated from five control childre n; enteroaggregative and diffuse adherent E. coli strains were isolate d with similar frequencies from children with and without diarrhea, th ereby showing no association with diarrhea; ETEC was significantly ass ociated with diarrhea in the diarrheal children as a whole and especia lly in the age groups of 0 to 24 months and 37 to 48 months (further a nalysis suggests an association with diarrhea for the heat-stable toxi n only and for both heat-labile- and heat-stable-toxin-producing ETEC only); and EPEC was significantly associated with diarrhea in the diar rhea group as a whole and particularly in infants up to 1 year of age. Further analysis suggested that EPEC strains of only the traditional serogroups were significantly associated with diarrhea. ETEC and EPEC infections peaked during warm months. Our data thus suggest that EPEC and ETEC are important causes of acute diarrhea in children in this se tting.