Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt

Enterotoxigenic Escherichia coil (ETEC) are diverse pathogens that express heat-labile (LT) and/or heat-stable (ST) enterotoxins, yet little is known about whether epidemiologic patterns of pediatric ETEC diarrhea vary by the expressed ETEC toxin phenotype, In total, 242 Egyptian children aged <3 ye ars were prospectively followed in 1993-1995. ETEC episodes were detected d uring twice-weekly home visits, and asymptomatic ETEC excretion was identif ied from monthly cross-sectional surveys. ETEC episodes were 0.6 per child- year. ST-only ETEC was 2.6 times (P < .001) more common in warmer than cool er months, while LT-only ETEC showed no seasonal variation. Ownership of a household sanitary latrine, but not breast-feeding, was associated with a l ower risk of both enterotoxin phenotypes, Coexpression of a colonization fa ctor by LT- or ST-only ETEC strengthened the association with diarrhea, The se findings indicate that the epidemiologic patterns of LT-only and ST-only ETEC are not identical and that disease interventions should include impro ved household sanitation.