Diarrhoea and Associated Clinical Features in Different Pathotypes of Diarrheagenic E. coli Isolated in Children: A Case-Control Study in a Tertiary Care Hospital
Abstract
Background: Acute gastroenteritis remains to be a major health problem in children causing high morbidity and mortalityIn India, diarrhoea is the third most common cause of death in children younger than 5 years
of age, with an estimation of 300,000 deaths each year. Diarrheagenic Escherichia coli (DEC) being one of the important bacterial agents, the present hospital-based study was done to enlighten on the occurrence
of different pathotypes and clinical features associated with DEC related diarrhoea.
Methods: The case-control study was carried out in SCB Medical College, Odisha from October 2014 to September 2016 on the childhood diarrhoea cases (≤ 14 years of age). Stool samples were collected
and processed to isolate the causative bacterial agent by standard biochemical test, serotyping and multiplex PCR.
Results: 350 cases and 100 controls were included in the study. The different pathotypes of DEC were isolated significantly more in cases than control group (P value = 0.0205) with an isolation rate of 7.4% in cases. 12 (46.2%) of DEC were in 0-1 year age group followed by 1-5 year of age group i.e. 11 (42.3%) and least in 5-14 years of age group i.e. 3 (11.5%). The most common pathotype was Enterotoxigenic E. coli (ETEC) followed by Enteropathogenic E.coli (EPEC). Fever is the most common symptom associated with DEC diarrhoea; the other two common symptoms were watery diarrhoea and vomiting. Exclusive breastfeeding was the protective factor. Seasonal variation of DEC was found more among the cases in the rainy season.
Conclusion: Different pathotypes of DEC being associated commonly with childhood diarrhoea, the correct identification of various types of DEC along with the clinical knowledge is important to reduce the morbidity and mortality caused by it.
How to cite this article:
Mohanty M, Kar PK, Rout B, Behera TR. Diarrhoea and Associated Clinical Features in Different Pathotypes of Diarrheagenic E. coli Isolated in Children: A Case-Control Study in a Tertiary Care Hospital. J Commun Dis. 2021;53(3):250-258.
DOI: https://doi.org/10.24321/0019.5138.202165
References
Saka HK, Dabo NT, Muhammad B, GarcÃa-Soto S, Ugarte-Ruiz M, Alvarez J. Diarrheagenic Escherichia
coli pathotypes from children younger than 5 years in Kano State, Nigeria. Front Public Health. 2019;7:348.
[PubMed] [Google Scholar]
Global Burden of Disease Pediatrics Collaboration; Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa
A, Charlson FJ, Coffeng LE, Dandona L, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming TD, Forouzanfar
MH, Graetz N, Guinovart C, Haagsma J, Higashi H, Kassebaum NJ, Larson HJ, Lim SS, Mokdad AH, Moradi-
Lakeh M, Odell SV, Roth GA, Serina PT, Stanaway JD, Misganaw A, Whiteford HA, Wolock TM, Wulf Hanson
S, Abd-Allah F, Abera SF, Abu-Raddad LJ, AlBuhairan FS, Amare AT, Antonio CA, Artaman A, Barker-Collo SL,
Barrero LH, Benjet C, Bensenor IM, Bhutta ZA, Bikbov B, Brazinova A, Campos-Nonato I, Castañeda-Orjuela
CA, Catalá-López F, Chowdhury R, Cooper C, Crump JA, Dandona R, Degenhardt L, Dellavalle RP, Dharmaratne
SD, Faraon EJ, Feigin VL, Fürst T, Geleijnse JM, Gessner BD, Gibney KB, Goto A, Gunnell D, Hankey GJ, Hay
RJ, Hornberger JC, Hosgood HD, Hu G, Jacobsen KH, Jayaraman SP, Jeemon P, Jonas JB, Karch A, Kim D, Kim
S, Kokubo Y, Kuate Defo B, Kucuk Bicer B, Kumar GA, Larsson A, Leasher JL, Leung R, Li Y, Lipshultz SE, Lopez
AD, Lotufo PA, Lunevicius R, Lyons RA, Majdan M, Malekzadeh R, Mashal T, Mason-Jones AJ, Melaku YA,
Memish ZA, Mendoza W, Miller TR, Mock CN, Murray J, Nolte S, Oh IH, Olusanya BO, Ortblad KF, Park EK,
Paternina Caicedo AJ, Patten SB, Patton GC, Pereira DM, Perico N, Piel FB, Polinder S, Popova S, Pourmalek
F, Quistberg DA, Remuzzi G, Rodriguez A, Rojas-Rueda D, Rothenbacher D, Rothstein DH, Sanabria J, Santos
IS, Schwebel DC, Sepanlou SG, Shaheen A, Shiri R, Shiue I, Skirbekk V, Sliwa K, Sreeramareddy CT, Stein
DJ, Steiner TJ, Stovner LJ, Sykes BL, Tabb KM, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Towbin JA, Ukwaja
KN, Vasankari T, Venketasubramanian N, Vlassov VV, Vollset SE, Weiderpass E, Weintraub RG, Werdecker A,
Wilkinson JD, Woldeyohannes SM, Wolfe CD, Yano Y, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, El Sayed Zaki
M, Naghavi M, Murray CJ, Vos T. Global and national burden of diseases and injuries among children and
adolescents between 1990 and 2013: findings from the global burden of disease 2013 study. JAMA Pediatr.
;170:267-87. [PubMed] [Google Scholar]
Lanata CF, Fischer-Walker CL, Olascoaga AC, Torres CX, Aryee MJ, Black RE; Child Health Epidemiology
Reference Group of the World Health Organization and UNICEF. Global causes of diarrheal disease mortality
in children <5 years of age: a systematic review. PLoS One. 2013;8:e72788. [PubMed]
Parashar U, Bresee JS, Glass RI. The global burden of diarrhoeal disease in children. Bull World Health Organ.
;81(4):236. [Google Scholar]
Kirk MD, Pires SM, Black RE, Caipo M, Crump JA, Devleesschauwer B, Döpfer D, Fazil A, Fischer-Walker CL,
Hald T, Hall AJ, Keddy KH, Lake RJ, Lanata CF, Torgerson PR, Havelaar AH, Angulo FJ. World Health Organization
estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases,
: a data synthesis. PLoS Med. 2015;12:e1001921. [PubMed] [Google Scholar]
Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published
between 1992 and 2000. Bull World Health Organ. 2003;81(3):197-204. [PubMed] [Google Scholar]
Hien BT, Trang DT, Scheutz F, Cam PC, Mølbak K, Dalsgaard A. Diarrhoeagenic Escherichia coli and other
causes of childhood diarrhoea: a case–control stud in children living in a wastewater-use area in Hanoi,
Vietnam. J Med Microbiol. 2007;56(Pt 8):1086-96. [PubMed] [Google Scholar]
Robins-Browne RM, Bordun AM, Tauschek M, Bennett-Wood VR, Russell J, Oppedisano F, Lister NA, Bettelheim
KA, Fairley CK, Sinclair MI, Hellard ME. Escherichia coli and community-acquired gastroenteritis, Melbourne,
Australia. Emerg Infect Dis. 2004;10:1797-805. [PubMed] [Google Scholar]
Okeke NI. Diarrheagenic Escherichia coli in sub-SaharanAfrica: status, uncertainties and necessities. J Infect Dev Ctries. 2009;3(11):817-42. [PubMed] [Google Scholar]
Lakshminarayanan S, Jayalakshmy R. Diarrheal diseases among children in India: Current scenario and future
perspectives, J Nat Sci Biol Med. 2015 Jan-Jun; 6(1): 24–28. [Google Scholar]
Verma S, Kumar V, Singh P. Managing childhood diarrhoea at homes in India: an opportunity to reduce
child morbidity and mortality. Infect Dis Health. 2016;21(4):176-83. [Google Scholar]
Keusch GT, Walker CF, Das JK, Horton S, Habte D. Diarrheal diseases. In: Black RE, Laxminarayan R,
Temmerman M, Walker N, editors. Washington, DC: World Bank; 2016.
John J, Sarkar R, Muliyil JBN, Bhan MK, Kang G. Rotavirus gastroenteritis in India, 2011-2013: Revised estimates of disease burden and potential impact of vaccines. Vaccine. 2014;32S:A5-9. [PubMed] [Google Scholar]
Bhandari N, Rongsen-Chandola T, Bavdekar A, John J, Antony K, Taneja S, Goyal N, Kawade A, Kang G, Rathore
SS, Juvekar S, Muliyil J, Arya A, Shaikh H, Abraham V, Vrati S, Proschan M, Kohberger R, Thiry G, Glass R,
Greenberg HB, Curlin G, Mohan K, Harshavardhan GV, Prasad S, Rao TS, Boslego J, Bhan MK; India Rotavirus
Vaccine Group. Efficacy of a monovalent humanbovine (116E) rotavirus vaccine in Indian infants: a
randomised double blind placebo controlled trial. Lancet. 2014;383:2136-43. [PubMed] [Google Scholar]
Kahn G, Fitzwater S, Tate J, Kang G, Ganguly N, Nair G, Steele D, Arora R, Chawla-Sarkar M, Parashar
U, Santosham M. Epidemiology and prospects for prevention of rotavirus disease in India. Indian Pediatr.
;49:467-74. [PubMed] [Google Scholar]
Clark A, Zandvoort KV, Flasche S, Sanderson C, Bines J, Tate J, Parashar U, Jit M. Efficacy of live oral rotavirus
vaccines by duration of follow-up: a meta-regression of randomised controlled trials. Lancet Infect Dis.
;19(7):717-27. [PubMed] [Google Scholar]
Al-Gallas N, Bahari O, Bouratbeen A, Hasen AB, Aissa RB. Etiology of acute diarrhea in children and adults
in Tunis, Tunisia, with emphasis on diarrheagenic Escherichia coli; prevalence, phenotyping & molecular
epidemiology. Am J Trop Med Hyg. 2007;77:571-82. [PubMed] [Google Scholar]
Gomes TA, Rassi V, Mac Donald KL, Ramos SR, Trabulsi LR, Vieira MA, Guth BE, Candeias JA, Ivery C, Toledo
MR, Blak PA. Enteropathgene associated with acute diarrheal disease in urban infants in Sao Paulo, Brazil. J
Infect Dis. 1991;164:331-7. [PubMed] [Google Scholar]
Kaper JB, Nataro JP, Mobley HL. Pathogenic Escherichia0 coli. Nat Rev Microbiol. 2004;2:123-40. [PubMed]
[Google Scholar]
Chandra M, Cheng P, Rondeau G, Porwollik S, McClelland M. A single step multiplex PCR for identification of six diarrheagenic E. coli pathotypes and Salmonella. Int J Med Microbiol. 2013;303:210-6. [PubMed] [Google
Scholar]
Rich C, Alfidja A, Sirot J, Joly B, Forestier C. Identification of human enterovirulent Escherichia coli strains by
multiplex PCR. J Clin Lab Anal. 2001;15:100-3. [PubMed] [Google Scholar]
Miliwebsky E, Schelotto F, Varela G, Luz D, Chinen I, Piazza RMF. Human diarrheal infections: diagnosis of
diarrheagenic Escherichia coli pathotypes. In: Torres AG, editor. Escherichia coli in the Americas. Switzerland:
Springer International Publishing; 2016. p.343-69. [Google Scholar]
Croxen MA, Law RJ, Scholz R, Keeney KM, Wlodarska M, Finlay BB. Recent advances in understanding
enteric pathogenic Escherichia coli. Clin Microbiol Rev. 2013;26(4):822-80. [PubMed] [Google Scholar]
Rajendran P, Ajjampur SS, Chidambaram D, Chandrabose G, Thangaraj B, Sarkar R, Samuel P, Rajan DP, Kang
G. Pathotypes of diarrheagenic Escherichia coli in children attending a tertiary care hospital in South
India. Diagn Microbiol Infect Dis. 2010;68:117-22. [PubMed] [Google Scholar]
Nataro JP, Kaper JB. Diarrheagenic Escherichia coli. Clin Microbiol. 1998;11:142-201. [PubMed] [Google
Scholar]
World Health Organization [Internet]. Diarrhoeal disease; 2017 [cited 2018 Dec 19]. Available from:
https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
World Health Organization. Manual for laboratory investigation of acute enteric infections. CDD/83.3.
WHO, Geneva, Switzerland; 1987.
Purwar S, Bhattacharya D, Metgud SC, Kumar D, Chitambar SD, Roy S. A cross-sectional study on
aetiology of diarrhoeal disease, India. Indian J Med Microbiol. 2016;34(3):375-9. [PubMed] [Google
Scholar]
Briend A, Hasan KZ, Aziz KM, Hoque BA. Are diarrhea control programmes likely to reduce childhood
malnutrition? Observations from rural Bangladesh. Lancet. 1989;2(8658):319-22. [PubMed] [Google
Scholar]
Lakshminarayanan S, Jayalakshmy R. Diarrhoeal diseases among children in India: current scenario and
future perspectives. J Nat Sci Biol Med. 2015;6(1):24-8. [PubMed] [Google Scholar]
Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson M, Roy SL, Griffin PM. Foodborne Illness Acquired in the United States-Major Pathogens. Emerging Infectious Diseases. 2011;17(1):7-15. https://doi.org/10.3201/
eid1701.p11101.32. Dhanashree BS, Roy S, Sunaifa M. Prevalence of Enteropathogenic Escherichia coli (EPEC) in adult diarrhea cases and their antibiotic susceptibility pattern. Bri Microb Res J. 2015;5:560-66. [Google
Scholar]
Nguyen TV, Van LV, Huy CL, Gia KN, Weintraub A. Detection and characterization of diarrheagenic
Escherichia coli from Young Children in Hanoi, Vietnam. J Clin Microbiol. 2005;43(2):755-60. [PubMed] [Google
Scholar]
Dutta S, Guin S, Ghosh S, Pazhani GP, Rajendran K, Bhattacharya MK, Takeda Y, Nair GB, Ramamurthy T.
Trends in the prevalence of diarrheagenic Escherichia coli among hospitalized diarrheal patients in Kolkata,
India. PLoS One. 2013;8(2):e56068. [PubMed] [Google Scholar]
Hegde A, Ballal M, Shenoy S. Detection of diarrheagenic Escherichia coli by multiplex PCR. Indian J Med
Microbiol. 2012;30(3):279-84. [PubMed] [Google Scholar]
Chomvarin C, Ratchtrachenchai OA, Chantarasuk Y, Srigulbutr S, Chaicumpar K, Namwat W, Kotimanusvanij
D. Characterization of diarrheagenic Escherichia coli isolated from food in Khon Kaen, Thailand. Southeast
Asian J Trop Med Public Health. 2005;36(4):931-9. [PubMed] [Google Scholar]
Allam AA, Amer A, Fahmy K, Siam AG. Rapid diagnosis and characterization of diarrheagenic Escherichia coli
In Egyptian children using multiplex PCR. Egyptian J Med Microbiol. 2006;15(3):523-30. [Google Scholar]
Gautam K, Pokhrel BM, Shrestha CD, Bhatia DR. Prevalence of diarrheagenic E. coli (DEC) determined
by polymerase chain reaction (PCR) in different tertiary care hospitals in Nepal. JSM Microbiol. 2015;3:1021-7.
Aly MEA, Essam TM, Amin MA. Involvement of virulence genes and antibiotic resistance in clinical and food
borne diarrheagenic Escherichia coli isolates from Egypt. World J Med Sc. 2012;7(4):276-84.
Ifeanyi C, Ikeneche NF, Bassey B, Al-Gallas N, Aissa RB, Boudabous A. Diarrheagenic Escherichia coli
pathotypes isolated from children with diarrhea in the Federal Capital Territory Abuja, Nigeria. J Infect Dev
Ctries. 2015;9(2):165-74. [PubMed] [Google Scholar]
Suganya D, Kanimozhi K, Panneerselvam A, Dhanapau K. Molecular Characterization of Diarrheagenic Escherichia coli from Tiruchirappalli District, Tamilnadu, India. Int J Curr Microbiol App Sci. 2016;5(3):478-84.
Moshtagian F, Alipour M, Yahyapour Y. Prevalence of Escherichia coli pathotypes among children with
diarrhea in Babol, Northern Iran. Int J Enteric Pathog. 2016;4(3): e36326. [Google Scholar]
Audu R, Omiliabu S, Renner J, Awodiji J. Risk factors, clinical features and management of children with
diarrhea in Lagos. J Niger Assoc Infect Control. 2000;3:24-9. [Google Scholar]
Gracey M. Diarrhea and malnutrition: a challenge for pediatricians. J Pediatr Gastroenterol Nutr.
;22(1):6-16. [PubMed] [Google Scholar]
Samal SK, Khuntia HK, Nanda PK, Satapathy CS, Nayak SR, Sarangi AK, Sahoo N, Pattnaik SK, Chhotray GP, Pal
BB. Incidence of bacterial enteropathogens among hospitalised diarrhea patients from Orissa, India. Jpn
J Infect Dis. 2008;61(5):350-5. [PubMed] [Google Scholar]
Faruque AS, Salam MA, Faruque SM, Fuchs GJ. Aetiological, clinical and epidemiological characteristics
of a seasonal peak of diarrhoea in Dhaka, Bangladesh. Scand J Infect Dis. 1998;30(4):393-6. [PubMed] [Google
Scholar]
Moyo SJ, Maselle SY, Matee MI, Langeland N, Mylvaganam H. Identification of diarrheagenic
Escherichia coli isolated from infants and children in Dar es Salaam, Tanzania. BMC Infect Dis. 2007;7:92.
[PubMed] [Google Scholar]
Copyright (c) 2021 Author's
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
