Enterotoxigenic

Traveller s diarrhoea may be eaused by one of many gastrointestinal pathogens (Table 6.4). However, enterotoxigenic Escherichia coli is the most common pathogen. Whilst it is generally short-lived, traveller s diarrhoea can seriously mar a brief period abroad, be it for holiday or business purposes. Although not universally accepted, the use of short-course co-trimoxazole or quinolone such as norfloxacin can abbreviate an attack in patients with severe disease. 

Empiric antibiotic therapy is an appropriate approach to traveler s diarrhea. Eradication of the causal microbe depends on the etiologic agent and its antibiotic sensitivity. Most cases of traveler s diarrhea and other community-acquired infections result from enterotoxigenic (ETEC) or enteropathogenic (EPEC) Escherichia coli. Routine stool cultures do not identify these strains primary empiric antibiotic choices include fluoroquinolones such as ciprofloxacin or levofloxacin. Azithromycin may be a feasible option when fluoroquinolone resistance is encountered. 

ETEC enterotoxigenic Escherichia coli GERD gastroesophageal reflux disease GI gastrointestinal... 

From Martin S, Jung R. Gastrointestinal infections and enterotoxigenic poisonings. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 2037. 

The mechanism of diarrhea has not been clearly elucidated, but theories include a reduction in the absorptive surface along with impaired absorption owing to cellular damage, enterotoxigenic effects of a rotavirus protein, and stimulation of the enteric nervous system.43... 

Clostridium perfringens E.coli 0157. H7 E.coli (enterotoxigenic) Listeria monocytogenes Salmonella spp. Shighella sonnei Vibrio cholerae Yersinia enterocoltica (Norovirus) ... 

Oyofo BA, el Etr SH, Wasfy MO, Peruski L, Kay B, Mansour M, Campbell JR, Svenner-holm AM, Churilla AM, Murphy JR Colonization factors of enterotoxigenic E. coli (ETEC) from residents of northern Egypt. Microbiol Res 1995 150 429-436. 

Knutton S, Lloyd DR, McNeish AS Identification of a new fimbrial structure in enterotoxigenic Escherichia coli (ETEC) serotype 0148 H28 which adheres to human intestinal mucosa A potentially new human ETEC colonization factor. Infect Immun 1987 55 86-92. 

Enterotoxigenic E. coli B subunits of the heat labile toxin (LTB) Maize seed Elicited neutralizing antibodies. Immunogenic when administered orally. Serum and secretory immune responses in humans. Partially protective in mouse gut fluid assay. 27-29, 89, unpublished data... 

Enterotoxigenic E. coli epitope and rotavirus epitope fused to CTB Potato tuber Mice developed detectable levels of serum and intestinal antibodies. Immunogenic in mice against ETEC, rotavirus, and V. cholerae when delivered orally. Symptoms reduced in passively immunized mouse neonates following rotavirus challenge. 63... 

Two of the most widely spread and well-studied enterotoxigenic forms of bacterial diarrhea are ETEC and Vibrio cholerae. The toxins they produce, labile toxin (LT) and cholera toxin (CT) respectively, are very similar in primary sequence, structure, and mechanism of action [72]. They are homologous multi-subunit proteins in which the non-toxic B subunit mediates GMj ganglioside binding, and thus are candidates for vaccines that can neutralize toxin activity. 

Escherichia coli GI disease may be caused by enterotoxigenic E. coli (ETEC), enteroinvasive E. coli, enteropathogenic E. coli, enteroadhesive E. coli, and enterohemorrhagic E. coli. ETEC is now incriminated as being the most common cause of traveler s diarrhea. 

See Chap. 117, Gastrointestinal Infections and Enterotoxigenic Poisonings, authored by Steven Martin and Rose Jung, for a more detailed discussion of this topic. 

Dean, E. A. (1990). Comparison of receptors for 987P pili of enterotoxigenic Escherichia coli in the small intestine of neonatal and older pig. Infect. Immun. 58, 4030-4035. 

Fleckenstein, J. M., Holland, J. T., and Hasty, D. L. (2002). Interaction of an outer membrane protein of enterotoxigenic Escherichia coli with cell surface heparan sulfate proteoglycans. Infect. Immun. 70,1530-1537. 

Laux, D. C., McSweegan, E. F., and Cohen, P. S. (1984). Adhesion of enterotoxigenic Escherichia coli to immobilized intestinal mucosal preparations A model of adhesion to mucosal surface components. /. Microbiol. Methods 2, 27-39. 

Lindahl, M., and Carlstedt, I. (1990). Binding of K99 fimbriae of enterotoxigenic Escherichia coli to pig small intestinal mucin glycopeptides. J. Gen. Microbiol. 136,1609-1614. 

Martin-Sosa, S., Martin, M.-J., and Hueso, P. (2002). The sialylated fraction of milk oligosaccharides is partially responsible for binding to enterotoxigenic and uropathogenic Escherichia coli human strains. /. Nutr. 132,3067-3072. 

Moon, H. W., and Bunn, T. O. (1993). Vaccines for preventing enterotoxigenic Escherichia coli infections in farm animals. Vaccine 11, 200-213. 

Ono, E., Abe, K., Nakazawa, M., and Naiki, M. (1989). Ganglioside epitope recognized by K99 fimbriae from enterotoxigenic Escherichia coli. Infect. Immun. 57, 907-911. 

Smit, H., Gaastra, W., Kamerling, J. P., Vliegenthart, J. F. G., and DeGraff, F. K. (1984). Isolation and structural characterization of the equine erythrocyte receptor for enterotoxigenic Escherichia coli. Infect. Immun. 46,578-584. 

Visai, L., Speziale, P., and Bozzini, S. (1990). Binding of collagens to an enterotoxigenic strain of Escherichia coli. Infect. Immun. 58, 449-455. 

Enterotoxigenic E. coli (ETEC) is the main cause of TD in Latin America, whereas in Asia it is reported in only 15% of cases. Enteroinvasive E. coli (EIEC) strains are recorded with even less frequency. ETEC is isolated in 0 to 5% of cases. Symptoms of poisoning develop after 16 hours from consumption of contaminated water, salads, cheeses, or meats. The outgrowth of ETEC rods takes place in a patient s gastrointestinal tract, where they produce thermostable and thermolabile toxins that imitate Vibrio cholerae infections. Stimulation of intestinal guanylcyclase and interruption of ion transport leads to watery stools, which do not require medical treatment or only need simple replacement of fluids and salts by means of multielectrolyte solutions. If a co-infection with EIEC strains occurs, the symptoms of enteritis will develop, with the presence of leukocytes, erythrocytes, and mucous in stools due to a cytotoxic influence of bacteria (Butterton and Claderwood, 2001). 

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