Enterotoxigenic Escherichia coli

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... 

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. 

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. 

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. 

Rabbani GH, Butler T, Knight J, Sanyal SC, Alam K. (1987) Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. J Infect Dis 155 979-984. 

Naimi, T. S., Wicklund, J. H., Olsen, S. J., Krause, G., Wells, J. G., Bartkus, J. M., Boxrud, D. J., Sullivan, M., Kassenborg, H., Besser, J. M., Mintz, E. D., Osterholm, M. T., et al. (2003). Concurrent outbreaks of Shigella sonnei and enterotoxigenic Escherichia coli infections associated with parsley Implications for surveillance and control of foodborne illness. J. Food Prot. 66,535-541. 

Has been used for diverticular disease and hepatic encephalopathy, but not FDA approved. Not effective for traveler s diarrhea due to bacteria other than enterotoxigenic Escherichia coli... 

Robinson HL (2007) HIV/AIDS vaccines 2007. Clin Pharmacol Ther 82(6) 686-693 Roland KL, Cloninger C, Kochi SK, Thomas LJ, Tinge SA, Rouskey C, Killeen KP (2007) Construction and preclinical evaluation of recombinant Peru-15 expressing high levels of the cholera toxin B subunit as a vaccine against enterotoxigenic Escherichia coli. Vaccine 25(51) 8574-8584... 

Gopal, P. K., Prasad, J., Smart, J., and Gill, H. S. (2001). In vitro properties of Lactobacillus rhamnosus DR20 and Bifidobacterium lactis DR10 strains and their antagonistic activity against an enterotoxigenic Escherichia coli. Int.. Food Microbiol. 67,207-216. 

Freedman, D.J., Tacket, C.O., Delehanty, A., Maneval, D.R., Nataro, J., and Crabb, J.H. 1998. Milk immunoglobulin with specific activity against purified colonization factor antigens can protect against oral challenge with enterotoxigenic Escherichia coli. J. Infect. Dis. Ill, 662-667. 

Tacket, C.O., Losonsky, G., Link, H., Hoang, Y., Guesry, P., Hilpert, H., and Levine, M.M. 1988. Protection by milk immunoglobulin concentrate against oral challenge with enterotoxigenic Escherichia coli. N. Engl. J. Med. 318, 1240-1243. 

Escherichia coli is a normal inhabitant of the bowel but some enterotoxigenic strains are pathogenic and are frequently a cause of travellers diarrhoea. A quinolone, e.g. ciprofloxacin, is the drug of choice in most high-risk parts of the world for a severe attack (see Travellers diarrhoea, p. 644). Antimicrobials are not generally given for prophylaxis but, when it is indicated, a quinolone should be used. 

Holland R E, Sriranganathan N, DuPont L 1989 Isolation of enterotoxigenic Escherichia coli from a foal with diarrhea. Journal of the American Veterinary Medical Association 194 389-391... 

Kunkel SL, Robertson DC (1979) Purification and chemical characterization of the heat-labile enterotoxin produced by enterotoxigenic Escherichia coli. In Infect. Immun. 25 586-596. 

Spencer, R.J. and Chesson, A. 1994. The effect of Lactobacillus spp. in the attachment of enterotoxigenic Escherichia coli to isolated porcine enterocytes. J. Appl. Bacteriol. 77, 115-220. 

The most common pathogens for traveler s diarrhea include enterotoxigenic Escherichia coli, Shigella, Campylobacter, Salmonella, and viruses. 

Katz DE, DeLorimier AJ, Wolf MK, et al. Oral immunization of adult volunteers with microencapsulated enterotoxigenic Escherichia coli (ETEC) CS6 antigen. Vaccine 2003 21 341-346. 

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