Biology Reference
In-Depth Information
Chapter 6
Enterotoxigenic
Escherichia coli
James M. Fleckenstein
Washington University School of Medicine, St. Louis, MO, USA
BACKGROUND
Definition and/or classification
The enterotoxigenic
E. coli
(ETEC) comprise a diverse pathotype of
diarrheagenic organisms that share the ability to produce and effectively deliver
heat-labile (LT) and/or heat-stable (ST) enterotoxins to target receptors in the
small intestine. While a number of additional virulence traits including both
fimbrial and non-fimbrial adhesins have been described, ETEC by definition
universally produce one of these toxins.
History
Enterotoxigenic
E. coli
were discovered in the course of clinical investigation
of patients with
Vibrio cholerae
culture-negative stools presenting with clinical
cholera characterized by acute onset of watery diarrhea and severe dehydration
(
Sack, 2011
). In the 1950s De, working in Calcutta, first described patients with
clinical cholera whose stool yielded pure cultures of
E. coli
(then referred to
as
Bacterium coli
) (
De et al., 1956
). Strains from these patients caused fluid
accumulation similar to
V. cholerae
in the rabbit ileal loop model that De had
used previously to identify the cholera toxin (
De, 1959
), suggesting that these
organisms also produced an enterotoxin. Subsequent study by a team of cholera
investigators from Johns Hopkins University working at the Calcutta School
of Tropical Medicine and the Infectious Disease Hospital in Calcutta in the
late 1960s led to definitive identification of enterotoxin-producing
E. coli
from
patients with diarrheal disease clinically indistinguishable from severe cholera
(
Carpenter et al., 1965
;
Lindenbaum et al., 1965
;
Gorbach et al., 1971
). Sim-
ilar to De, these investigators recognized that many patients presenting with
cholera-like syndromes had pure cultures of
E. coli
in their stools, and that
these organisms produced a heat-labile filterable enterotoxin (
Sack et al., 1971
).
Analysis of patients presenting with severe acute watery diarrheal syndromes
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