Biology Reference
In-Depth Information
Chapter 8
Enteroaggregative
Escherichia coli
Nadia Boisen 1 , Karen A. Krogfelt 2 , and James P. Nataro 1
1 University of Virginia School of Medicine, Charlottesville, VA, USA, 2 Statens Serum Institut,
Copenhagen, Denmark
INTRODUCTION
Diarrhea is a significant cause of morbidity and mortality worldwide,
particularly in children under 5 years of age. In addition to almost one million
directly attributable deaths per year ( Black et al., 2010 ), morbidity associated
with repeated episodes during childhood diarrhea can be lifelong ( Petri et al.,
2008 ). Repeated bouts of diarrhea during infancy result in malabsorption of
nutrients leading to developmental disabilities, which include growth shortfalls
and impaired cognition.
Collectively, the diarrheagenic Escherichia coli (DEC) represent the most
common bacterial pathogen worldwide ( Farthing, 2000 ; Wanke, 2001 ; Ina et al.,
2003 ). Included among the DEC is enteroaggregative Escherichia coli (EAEC),
a pathogen of emerging significance. However, identification and isolation of
pathogenic strains remain elusive, given an as yet imperfect definition of this
pathotype. Thus, the global burden of diarrheal diseases resulting from EAEC
may be vastly underestimated ( Bryce et al., 2005 ). This underestimation is also
true of the sequelae of persistent diarrhea for which EAEC is reportedly a preva-
lent cause ( Fang et al., 1995 ; Lima et al., 2000 ). Hence, detailed understanding
of EAEC heterogeneity and pathogenic mechanisms are important.
ENTEROAGGREGATIVE ESCHERICHIA COLI (EAEC) HISTORY
EAEC was first described by the senior author in 1983, while a student in the
lab of Dr. James Kaper. During adhesion studies of E. coli to Hep-2 cells it
was observed that three distinct adhesion patterns could be described as diffuse,
localized and aggregative patterns. The role of these patterns in disease was
yet to be elucidated. Thus, the first association of EAEC with diarrheal disease
was published in 1987, as part of a prospective study of pediatric diarrhea in
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