| We studied the distribution, pathogenicity and virulence of enterotoxigenic E. coli diarrhea and the association between diarrhea and malnutrition in a cohort of children aged less than three years from a periurban area of Egypt. Home visits were made to each household twice weekly from Nov. 1993 to Sept. 1995. Clinical data and rectal swabs were obtained from each child with a loose stool. Fecal specimens were collected once a month from non-diarrheal participants. Anthropometric measurements were made at three month intervals. E. coli colonies were tested for heat labile (LT) and heat stable (ST) toxin and colonization factor antigens (CFAs). A diarrhea episode was defined as three or more loose or watery stools or one bloody stool in a 24 hour period.;Among 242 children, diarrhea incidence was 2.9 episodes per year (epy), while ETEC was 0.6 epy. Children ;Among 143 children included in the nutrition study, 358 diarrheal episodes were reported, 1% of which lasted ;In this nominally well off population, diarrhea is moderately high with ETEC representing 20% of all episodes. The results suggest that ETEC epidemiology differs by toxin; ST-ETEC is more pathogenic and more frequent during warm months than LT-ETEC. Improved sanitation could reduce ETEC incidence. Diarrhea does not appear to substantially contribute to malnutrition when these children had diarrhea free time for catch up growth. Low weight-for-age among the poor and diarrhea itself was associated with subsequent risk of diarrhea. |
