Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt

Remon Abu-Elyazeed, Thomas F. Wierzba, Ali S. Mourad, Leonard F. Peruski, Bradford A. Kay, Malla Rao, Albert M. Churilla, A. Louis Bourgeois, Ahmed K. Mortagy, Salwa M. Kamal, Stephen J. Savarino, James R. Campbell, James R. Murphy, Abdollah Naficy, John D. Clemens

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Enterotoxigenic Escherichia coli (ETEC) are diverse pathogens that express heat-labile (LT) and/or heat-stable (ST) enterotoxins, yet little is known about whether epidemiologic patterns of pediatric ETEC diarrhea vary by the expressed ETEC toxin phenotype. In total, 242 Egyptian children aged <3 years were prospectively followed in 1993-1995. ETEC episodes were detected during twice-weekly home visits, and asymptomatic ETEC excretion was identified from monthly cross-sectional surveys. ETEC episodes were 0.6 per child-year. ST-only ETEC was 2.6 times (P< .001) more common in warmer than cooler months, while LT-only ETEC showed no seasonal variation. Ownership of a household sanitary latrine, but not breast-feeding, was associated with a lower risk of both enterotoxin phenotypes. Coexpression of a colonization factor by LT- or ST-only ETEC strengthened the association with diarrhea. These findings indicate that the epidemiologic patterns of LT-only and ST- only ETEC are not identical and that disease interventions should include improved household sanitation.

Original languageEnglish (US)
Pages (from-to)382-389
Number of pages8
JournalJournal of Infectious Diseases
Issue number2
StatePublished - 1999
Externally publishedYes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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