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Improvement in Detection of Enterotoxigenic Escherichia coli in Patients with Travelers’ Diarrhea by Increasing the Number of E. coli Colonies Tested

No cause of one-third of travelers’ diarrhea (TD) cases can be detected despite microbiologic assessment. We propose that these pathogen-negative TD cases include undetected enterotoxigenic Escherichia coli (ETEC). As a standard in diagnostic microbiology, samples of five E. coli colonies were tested to detect ETEC from stool cultures. We compared the sensitivities and the number of ETEC detected by 20 colonies with those of 5, 10, and 15 colonies. The percent detection of ETEC with five E. coli colonies was significantly different from that using 20 E. coli colonies. Of the 116 subjects studied, the number positive for ETEC for 5, 10, 15 and 20 colonies tested were 22 (19.0%), 37 (31.9%), 45 (38.8%) and 46 (39.7%), respectively. Based on our results, we recommend the testing of at least 10 E. coli colonies for optimum detection of ETEC in patients with TD.

Received July 23, 2008. Accepted for publication September 28, 2008.

Acknowledgments: We thank Dr. Asha S. Kapadia (The University of Texas School of Public Health [UTSPH]) for assisting with the statistical analyses, Dr. Ismail M. Meraz (UTSPH) for his contributions to the initial laboratory procedures, and the students of The University of Texas Medical School for collecting stool specimens used in this study. This project fulfilled the requirement for MPH for Thushara Galbadage at the University of Texas School of Public Health.

^* Address correspondence to Zhi-Dong Jiang, 1200 Herman Pressler, RAS E-739, Houston, TX 77030. E-mail: Zhi-Dong.Jiang{at}uth.tmc.edu

Authors’ addresses: Thushara Galbadage sand Zhi-Dong Jiang, The University of Texas School of Public Health at Houston, Houston, TX 77225. Herbert L. DuPont, The University of Texas School of Public Health at Houston, Houston, TX 77225; The University of Texas Medical School at Houston, Houston, TX 77030; St. Luke’s Episcopal Hospital, Houston, TX 77030; Baylor College of Medicine, Houston, TX 77030.

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