Volume 88, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



This study compares pathotypes circulating among children in Pakistan during the floods of 2010 and 2011 and from sporadic cases outside flood affected areas. Using multiplex polymerase chain reaction 115 of 205 stool samples (56.29%) were positive for diarrheagenic from specimens taken during the floods compared with 50 of 400 (12.5%) stool samples being positive for sporadic cases. The pathotypes were categorized as Enteropathogenic 33 (28.69%) and 13 (26%), Enterotoxigenic 29 (25.21%) and 15 (30%), Enteroaggregative 21 (18.2%) and 18 (36%), Enterohemorrhagic 5 (4.34%) and 1 (2%) from flood and sporadic cases, respectively. Furthermore, patients co-infected with more than one pathotype were 26 (22.60%) and 3 (6%) from flood and sporadic cases, respectively. The study shows an unexpectedly high rate of isolation of pathotypes suggesting Pakistan as an endemic region that requires active surveillance particularly during flood periods.


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  1. Cohen MB, Nataro JP, Bernstein DI, Hawkins J, Roberts N, Staat MA, , 2005. Prevalence of diarrheagenic Escherichia coli in acute childhood enteritis: a prospective controlled study. J Pediatr 146: 5461.[Crossref] [Google Scholar]
  2. Nguyen TV, Van PL, Huy CL, Gia KN, Weintraub A, , 2005. Detection and characterization of diarrheagenic Escherichia coli from young children in Hanoi, Vietnam. J Clin Microbiol 43: 755760.[Crossref] [Google Scholar]
  3. Iruka IN, , 2009. Diarrheagenic Escherichia coli in sub-Saharan Africa: status, uncertainties and necessities. J Infect Dev Ctries 3: 817842. [Google Scholar]
  4. Nataro JP, Kaper JP, , 1998. Diarrheagenic Escherichia coli . Clin Microbiol Rev 11: 142201. [Google Scholar]
  5. Albert MJ, Rotimi VO, Dhar R, Silpikurian S, Pacsa AS, Molla AM, Szucs G, , 2009. Diarrheagenic Escherichia coli are not a significant cause of diarrhea in hospitalized children in Kuwait. BMC Microbiol 9: 62.[Crossref] [Google Scholar]
  6. Ibenyassine K, Aitmhand R, Karamoko Y, Ennajim M, , 2007. A simple and rapid detection by PCR of enteropathogenic Escherichia coli in naturally contaminated vegetables. J Rap Meth Auto Microbiol 16: 113121.[Crossref] [Google Scholar]
  7. Robins-browne RM, Hartland EL, , 2002. Escherichia coli as a cause of diarrhea. J Gastro Hepatol 17: 467475.[Crossref] [Google Scholar]
  8. Kaper JB, Nataro JP, Mobley HL, , 2004. Pathogenic Escherichia coli . Nat Rev Microbiol 2: 123140.[Crossref] [Google Scholar]
  9. Croxen MA, Finlay BB, , 2010. Molecular mechanisms of Escherichia coli pathogenicity. Nature 8: 2638. [Google Scholar]
  10. Aranda KR, Fabbricotti SH, Fagundes-Neto U, Scaletsky IC, , 2007. Single multiplex assay to identify simultaneously enteropathogenic, enteroaggregative, enterotoxigenic, enteroinvasive and Shiga toxin-producing Escherichia coli strains in Brazilian children. FEMS Microbiol Lett 267: 145150.[Crossref] [Google Scholar]
  11. Vidal M, Kruger E, Duran C, Lagos R, Levine M, Prado V, , 2005. Single multiplex PCR assay to identify simultaneously the six categories of diarrheagenic Escherichia coli associated with enteric infections. J Clin Microbiol 43: 53625365.[Crossref] [Google Scholar]
  12. Gómez-Duarte OG, Bai J, Newell E, , 2009. Detection of Escherichia coli, Salmonella spp., Shigella spp., Yersinia enterocolitica, Vibrio cholerae and Campylobacter spp. enteropathogens by 3-reaction multiplex polymerase chain reaction. Diagn Microbiol Infect Dis 63: 19.[Crossref] [Google Scholar]
  13. Hulton CS, Higgins CF, Sharp PM, , 1991. ERIC sequences: a novel family of repetitive elements in the genomes of Escherichia coli, Salmonella typhimurium and other enterobacteria. Mol Microbiol 5: 825834.[Crossref] [Google Scholar]
  14. Sharlpes GJ, Lloyd RG, , 1990. A novel repeated DNA sequence located in the intergenic regions of bacterial chromosomes. Nucleic Acids Res 18: 65036508.[Crossref] [Google Scholar]
  15. Hai-Rong C, Ning J, , 2006. Extremely rapid extraction of DNA from bacteria and yeasts. Biotechnol Lett 28: 5559.[Crossref] [Google Scholar]
  16. Johnson JR, O'Bryan TT, , 2000. Improved repetitive-element PCR fingerprinting for resolving pathogenic and nonpathogenic phylogenetic groups within Escherichia coli . Clin Diagn Lab Immunol 7: 265273. [Google Scholar]
  17. Manges AR, Johnson JR, Foxman B, O'Bryan T, Fullrton KE, Riley LW, , 2001. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N Engl J Med 345: 10071013.[Crossref] [Google Scholar]
  18. Vieira MA, Andrade JR, Trabulsi LR, Rosa AC, Dias AM, Ramos SR, Frankel G, Gomes TA, , 2001. Phenotypic and genotypic characteristics of Escherichia coli strains of non-enteropathogenic E. coli (EPEC) serogroups that carry EAE and lack the EPEC adherence factor and Shiga toxin DNA probe sequences. J Infect Dis 183: 762772.[Crossref] [Google Scholar]
  19. Jenkins C, Lawson AJ, Cheasty T, Willshaw GA, Wright P, Dougan G, Frankel G, Smith HR, , 2003. Subtyping intimin genes from enteropathogenic Escherichia coli associated with outbreaks and sporadic cases in the United Kingdom and Eire. Mol Cell Probes 17: 149156.[Crossref] [Google Scholar]
  20. Bouckenooghe AR, Jiang ZD, DeLaCabada FJ, Ericsson CD, DuPont HL, , 2002. Enterotoxigenic Escherichia coli as cause of diarrhea among Mexican adults and US travelers in Mexico. J Travel Med 9: 137140.[Crossref] [Google Scholar]
  21. Hien BT, Scheutz F, Cam PD, Serichantalergs O, Huong TT, Thu TM, Dalsgaard A, , 2008. Diarrheagenic Escherichia coli and Shigella strains isolated from children in a hospital case-control study in Hanoi, Vietnam. J Clin Microbiol 46: 9961004.[Crossref] [Google Scholar]
  22. Qadri F, Svennerholm AM, Faruque ASG, Sack RB, , 2005. Enterotoxigenic Escherichia coli (ETEC): epidemiology, microbiology, and clinical features in developing countries. Clin Microbiol Rev 18: 465483.[Crossref] [Google Scholar]
  23. Dulguer MV, Fabbricotti SH, Bando SY, Moreira-Filho CA, Fagundes-Neto U, Scaletsky IC, , 2003. Atypical enteropathogenic Escherichia coli strains: phenotypic and genetic profiling reveals a strong association between enteroaggregative E. coli heat-stable enterotoxin and diarrhea. J Infect Dis 188: 16851694.[Crossref] [Google Scholar]
  24. Yatsuyanagi J, Saito S, Sato H, Miyajima Y, Amano K, Enomoto K, , 2002. Characterization of enteropathogenic and enteroaggregative Escherichia coli isolated from diarrheal outbreaks. J Clin Microbiol 40: 294297.[Crossref] [Google Scholar]
  25. Harris AM, Chowdhury F, Begum YA, Khan AI, Faruque AS, Svennerholm AM, Harris JB, Ryan ET, Cravioto A, Calderwood SB, Qadri F, , 2008. Shifting prevalence of major diarrheal pathogens in patients seeking hospital care during floods in 1998, 2004, and 2007 in Dhaka, Bangladesh. Am J Trop Med Hyg 79: 708714. [Google Scholar]
  26. Huilan S, Guang ZL, Mathan MM, Mathew MM, Olarte J, Espejo R, Khin MU, Ghafoor MA, Khan MM, Sami Z, Sutton RG, , 1991. Aetiology of acute diarrhea among children in developing countries: a multicentre study in five countries. Bull World Health Organ 69: 549555. [Google Scholar]
  27. Gunzburg ST, Chang BJ, Elliott SJ, Burke V, Gracey M, , 1993. Diffuse and enteroaggregative patterns of adherence of enteric Escherichia coli isolated from aboriginal children from the Kimberley region of Western Australia. J Infect Dis 167: 755758.[Crossref] [Google Scholar]
  28. Nguyen T, Van PL, Huy CL, Gia KN, Weintraub A, , 2005. Detection and characterization of diarrheagenic Escherichia coli from young children in Hanoi, Vietnam. J Clin Microbiol 43: 755760.[Crossref] [Google Scholar]
  29. Prabhu S, Vivek Isloor S, Balu M, Suryanarayana VV, Rathnamma D, , 2010. Genotyping by ERIC-PCR of Escherichia coli isolated from bovine mastitis cases. Indian J Biotechnol 9: 298301. [Google Scholar]
  30. Lipman LJ, de-Nijs A, Lam TJ, Gaastra W, , 1995. Identification of Escherichia coli strains from cows with clinical mastitis by serotyping and DNA polymorphism patterns with REP and ERIC primers. Vet Microbiol 43: 1319.[Crossref] [Google Scholar]
  31. Shamim A, Ansari V, Springthorpe S, Sattar SA, , 1991. Survival and vehicular spread of human rotaviruses: possible relation to seasonality of outbreaks. Rev Infect Dis 13: 448461.[Crossref] [Google Scholar]
  32. Glass RI, Kilgore PE, Holman RC, Jin S, Smith JC, Woods PA, Clarke MJ, Ho MS, Gentsch JR, , 1996. The epidemiology of rotavirus diarrhea in United States: surveillance and estimates of disease burden. J Infect Dis 174: S5S11.[Crossref] [Google Scholar]
  33. Peasey AE, Ruiz-Palacious GM, Quigley M, Newsholme W, Martinez J, Resales G, Jiang X, Blumenthal UJ, , 2004. Seroepidemiology and risk factors for sporadic norovirus/Mexico strain. J Infect Dis 189: 20272036.[Crossref] [Google Scholar]
  34. Kaur R, Rawat D, Kakkar M, Uppal B, Sharma VK, , 2002. Intestinal parasites in children with diarrhea in Delhi, India. Southeast Asian J Trop Med Public Health 33: 725729. [Google Scholar]
  35. Tripathi NK, Anceno AJ, , 2009. GIS-based analysis of the fate of waste related pathogens, Cryptosporidium parvum, Giardia lamblia and Escherichia coli in tropical canal network. J Water Health 7: 133143.[Crossref] [Google Scholar]
  36. Rose JB, Epstein PR, Lipp EK, Sherman BH, Bernard SM, Patz JA, , 2001. Climate variability and change in the United States: potential impact on water and food-borne diseases caused by microbiologic agents. Environ Health Perspect 109: 211221.[Crossref] [Google Scholar]

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Supplementary PDF

  • Received : 07 Jun 2012
  • Accepted : 16 Oct 2012
  • Published online : 06 Mar 2013

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