Volume 83, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We conducted a prospective study in three hospitals in Lima in human immunodeficiency virus (HIV) children to determine the frequency of diarrheagenic Five colonies/patients were studied by a multiplex real-time polymerase chain reaction to identify the six currently recognized groups of diarrhea-associated . We have analyzed 70 HIV-associated diarrheal and 70 control samples from HIV-infected children without diarrhea. Among the diarrheal episodes 19% were persistent, 3% dysenteric, and 33% were associated with moderate or severe dehydration. The diarrheagenic were the most commonly isolated pathogens in diarrhea (19%) and control samples (26%) ( = 0.42), including enteroaggregative (6% versus 10%), enteropathogenic (6% versus 10%), and enterotoxigenic (4% versus 3%), respectively. The HIV-infected children with diarrhea had the worse age-related immunosuppression, higher viral loads, and were on highly active antiretroviral treatment (HAART) less often than HIV-infected children without diarrhea. Diarrheagenic were highly resistant to ampicillin (74%) and cotrimoxazole (70%).


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Cárcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J, Carrasco J, Seas C, Caballero M, Holmes KK, , 2005. Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: a case-control study in Lima, Peru. J Infect Dis 191: 1119.[Crossref] [Google Scholar]
  2. Johnson S, Hendson W, Crewe-Brown H, Dini L, Frean J, Perovic O, Vardas E, , 2000. Effect of human immunodeficiency virus infection on episodes of diarrhea among children in South Africa. Pediatr Infect Dis J 19: 972979.[Crossref] [Google Scholar]
  3. Kartalija M, Sande MA, , 1999. Diarrhea and AIDS in the era of highly active antiretroviral therapy. Clin Infect Dis 28: 701705.[Crossref] [Google Scholar]
  4. Oldfield EC, 3rd, 2002. Evaluation of chronic diarrhea in patients with human immunodeficiency virus infection. Rev Gastroenterol Disord 2: 176188. [Google Scholar]
  5. Niehaus MD, Moore SR, Patrick PD, Derr LL, Lorntz B, Lima AA, Guerrant RL, , 2002. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. Am J Trop Med Hyg 66: 590593. [Google Scholar]
  6. Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, , 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564571.[Crossref] [Google Scholar]
  7. Lorntz B, Soares AM, Moore SR, Pinkerton R, Gansneder B, Bovbjerg VE, Guyatt H, Lima AM, Guerrant RL, , 2006. Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25: 513520.[Crossref] [Google Scholar]
  8. O'Ryan M, Prado V, Pickering LK, , 2005. A millennium update on pediatric diarrheal illness in the developing world. Semin Pediatr Infect Dis 16: 125136.[Crossref] [Google Scholar]
  9. Nataro JP, Mai V, Johnson J, Blackwelder WC, Heimer R, Tirrell S, Edberg SC, Braden CR, Glenn Morris J, Jr Hirshon JM, , 2006. Diarrheagenic Escherichia coli infection in Baltimore, Maryland, and New Haven, Connecticut. Clin Infect Dis 43: 402407.[Crossref] [Google Scholar]
  10. 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]
  11. Nataro JP, Kaper JB, , 1998. Diarrheagenic Escherichia coli . Clin Microbiol Rev 11: 142201. [Google Scholar]
  12. Huang DB, Nataro JP, DuPont HL, Kamat PP, Mhatre AD, Okhuysen PC, Chiang T, , 2006. Enteroaggregative Escherichia coli is a cause of acute diarrheal illness: a meta-analysis. Clin Infect Dis 43: 556563.[Crossref] [Google Scholar]
  13. Durrer P, Zbinden R, Fleisch F, Altwegg M, Ledergerber B, Karch H, Weber R, , 2000. Intestinal infection due to enteroaggregative Escherichia coli among human immunodeficiency virus-infected persons. J Infect Dis 182: 15401544.[Crossref] [Google Scholar]
  14. Gassama-Sow A, Sow PS, Guèye M, Guèye-N'diaye A, Perret JL, M'boup S, Aïdara-Kane A, , 2004. Characterization of pathogenic Escherichia coli in human immunodeficiency virus-related diarrhea in Senegal. J Infect Dis 189: 7578.[Crossref] [Google Scholar]
  15. Villaseca JM, Hernández U, Sainz-Espuñes TR, Rosario C, Eslava C, , 2005. Enteroaggregative Escherichia coli an emergent pathogen with different virulence properties. Rev Latinoam Microbiol 47: 140159. [Google Scholar]
  16. Pavia AT, Long EG, Ryder RW, Nsa W, Puhr ND, Wells JG, Martin P, Tauxe RV, Griffin PM, , 1992. Diarrhea among African children born to human immunodeficiency virus 1-infected mothers: clinical, microbiologic and epidemiologic features. Pediatr Infect Dis J 11: 9961003.[Crossref] [Google Scholar]
  17. Thea DM, St Louis ME, Atido U, Kanjinga K, Kenbo B, Matando M, Tshiamala T, Kamenga C, Davachi F, Brown C, Rand WM, Keusch GT, , 1993. A prospective study of diarrhea and HIV-1 infection among 429 Zairian infants. N Engl J Med 329: 16961702.[Crossref] [Google Scholar]
  18. Samie A, Obi CL, Dillingham R, Pinkerton RC, Guerrant RL, , 2007. Enteroaggregative Escherichia coli in Venda, South Africa: distribution of virulence-related genes by multiplex polymerase chain reaction in stool samples of human immunodeficiency virus (HIV)-positive and HIV-negative individuals and primary school children. Am J Trop Med Hyg 77: 142150. [Google Scholar]
  19. Rossit AR, de Almeida MT, Nogueira CA, da Costa Oliveira JG, Barbosa DM, Moscardini AC, Mascarenhas JD, Gabbay YB, Marques FR, Cardoso LV, Cavasini CE, Machado RL, , 2007. Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from São Paulo State, southeastern Brazil. Diagn Microbiol Infect Dis 57: 5966.[Crossref] [Google Scholar]
  20. Musiime V, Kalyesubula I, Kaddu-Mulindwa D, Byarugaba J, , 2009. Enteric bacterial pathogens in HIV-infected children with acute diarrhea in Mulago referral and teaching hospital, Kampala, Uganda. J Int Assoc Physicians AIDS Care (Chic Ill) 8: 185190.[Crossref] [Google Scholar]
  21. Guion CE, Ochoa TJ, Walker CM, Barletta F, Cleary TG, , 2008. Detection of diarrheagenic Escherichia coli by use of melting-curve analysis and real-time multiplex PCR. J Clin Microbiol 46: 17521757.[Crossref] [Google Scholar]
  22. Barletta F, Ochoa TJ, Ecker L, Gil AI, Lanata CF, Cleary TG, , 2009. Validation of a five-colony pool analysis using multiplex real time PCR for detection of diarrheagenic E. coli . J Clin Microbiol 47: 19151917.[Crossref] [Google Scholar]
  23. Clinical Laboratory Standards Institute (CLSI), 2008. Performance Standards for Antimicrobial Susceptibility Testing; Eighteenth Informational Supplement. M100-S18. Wayne, PA: CLSI. [Google Scholar]
  24. Centers for Disease Control and Prevention, 1994. Revised classification systems for human immunodeficiency virus infection in children less than 13 years of age. MMWR 43: 119. [Google Scholar]
  25. Dirección General de Epidemiología, Ministerio de Salud, Perú, 2009. Situación del VIH/SIDA en el Peru. Boletín Epidemiológico Mensual. [Google Scholar]
  26. Ochoa TJ, Ecker L, Barletta F, Mispireta M, Gil AI, Contreras C, Molina M, Amemiya I, Verastegui H, Hall ER, Cleary TG, Lanata LF, , 2009. Age-related susceptibility to infection with diarrheagenic E. coli in infants from Periurban areas of Lima, Peru. Clin Infect Dis 49: 16941702.[Crossref] [Google Scholar]
  27. Huang DB, Okhuysen PC, Jiang ZD, DuPont HL, , 2004. Enteroaggregative Escherichia coli: an emerging enteric pathogen. Am J Gastroenterol 99: 383389.[Crossref] [Google Scholar]
  28. Lanata CF, Mendoza W, Black RE, , 2002. Improving Diarrhoea Estimates. Available at: http://www.who.int/child_adolescent_health/documents/pdfs/improving_diarrhoea_estimates.pdf. [Google Scholar]
  29. Ochoa TJ, Salazar-Lindo E, Cleary TG, , 2004. Management of children with infection-associated persistent diarrhea. Semin Pediatr Infect Dis 15: 229236.[Crossref] [Google Scholar]
  30. Kotloff KL, Johnson JP, Nair P, Hickman D, Lippincott P, Wilson PD, Clemens JD, , 1994. Diarrheal morbidity during the first 2 years of life among HIV-infected infants. JAMA 271: 448452.[Crossref] [Google Scholar]
  31. Ochoa TJ, Ruiz J, Molina M, Del Valle LJ, Vargas M, Gil AI, Ecker L, Barletta F, Hall E, Cleary TG, Lanata CF, , 2009. High frequency of antimicrobial resistance of diarrheagenic E. coli in Peruvian infants. Am J Trop Med Hyg 81: 296301. [Google Scholar]
  32. Raju B, Ballal M, , 2009. Multidrug resistant enteroaggregative Escherichia coli diarrhoea in rural southern Indian population. Scand J Infect Dis 41: 105108.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 06 Oct 2009
  • Accepted : 26 Mar 2010
  • Published online : 06 Jul 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error