Colonizing and Virulence Factors in Enterotoxigenic Escherichia coli from Peru

Fulton P. Rivera Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;
Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru;
Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru;

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Anicia Medina Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Maribel Riveros Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;
Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru;
Facultad de Ciencias Naturales y Matemática, Universidad Nacional Federico Villarreal, Lima, Peru;
Laboratorio de Infectología Pediátrica, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Theresa J. Ochoa Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;
Laboratorio de Infectología Pediátrica, Universidad Peruana Cayetano Heredia, Lima, Peru;
University of Texas School of Public Health, Houston, Texas;

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Maria J. Pons Grupo de Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru

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Joaquim Ruiz Grupo de Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru

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ABSTRACT.

Enterotoxigenic Escherichia coli (ETEC) ranks among the most relevant diarrheagenic pathogens. Efforts to design vaccines to fight ETEC have been focused on colonizing factors (CFs) and atypical virulence factors (AVF). An effective vaccine must account for differences in the regional prevalence of these CFs and AVFs to be truly effective in a given area. In the present study, the presence of 16 CFs and 9 AVFs, as well as the heat-stable (ST) variants (STh or STp), was established by polymerase chain reaction in 205 Peruvian ETEC isolates (120 from diarrhea cases and 85 from healthy controls). Ninety-nine (48.3%) isolates were heat-labile, 63 (30.7%) ST, and 43 (21.0%) presented both toxins. Of ST isolates, 59 (28.8%) possessed STh, 30 (14.6%) STp, five (2.4%) both STh and STp, and 12 (5.8%) were not amplified for any variant tested. The presence of CFs was associated with diarrhea (P < 0.0001). The presence of eatA as well as concomitant presence of CSI, CS3, and CS21 and of C5 and C6 was statistically related to diarrhea cases. The present results suggests that, if effective, a vaccine considering CS6, CS20, and CS21, together with EtpA, would provide protection against 64.4% of the isolates analyzed, whereas the addition of CS12 and EAST1 would lead to 83.9% coverage. Large studies are needed to establish both the ideal candidates to be considered to develop a vaccine effective in the area, and continuous surveillance is needed to detect displacement of circulating isolates that may compromise future vaccines.

Author Notes

Address correspondence to Fulton Rivera, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porras, Lima 15102, Peru. E-mail: fulton.rivera@upch.pe or Joaquim Ruiz, Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, Lima 15067, Peru. E-mail: joruiz.trabajo@gmail.com

Authors’ addresses: Fulton Rivera, Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru, and Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru, E-mail: fulton.rivera@upch.pe. Anicia Medina, Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: anicia.medina.p@upch.pe. Maribel Riveros, Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru, Facultad de Ciencias Naturales y Matemática, Universidad Nacional Federico Villarreal, Lima, Peru, and Laboratorio de Infectología Pediátrica, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: maribel.riveros@upch.pe. Theresa Ochoa, Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Laboratorio de Infectología Pediátrica, Universidad Peruana Cayetano Heredia, Lima, Peru, and University of Texas School of Public Health, Houston, TX, E-mail: theresa.ochoa@upch.pe. Maria Pons and Joaquim Ruiz, Grupo de Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru, E-mails: ma.pons.cas@gmail.com and joruiz.trabajo@gmail.com.

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