Diarrheagenic Escherichia coli: Prevalence and Pathotype Distribution in Children from Peruvian Rural Communities

Gonzalo J. Acosta Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.

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Natalia I. Vigo Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.

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David Durand Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.

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Maribel Riveros Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.

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Sara Arango Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.

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Mara Zambruni University of Texas Medical Branch, Galveston, Texas.

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Theresa J. Ochoa Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas.

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Diarrheagenic Escherichia coli (DEC) are common pathogens of childhood gastrointestinal infections worldwide. To date, research tracking DEC has mainly been completed in urban areas. This study aims to determine the prevalence and pathotype distribution of DEC strains in children from rural Peruvian communities and to establish their association with malnutrition. In this prospective cohort, 93 children aged 6–13 months from rural communities of Urubamba (Andes) and Moyobamba (jungle) were followed for 6 months. Diarrheal and control stool samples were analyzed using multiplex real-time polymerase chain reaction to identify the presence of virulence genes of DEC strains. The overall isolation rate of DEC was 43.0% (352/820). Enteroaggregative E. coli (EAEC, 20.4%), enteropathogenic E. coli (EPEC, 14.2%), and diffusely aggregative E. coli (DAEC, 11.0%) were the most prevalent pathotypes. EAEC was more frequently found in Moyobamba samples (P < 0.01). EPEC was the only strain significantly more frequent in diarrheal than asymptomatic control samples (P < 0.01). DEC strains were more prevalent among younger children (aged 6–12 months, P < 0.05). A decline in height-for-age Z-score (HAZ) was observed in 75.7% of children overall. EAEC was more frequently isolated among children who had a greater HAZ decline (P < 0.05). In conclusion, DEC strains were frequently found in stool samples from children in rural communities of the highlands and jungle of Peru. In addition, children with a greater decline in their growth rate had higher EAEC isolation rates, highlighting the importance of this pathogen in child malnutrition.

Author Notes

* Address correspondence to Theresa J. Ochoa, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, San Martin de Porres, Lima 31, Peru. E-mail: theresa.j.ochoa@uth.tmc.edu
† These authors contributed equally to this work.

Financial support: This work was supported by the Thrasher Research Funds (Thrasher Award No. 11955) to Mara Zambruni and Theresa J. Ochoa.

Authors' addresses: Gonzalo J. Acosta, Natalia I. Vigo, David Durand, Maribel Riveros, and Sara Arango, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: gjacosta89@gmail.com, natalia.vigo@outlook.com, david.durand@upch.pe, maribel.riveros@upch.pe, and sara.arango29@gmail.com. Mara Zambruni, Department of Pediatric Infectious Diseases, University of Texas Medical Branch, Galveston, TX, E-mail: mazambru@utmb.edu. Theresa J. Ochoa, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, and University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, E-mails: theresa.j.ochoa@uth.tmc.edu or theresa.ochoa@upch.pe.

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