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  • Title: Epidemiologic studies of Escherichia coli diarrheal infections in a low socioeconomic level peri-urban community in Santiago, Chile.
    Author: Levine MM, Ferreccio C, Prado V, Cayazzo M, Abrego P, Martinez J, Maggi L, Baldini MM, Martin W, Maneval D.
    Journal: Am J Epidemiol; 1993 Nov 15; 138(10):849-69. PubMed ID: 8237973.
    Abstract:
    The incidence of diarrhea due to six categories of diarrheogenic Escherichia coli was determined in two pediatric cohorts in a low socioeconomic level community in Santiago, Chile, with access to chlorinated water. An age cross-sectional cohort of 340 children aged birth to 47 months was assembled. A newborn cohort was assembled by enrolling 10-12 newborns monthly for 12 months. Episodes of diarrhea were detected by twice weekly household visits. E. coli from stool cultures of cases and matched controls were hybridized with DNA probes specific for enterotoxigenic, enteroinvasive, enteropathogenic, enterohemorrhagic, enteroaggregative, and diffuse adherence E. coli. Overall, the incidence of diarrhea was low (2.1 episodes/infant/year). Nevertheless, a putative E. coli enteropathogen was found in a large proportion of diarrheal episodes, particularly during the summer. In both cohorts, enterotoxigenic E. coli were important pathogens. Enteropathogenic E. coli were incriminated during the first year of life in the newborn cohort, where they were found significantly more often in cases (p = 0.021) than in controls; beyond this age, isolation rates were similar. In contrast, the relative risk of isolation of diffuse adherence E. coli increased with age in the age cross-sectional cohort, where, overall, the difference in rate of isolation between cases and controls was significant (p = 0.0024). Enteroinvasive and enterohemorrhagic E. coli were isolated infrequently. Enteroaggregative E. coli were encountered equally in cases and controls. Facile transmission of E. coli enteropathogens is occurring in this community despite the availability of potable water. Researchers conducted an age cross sectional cohort analysis of 340 0-47 month old children and newborn cohort analysis of 144 newborns to determine the diarrheogenic Escherichia coli incidence in Santa Julia, a low socioeconomic community in Santiago, Chile. Children in the age cross sectional cohort had age, sex, and sector matched controls. The newborns had sex matched controls. A public health nurse or nurse auxiliary visited the household of each subject 2 times a week to detect diarrhea episodes. Between December 1986 and February 1990, the age cross sectional cohort had 1178 episodes of diarrhea and the newborn cohort had 674 episodes. The overall diarrhea incidence was only 2.1 episodes/child/year. An E. coli enteropathogen was isolated in many of these episodes, especially during the summer (e.g. enterotoxigenic E. coli [ETEC], 2.2 cases/month in summer vs. 0.4 cases/month in winter; p = .00001). Diffuse adherence E. coli (DAEC) and enteropathogenic E. coli (EPEC) infections also peaked in the summer. ETEC contributed greatly to diarrheal episodes in both cohorts. Among newborns, EPEC was isolated significantly more often in cases than controls during the 1st 12 months of life (6.7% vs. 2.5%; p = .021). After 1 year, however, E. coli isolation rates were essentially the same. On the other hand, in the age cross sectional cohort, the relative risk of isolation of DAEC rose with age (e.g., 1.1 for 0.11 months, 1.4 for 36-47 months, and 2.1 for = or 48 months). In the same cohort, DAEC infections were much more common in cases than controls (16.6% vs. 11.9%; p = .0024). Enteroinvasive and enterohemorrhagic E. coli were the most rarely isolated E. coli types. No difference in the isolation rate of enteroaggregative E. coli existed between cases and controls. Since most households in Santa Julia have access to potable water (68%) and an indoor toilet (64%), food contamination were likely the vehicles of E. coli transmission because more than 50% of households do not have a refrigerator.
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