Persistent bloody diarrhoea without fever associated with diffusely adherent Escherichia coli in a young child

S. Patzi-Vargas, M. Zaidi, R. Bernal-Reynaga, M. Leon-Cen, A. Michel, T. Estrada-Garcia
2013 Journal of Medical Microbiology  
Diffusely adherent Escherichia coli (DAEC) is thought to cause diarrhoea in children, and so too are other diarrhoeagenic E. coli (DEC); however, the evidence base is inconclusive. DEC pathotypes are differentiated on the basis of their pathogenic features, and thus cannot be quickly identified on selective culture media. Molecular techniques, not readily available in most clinical laboratories, are required to differentiate DEC strains from non-pathogenic E. coli in the stool flora. We report
more » ... case of persistent bloody diarrhoea, without fever, in a previously healthy 21month infant from whom we isolated five DAEC strains. The child's stools movements were loose, with gross blood and mucus; fresh mount analysis revealed numerous faecal leukocytes and erythrocytes. Response to antimicrobial treatment with trimethoprim-sulfamethoxazole was poor despite susceptibility in vitro. Although the patient improved with azithromycin, blood was present in the patient's stools for over 30 days. The severe diarrhoea in this patient might be explained by the fact that these DAEC isolates harboured a siderophore receptor, which allows the bacteria to use iron derived from haem compounds that promote its multiplication. The isolates also induced in vitro secretion of several immunomodulatory cytokines that may account for the patient's loose stools and faecal leukocytes. DAEC may play a greater role than suspected in afebrile children with bloody diarrhoea. Abbreviations: DAEC, diffusely adherent Escherichia coli; DEC, diarrhoeagenic Escherichia coli.
doi:10.1099/jmm.0.062349-0 pmid:24025346 fatcat:ky4di6py2jardpnsplxrbf7onm