Relationship between enterotoxigenic Escherichia coli and travelers\u27 diarrhea in Mexico, from 1992 to 1997

The purpose of this study was to examine the relationship between enterotoxigenic ETEC and travelers\u27 diarrhea over a period of five years in Guadalajara, Mexico. Specifically, this study identified and characterized ETEC from travelers with diarrhea. The objectives were to study the colonization factor antigens, toxins and antibiotic sensitivity patterns in ETEC from 1992 to 1997 and to study the molecular epidemiology of ETEC by plasmid content and DNA restriction fragment patterns. In this survey of travelers\u27 diarrhea in Guadalajara, Mexico, 928 travelers with diarrhea were screened for enteric pathogens between 1992 and 1997. ETEC were isolated in 195 (19.9%) of the patients, representing the most frequent enteric pathogen identified. A total of 31 antimicrobial susceptibility patterns were identified among ETEC isolates over the five-year period. The 195 ETEC isolates contained two to six plasmids each, which ranged in size from 2.0 to 23 kbp. Three different reproducible rRNA gene restriction patterns (ribotypes R-1 to R-3) were obtained among the 195 isolates with the enzyme, HindIII. Colonization factor antigens (CFAs) were identified in 99 (51%) of the 195 ETEC strains studied. Cluster analysis of the observations seen in the four assays all confirmed the five distinct groups of study-year strains of ETEC. Each group had a \u3e95% similarity level of strains within the group and \u3c60% similarity level between the groups. In addition, discriminant analysis of assay variables used in predicting the ETEC strains, reveal a \u3e80% relationship between both the plasmid and rRNA content of ETEC strains and study-year. These findings, based on laboratory observations of the differences in biochemical, antimicrobial susceptibility, plasmid and ribotype content, suggest complex epidemiology for ETEC strains in a population with travelers\u27 diarrhea. The findings of this study may have implications for our understanding of the epidemiology, transmission, treatment, control and prevention of the disease. It has been suggested that an ETEC vaccine for humans should contain the most prevalent CFAs. Therefore, it is important to know the prevalence of these factors in ETEC in various geographical areas. CFAs described in this dissertation may be used in different epidemiological studies in which the prevalence of CFAs and other properties on ETEC will be evaluated. Furthermore, in spite of an intense search in near 200 ETEC isolates for strains that may have clonal relationship, we failed to identify such strains. However, further studies are in progress to construct suitable live vaccine strains and to introduce several of CFAs in the same host organism by recombinant DNA techniques (Dr. Ann-Mari Svennerholm\u27s lab). (Abstract shortened by UMI.