Epidemiology and Clinical Manifestations of Enteroaggregative Escherichia coli

• Published in: Clinical microbiology reviews Vol. 27; no. 3; pp. 614 - 630
• Main Authors: JENSEN, Betina Hebbelstrup, OLSEN, Katharina E. P, STRUVE, Carsten, KROGFELT, Karen Angeliki, PETERSEN, Andreas Munk
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01-07-2014
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Bacteriology; Biological and medical sciences; Child; Coinfection; Developed Countries; Developing Countries; Diarrhea - drug therapy; Diarrhea - epidemiology; Diarrhea - microbiology; Disease Outbreaks; Disease Reservoirs - microbiology; Drug Resistance, Multiple, Bacterial; Escherichia coli - drug effects; Escherichia coli - pathogenicity; Escherichia coli - physiology; Escherichia coli Infections - diagnosis; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Escherichia coli Infections - transmission; Fundamental and applied biological sciences. Psychology; HIV Infections; Humans; Infectious diseases; Medical sciences; Microbiology; Miscellaneous; Reviews; Travel; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Bacteria; Review; Epidemiology; Escherichia coli; Enterobacteriaceae
• ISSN: 0893-8512; 1098-6618
• DOI: 10.1128/cmr.00112-13

Enteroaggregative Escherichia coli (EAEC) represents a heterogeneous group of E. coli strains. The pathogenicity and clinical relevance of these bacteria are still controversial. In this review, we describe the clinical significance of EAEC regarding patterns of infection in humans, transmission, reservoirs, and symptoms. Manifestations associated with EAEC infection include watery diarrhea, mucoid diarrhea, low-grade fever, nausea, tenesmus, and borborygmi. In early studies, EAEC was considered to be an opportunistic pathogen associated with diarrhea in HIV patients and in malnourished children in developing countries. In recent studies, associations with traveler's diarrhea, the occurrence of diarrhea cases in industrialized countries, and outbreaks of diarrhea in Europe and Asia have been reported. In the spring of 2011, a large outbreak of hemolytic-uremic syndrome (HUS) and hemorrhagic colitis occurred in Germany due to an EAEC O104:H4 strain, causing 54 deaths and 855 cases of HUS. This strain produces the potent Shiga toxin along with the aggregative fimbriae. An outbreak of urinary tract infection associated with EAEC in Copenhagen, Denmark, occurred in 1991; this involved extensive production of biofilm, an important characteristic of the pathogenicity of EAEC. However, the heterogeneity of EAEC continues to complicate diagnostics and also our understanding of pathogenicity.