Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. A review highlighting the characteristics and clinical importance of enterotoxigenic Escherichia coli in the developing world.
Enterotoxigenic Escherichia coli (ETEC) is an underrecognized but extremely important cause of diarrhoea in the developing world where there is inadequate clean water and poor sanitation. It is the most frequent bacterial cause of diarrhoea in children and adults living in these areas and also the most common cause of traveller's diarrhea. ETEC diarrhoea is most frequently seen in children, suggesting that a protective immune response occurs with age.
The pathogenesis of ETEC-induced diarrhoea is similar to that of cholera and includes the production of enterotoxins and colonization factors. The clinical symptoms of ETEC infection can range from mild diarrhoea to a severe cholera-like syndrome. The effective treatment of ETEC diarrhoea by rehydration is similar to treatment for cholera, but antibiotics are not used routinely for treatment except in traveller's diarrhea. The frequency and characterization of ETEC on a worldwide scale are inadequate because of the difficulty in recognizing the organisms; no simple diagnostic tests are presently available.
Protection strategies, as for other enteric infections, include improvements in hygiene and development of effective vaccines. Increases in antimicrobial resistance will dictate the drugs used for the treatment of traveller's diarrhoea. Efforts need to be made to improve our understanding of the worldwide importance of ETEC.