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American Journal of Epidemiology Vol. 131, No. 5: 886-904
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health

research-article

RISK OF DIARRHEA DURING THE FIRST YEAR OF LIFE ASSOCIATED WITH INITIAL AND SUBSEQUENT COLONIZATION BY SPECIFIC ENTEROPATHOGENS

ALEJANDRO CRAVIOTO1 2,, ROSA E. REYES1, FRANCISCA TRUJILLO1, FELIPE URIBE1 2, ARMANDO NAVARRO1 2, JOSE M. DE LA ROCA1, JUAN M. HERNANDEZ1, GABRIEL PEREZ1 and VIRGINIA VAZQUEZ1

1 Research Department, Instituto Nacional de Ciencias {gamma} Tecnologia-DIF Mexico City 14410, Mexico

Reprint requests to Dr. Alejandro Cravioto, Centrode Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Püblica, Apartado Postal 16.116, Mexico, D.F. 02000, Mexico

The incidence of colonization by enteropathogenic, enterotoxigenic, enteroinvasive, and enterohemorrhagic Escherichia coli (detected by DNA hybridization with specific radiolabeled probes), Salmonella sp., Shigella sp., Campylobacter jejunl, and rotavirus was related to the presence of diarrhea in a cohort of 75 rural infants followed longitudinally during the first year of life. The study was carried out between August 1985 and February 1987 in the village of Lugar Sobre la Tierra Blanca, in the state of Morelos, 180 km southwest of Mexico City. Intestinal colonization by specific enteropathogens was followed with fecal cultures taken every fortnight and every time a child had diarrhea. Pathogens isolated from cultures taken in the 48 hours prior to the initiation of the diarrheal episode were considered to be associated with the disease. Diarrhea was detected in 82% of the children with initial isolation of enterohemorrhagic E. coli and in 64% of the children with enteropathogenic E. coli or Shigella sp. The risk of diarrhea associated with the initial isolation of other pathogens was lower, at 41% for rotavirus and approximately 25% for enterotoxigenic E. coli, Salmonella sp., and C. jejunl. Initial colonization by the enteropathogens studied, whether or not they were associated with diarrhea, prevented disease, but not colonization by the same organism, when the children were reinfected during the first year of life. Enteropathogenic E. coli adherence factor, human or porcine heat-stable enterotoxins, fimbrial colonization factor antigens, and Shiga-like toxins I and II were important pathogenic characteristics related to the presence of diarrhea and to protection against subsequent infection by the same organisms.

Campylobacter infections; diarrhea; diarrhea, infantile; Escherichia coli infections; rotaviruses; Salmonella infections; Shigella

2Present address: Division of Microbiology, Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Püblica, Cuernavaca, Morelos 62508, Mexico.


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