ENTEROAGGREG

I.

Escherichia
coli
AT I V E

DEFINITION OF DISEASE

Enteroaggregative Escherichia coli (EAEC), an increasingly recognized

cause of diarrhea in children in developing countries, has been
particularly associated with persistent diarrhea (more than 14 days), a
major cause of illness and death.A bacterial infection that results from
ingesting contaminated food or water and results in diarrhea that tends to
last for weeks. Characterized by their ability to adhere to particular
laboratory cultured cells in an aggregative or stacked bricked pattern.

II. SYNONYMS
Enteric food borne pathogen
Enteroadherent E. coli
Intestinal Pathogenic E. coli
Acute and persistent children and adult diarrhea
Diffusely Adherent E. coli (DAEC)

III. MORPHOLOGICAL DESCRIPTION

EAEC has specialized adherence factors which facilitate their attachment
to the intestinal cells. EAEC adheres to intestinal mucosa, forms a mucoid
biofilm and induces toxic effects on the intestinal mucosa that result in
diarrhea.
MAJOR VIRULENCE FACTORS

Heat stable toxin-1 (EAST-1)

Plasmid encoded toxin (PET)
Shigella enterotoxin 1 (ShET1)
Aggregative adherence fimbriae I, II and III (AAF/I, AAF/II and AAF/III)
Transcriptional activator gene

 Anti-aggregation protein gene

Anti-aggregation protein transporter gene
18 and 30 kDa outer membrane adhesins
EAEC pathogenesis involves three stages: (1) adherence to the intestinal
mucosa by aggregative adherence fimbriae (AAF) and adherence factors, (2)
increased production of mucus that encrusts EAEC on the surface of
enterocytes; and (3) release of toxins and elicitation of an inflammatory
response, mucosal toxicity, and intestinal secretion.

IV. CLINICAL HORIZON

Enteroaggregative E. Coli infection includes the 7 symptoms listed below:

V.

Persistent diarrhea
Blood in stool
Mucus in stool
Abdominal cramps
Malaise
Fever
Abdominal pain

INCUBATION PERIOD
The incubation period has been estimated to be 20 to 48 hours.

VI. PERIOD OF COMMUNICABILITY

EAEC can be readily transmitted through the fecal-oral route. While
excreting pathogen, up to a week in adults and up to three
weeks in children.

VII. LABORATORY DIAGNOSIS

The differential diagnosis of EAEC associated diarrhea does not differ from
that of viral, other bacterial, or parasitic enteric pathogens that cause
community-acquired and travelers diarrhea.
The HEp-2 cell adherence assay remains the gold standard for
diagnosing EAEC infection.

Another diagnostic tool is a DNA probe to the pCVD432 (aatA) gene

sequence. Although cific (99%), its sensitivity is variable (15% to 89%).
This test may help identify more virulent typical EAEC strains because a
positive result can be considered a surrogate marker for the presence of
aggR.
The biofilm assay using a microtiter plate has potential as a preliminary
screening tool in developing countries.

VIII.TREATMENT
Specific
Clinical studies indicate that the fluoroquinolones, especially
ciprofloxacin 500 mg bid for 3 to 7 days and rifaximin 200 or
400 mg bid for 3 days, may be the antimicrobial treatments of choice
for EAEC infections.

Symptomatic
Fluid replacement can conservatively treat EAEC infections

Oral rehydration for mild cases

Parenteral rehydration for severe cases.

Preventive/ Prophylaxis
Bovine lactoferrin inhibited EAEC biofilm formation and increase
auto-agglutination, further suggesting that surface adhesins were
affected. However it is not yet clear whether lactoferrin as a
nonantibiotic approach is effective for the treatment and prophylaxis
of EAEC.

IX. PROGNOSIS
EAEC can cause both an acute and a chronic (14 days) diarrheal illness.
Sporadic food poisoning outbreaks were also observed in the
developed world. This type of E.coli is also an increasingly recognized
cause of diarrhea in developing countries. Recent outbeaks implicate
EAEC as a cause of foodborne illness in industrialized countries. It has

also been implicated in severe diarrhea among patients infected with

HIV.

X.

PREVENTION
Enteroaggregative E. coli can be prevented by the following:
Wash your hands thoroughly after using the bathroom or changing
diapers and before preparing or eating food.
Wash your hands after contact with animals or their environments.
Cook meats thoroughly
Avoid raw milk, unpasteurized dairy products and unpasteurized
juices.
Avoid swallowing water when swimming or playing in lakes, ponds,
streams, swimming pools and backyard kiddie pools.
Prevent cross contamination in food preparation areas by thoroughly
washing hands, counters, cutting boards and utensils after they
touch raw meat.

REFERENCES
http://wwwnc.cdc.gov/eid/article/4/2/98-0212_article
https://www.hindawi.com/journals/ipid/2010/254159/
http://www.floridahealth.gov/diseases-and-conditions/e-coli-o157h7/_documents/non-o157.pdf