COLONIZATION OF THE UPPER JEJUNUM BY ENTEROPATHOGENIC AND ENTEROTOXIGENIC ESCHERICHIA COLI IN PAEDIATRIC DIARRHOEA

Abstract

Aspirated fluid from the upper jejunum was obtained by intubation of 27 children with diarrhea and 7 control children without diarrhea. The aspirated jejunal fluid was analyzed for total counts of viable aerobic and anaerobic microorganisms. Gram-negative aerobic bacteria were typed biochemically and analyzed for the production of heat-labile and heat-stable enterotoxins. Enteropathogenic E. coli (EPEC) strains of serogroups 0111, 055 and 0127 were detected in the stools of 9 patients and the respective strains concomitantly in the upper jejunum (103-108 bacteria/ml) in 7 patients with diarrhea. In 6 patients from whom isolates of enterotoxigenic E. coli (ETEC) were obtained, there were high total viable counts of non-enterotoxigenic bacteria in the upper jejunum and ETEC were recovered from this location in 3 cases. Enterotoxigenic Klebsiella was recovered from feces but not from the upper jejunum in 1 case. Compared to the controls, the total number of bacteria in the upper jejunum was 100-1000 times higher in patients with enteropathogenic E. coli (EPEC) or enterotoxigenic E. coli (ETEC). In another 11 cases with diarrhea caused by Shigella, rotavirus or of unknown etiology, the total viable counts of bacteria were similar to those of the controls. Five patients with severe EPEC diarrhea received antibiotics for 5 days. The patients improved clinically; the EPEC strain had disappeared from the upper jejunum when they were reexamined. Thus, in EPEC diarrhea, a colonization of the upper jejunum by the causative organism seemed to take place; in ETEC diarrhea, there appeared to be a nonspecific contamination by enteric bacteria.