Association of atypical enteropathogenic Escherichia coli (EPEC) with prolonged diarrhoea

The aim of the present case control study was to investigate the prevalence of atypical enteropathogenic Escherichia coli (EPEC) and its possible role in causing diarrhoea among children < 5 years of age in Norway. Stool specimens received in the laboratory from children with suspected gastroenteritis (n = 251) were, in addition to routine testing, analysed for the presence of EPEC by PCR of the eae, bfpA and stx genes. Specimens from healthy children (n 210) recruited from Maternal and Child Health Centres were analysed for EPEC only. EPEC isolates (eae(+), stx(-)) were classified as typical (bfpA(+)) or atypical (bfpA(-)), and were tested for 0 : K serogroup. Information on duration of diarrhoea was recorded in a questionnaire and from referral forms. Atypical EPEC was diagnosed in 37 patients (14.7%) compared to 21 (110.0%) of the healthy controls [Odds ratio (OR) = 1.4, P = 0,3]. Only three isolates, all from patients, belonged to EPEC serogroups. One patient had typical EPEC. Twenty (22.5%) of 89 patients with diarrhoea lasting greater than or equal to 14 days had atypical EPEC. The association between atypical EPEC and prolonged diarrhoea (OR = 2.1, P = 0.04) was caused by a high prevalence among female patients (40.6%). In conclusion, atypical EPEC was found to be slightly more prevalent in patients than controls, without any overall significant association with diarrhoea. However, a significant association was observed with diarrhoea lasting 14 days or more, a finding that may indicate a role for atypical EPEC in prolonged disease.