The epidemiological and clinical characteristics of diarrhea associated with enteropathogenic, enteroaggregative and diffuse-adherent Escherichia coli in Egyptian children.

A total of 220 enteroadherent Escherichia coli were identified from 729 Egyptian children with diarrhea using the HEp-2 adherence assay. Enteropathogenic E.coli (EPEC = 38) was common among children <6 months old and provoked vomiting, while diffuse-adhering E.coli (DAEC = 109) induced diarrheal episodes of short duration, and enteroaggregative E.coli (EAEC = 73) induced mild non-persistent diarrhea. These results suggest that EPEC is associated with infantile diarrhea in Egyptian children.

Fractionation of organ extracts of Culex pipiens mosquitoes for the isolation of active components that impair biological parameters of the insect.

The previous phase of the present study revealed that when crude extracts of Culex pipiens midgut, ovaries, and salivary glands are injected into New Zealand White (NZW) rabbits (Oryctolagus cuniculus), rabbits immunized with midgut extract exert the greatest negative impact on adult Cx. pipiens survival and fecundity. This study was conducted to further our understanding of the immunogenic nature of the aforementioned antigenic preparations, thus providing data for the ultimate goal of developing a vaccine against the numerous Cx. pipiens-vectored diseases that affect human populations throughout the world. Extracts of Cx. pipiens midgut, ovaries, and salivary glands were fractionated using Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE). The high (> 80.0 to >106.0 kDa) and low (< 18.5 kDa) molecular weight (MW) fractions of midgut extract, high MW fractions (75.0 - <106.0 kDa) of salivary gland extract, and low MW fraction (27.5 kDa) of ovary extract were excised, and used to immunize rabbits. Following immunization, anti-sera from all immunized rabbits were assayed for antibody response using Enzyme-Linked Immunosorbent Assay (ELISA), Enzyme Immunoblot transfer (EIB), and Indirect Fluorescent Antibody Techniques (IFAT). These assays resulted in both high and low MW fractions of midgut extract, with special reference to the midgut extract low MW fraction (18.0 kDa), eliciting the strongest humoral responses in immunized hosts. When Cx. pipiens were fed on rabbits immunized with the low MW fractions of midgut extract, the fecundity and survival rates were significantly less than those of mosquitoes fed on rabbits immunized with the high MW fractions of midgut extract and control rabbits (P < 0.001). It is concluded that, the low MW fraction of midgut extract is highly immunogenic, and the antibody response of immunized rabbits contributes to a significant disturbance in the life cycle of Cx. pipiens and their progeny. This impairment of feeding behavior and reproduction, in turn, could interfere with pathogen transmission.

Clinic-based surveillance for bacterial- and rotavirus-associated diarrhea in Egyptian children.

To identify enteropathogens for vaccine development, we implemented clinic-based surveillance for severe pediatric diarrhea in Egypt's Nile River Delta. Over 2 years, a physician clinically evaluated and obtained stool samples for microbiology from patients with diarrhea and less than 6 years of age. In the first (N = 714) and second clinic (N = 561), respectively, 36% (N = 254) and 46% (N = 260) of children were infected with rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter, or Shigella. When excluding mixed rotavirus-bacterial infections, for the first and second clinic, 23% and 10% had rotavirus-associated diarrhea, and 14% and 17% had ETEC-associated diarrhea, respectively. Campylobacter-associated diarrhea was 1% and 3%, and Shigella-associated diarrhea was 2% and 1%, respectively, for the two clinics. Rotavirus-associated diarrhea peaked in late summer to early winter, while bacterial agents were prevalent during summer. Rotavirus-associated cases presented with dehydration, vomiting, and were often hospitalized. Children with Shigella- or Campylobacter-associated diarrhea reported as watery diarrhea and rarely dysentery. ETEC did not have any clinically distinct characteristics. For vaccine development and/or deployment, our study suggests that rotavirus is of principle concern, followed by ETEC, Shigella, and Campylobacter.

Epidemiology of Shigella-associated diarrhea in rural Egyptian children.

During the period from February 1995 to February 1998, the epidemiology of Shigella diarrhea was studied among children less than three years of age residing in Egypt's Nile Delta. Children were visited twice a week and a stool sample was collected from any of them with diarrhea. The incidence of Shigella-associated diarrhea was 0.2 episodes/child-year, with S. flexneri being the most common serogroup isolated (55% of Shigella episodes). Younger age and the warm months increased the risk of developing Shigella-associated diarrhea, while breastfeeding was protective. Children with Shigella were ill for a mean of four days and passed a mean of six stools per day. Common symptoms included fever (35%), vomiting (19%), and dehydration (16%). Dysentery, however, was unusual, occurring in only 11% of the cases. In conclusion, Shigella-associated diarrhea remains relatively common in Egyptian children and supports the need for additional control measures including vaccine development.

Phenotypic diversity of enterotoxigenic Escherichia coli (ETEC) isolated from cases of travelers' diarrhea in Kenya.

BACKGROUND: The aim of this study was to characterize phenotypically enterotoxins, colonization factors (CFs) and the antibiotic susceptibility of enterotoxigenic Escherichia coli (ETEC) strains isolated from cases of acute diarrhea that occurred in Europeans traveling to resorts in Mombasa, Kenya; this information is critical for the development of vaccines and empirical treatment. METHODS: Over a 1-year period from 1996 to 1997, five E. coli-like colonies were obtained from each of 463 cases with acute diarrhea. These strains were characterized for enterotoxins using GM-1 ELISA, for CFs using a dot-blot assay, and for antibiotic susceptibility using antibiotic disks. RESULTS: Of 164 strains characterized for ETEC phenotype, 30 (18%) expressed heat-labile toxin (LT) only, 83 (51%) heat-stable toxin (ST) only, and 51 (31%) both LT and ST. Analysis for CF expression demonstrated that 107 (65%) of the strains were positive for CFs, including CFA/IV (46%), CFA/II (35%), and CFA/I (5%), while less than 4% expressed less common CFs. All ETEC strains tested were resistant to erythromycin and sensitive to ceftriaxone. Over one-third of the strains were resistant to sulfamethoxazole-trimethoprim or tetracycline. Six strains were resistant to nalidixic acid; none of these were resistant to ciprofloxacin. CONCLUSIONS: Cumulatively, our findings indicate that ETEC in this region comprises a highly diverse group of bacterial enteropathogens, and that the development of prophylactic agents against ETEC faces major challenges because of this diversity.

Lymphoproliferative responses of splenocytes before and after challenge with Schistosoma haematobium in C57BL/6 mice vaccinated with human anti-Idiotypes.

Anti-idiotypic vaccines (anti-Id or antibody 2; Ab2) in experimental schistosomiasis engender varying degrees of resistance to challenge infection. To further characterize the mechanisms involved in the induction of protective immunity associated with such a vaccine model, spleen cells of mice vaccinated with human Ab2 (HAb2) were investigated for their lymphoproliferative responses before and after challenge infection with normal S. haematobium cercariae. HAb2 was purified from sera of chronically infected patients using protective rabbit antibodies (RAb1) isolated from sera of rabbits multiply immunized with UV-irradiated cercariae by affinity chromatography over soluble worm antigenic preparation (SWAP). Vaccination of C57BL/6 (C57) mice with HAb2 resulted in approximately 31% and approximately 36% protection in two experiments of resistance to infection. Splenocytes were collected prior to challenge at week 6-post initial immunization and after challenge at days 6, 10, 28 and 90. Prior to challenge, in vitro splenic responses of HAb2-vaccinated animals (HAb2-group) to phytohaemagglutinin (PHA) declined while both SWAP and HAb2-driven responses increased, all compared to naive control. After challenge, PHA responses increased in the two test groups on day 6 then significantly decreased to lower levels. On the other hand, SWAP- and HAb2-driven responses of HAb2 group increased by day 6 then declined while the same responses in infected control mice increased on days 10 through 28 and decreased by day 90. Generally, proliferation obtained following in vitro stimulation with HAb2 was greater than that with SWAP in the HAb2-group after challenge. These results suggested that human anti-Id antibodies could mimic at the T cell level the properties of a protective antigenic epitopes of the irradiated-cercariae vaccine.