The Association of Enterotoxigenic and Enteropathogenic Escherichia coli and Other Enteric Pathogens with Childhood Diarrhoea in Yugoslavia

The presence of enterotoxigenic and enteropathogenic Escherichia coli (ETEC and EPEC, respectively) was investigated in stool specimens of 1082 preschool children with diarrhoea and in stools of 335 healthy controls in localities in southern Yugoslavia, as well as in 566 children with diarrhoea and in 231 controls living in northern part of the country, during the seasonal peak (August-November) of enteric diseases in 1986. ETEC were found in 114 (10·5%) children with diarrhoea and in 14 (4·2%) controls (P < 0·001) in the southern part, and in 26 (4·6%) ill children and one (0·4%) well child (P < 0·005) in the northern part of Yugoslavia. EPEC were isolated from stools of 85 (7·9%) children with diarrhoea and of 14 (4·2%) well children (P < 0·05) in localities of southern Yugoslavia, and from 22 (3·9%) ill children and from 10 (4·3%) controls in northern Yugoslavia. Nineteen EPEC strains expressed localized adherence to HEp-2 tissue culture cells; all were isolated from stools of ill children. In southern Yugoslavia, where other enteropathogens were sought, the most commonly found agents in ill children were shigellae (17·5%), rotavirus (11·8%), ETEC, and EPEC. Potential pathogens were detected in 44·5% cases of sporadic diarrhoea and in 15·8% controls. This study revealed that ETEC were associated with acute diarrhoeal disease in Yugoslav preschool children. On the other hand, the diagnosis of EPEC-diarrhoea by routine determination of serogroup established the association of these agents with sporadic diarrhoea only in the 0-2 years age categories in all investigated localities. In the less developed southern part of Yugoslavia bacteria were the predominant causative agents of enteric illness during the seasonal peak of this disease.