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Clinical Microbiology Reviews, July 2005, p. 465-483, Vol. 18, No. 3
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.3.465-483.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Enterotoxigenic Escherichia coli in Developing Countries: Epidemiology, Microbiology, Clinical Features, Treatment, and Prevention

Firdausi Qadri,1 Ann-Mari Svennerholm,2 A. S. G. Faruque,1 and R. Bradley Sack3*

International Centre for Diarrhoeal Disease Research, Bangladesh, and Centre for Health and Population Research, Mohakhali, Dhaka 1212, Bangladesh,1 Department of Medical Microbiology and Immunology, Göteborg University, 40530 Göteborg, Sweden ,2 Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland3

ETEC is an underrecognized but extremely important cause of diarrhea in the developing world where there is inadequate clean water and poor sanitation. It is the most frequent bacterial cause of diarrhea in children and adults living in these areas and also the most common cause of traveler's diarrhea. ETEC diarrhea is most frequently seen in children, suggesting that a protective immune response occurs with age. The pathogenesis of ETEC-induced diarrhea is similar to that of cholera and includes the production of enterotoxins and colonization factors. The clinical symptoms of ETEC infection can range from mild diarrhea to a severe cholera-like syndrome. The effective treatment of ETEC diarrhea by rehydration is similar to treatment for cholera, but antibiotics are not used routinely for treatment except in traveler's diarrhea. The frequency and characterization of ETEC on a worldwide scale are inadequate because of the difficulty in recognizing the organisms; no simple diagnostic tests are presently available. Protection strategies, as for other enteric infections, include improvements in hygiene and development of effective vaccines. Increases in antimicrobial resistance will dictate the drugs used for the treatment of traveler's diarrhea. Efforts need to be made to improve our understanding of the worldwide importance of ETEC.

* Corresponding author. Mailing address: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room W5035, Baltimore, MD 21205. Phone: (410) 955-2719. Fax: (410) 502-6733. E-mail: rsack{at}jhsph.edu.

Clinical Microbiology Reviews, July 2005, p. 465-483, Vol. 18, No. 3
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.3.465-483.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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