Diarrheagenic Escherichia coli isolated from stools of sporadic cases of diarrheal illness in Osaka City, Japan between 1997 and 2000: prevalence of enteroaggregative E. coli heat-stable enterotoxin 1 gene-possessing E. coli.

Diarrheagenic Escherichia coli (DEC) represents an elusive target, since they are not easily distinguished from fecal coliforms. To clarify if DEC are prevalent among sporadic cases of diarrheal illness in Osaka City, Japan, diarrheal specimens were examined for E. coli that were enterohemorrhagic (EHEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), or enteroaggregative (EAggEC). EAST1EC, a strain of E. coli that does not possess any diarrheagenic characteristics except the EAggEC heat-stable toxin 1 (EAST1) gene, was also included as a possible DEC. A total of 924 specimens were examined between July 1997 and March 2000. DEC and Salmonella were isolated from 7.3% (67/924) and 6.8% (63/924) of specimens, respectively. DEC was therefore as prevalent as Salmonella among sporadic cases. The 67 strains were composed of 17 EPEC (26%), 10 EHEC (15%), four ETEC (6%), 13 EAggEC (20%), and 23 EAST1EC (35%), including two strains of EAST1EC O166:H15. Although PCR and tissue culture adhesion tests were useful to detect DEC, the effectiveness of serotyping was limited: only 40 strains (17.5%) out of 229 isolates that had been assumed to be enterovirulent on the basis of their O antigen were recognized to be diarrheagenic. In conclusion, not only EHEC but also the other subgroups of DEC, including EAST1EC, seem to play an important role in causing sporadic diarrheal illnesses. Methods to detect and unified criteria to identify various kinds of DEC are strongly desired.