Phage-associated cytotoxin production by and enteroadhesiveness of enteropathogenic Escherichia coli isolated from infants with diarrhea in West Germany.

We assessed the frequency of isolating enteropathogenic Escherichia coli (EPEC) from the stools of infants with diarrhea, the enteroadhesiveness of the EPEC, their production of cytotoxin, and the association of cytotoxin synthesis with lysogenic phages. One hundred twenty-five isolates of EPEC obtained from 1,674 children with diarrhea; three were isolated from 868 controls. Thirty EPEC made elevated levels (greater than or equal to 10(4) 50% cytotoxic doses/mg of cell lysate protein) of a cytotoxin for HeLa cells, and cell-associated cytotoxicity for 27 of these isolates was neutralized by antibody to Shiga toxin. Cell lysates of these isolates were paralytic and lethal for mice. Phages from cytotoxin-producing strains were tested for toxin-converting capacity. Fifteen of 30 such strains harbored toxin-converting phages, and the cytotoxicity of 12 isolates of E. coli K12 transduced with these phages was neutralized by antibody to Shiga toxin. Fifty-seven EPEC exhibited either localized or diffuse adherence to HEp-2 cells, but only nine producers of elevated levels of cytotoxin were adherent.