Enteropathogenicity: recent developments.

Recent studies have added important new information to our understanding of the pathogenesis and ethiology of diarrheal disease. Vibrio cholerae produces a heat-labile enterotoxin, affecting cyclic AMP. A very similar heat-labile enterotoxin is produced also by certain strains of Escherichia coli, as well as by Citrobacter, Klebsiella, and Aeromonas. E. coli may also produce a heat-stable enterotoxin, stimulating guanylate cyclase activity. In order to produce the pathologic effects, E. coli first attaches to epithelial cells of the intestinal tract by means of pili or surface antigens. Enterotoxin can be demonstrated by both in vivo and in vitro tests, but none are yet suitable for routine diagnostic laboratories. A third mechanism whereby E. coli causes diarrheal disease consists of enteroinvasiveness. Campylobacter, Yersinia, and Clostridium difficile have been added to the list of enteric pathogens of man.