Colonization of the upper jejunum by enteropathogenic and enterotoxigenic Escherichia coli in paediatric diarrhoea.

Aspirated fluid from the upper jejunum was obtained by intubation of 27 children with diarrhoea and 7 control children without diarrhoea. The aspirated jejunal fluid was analysed for total counts of viable aerobic and anaerobic microorganisms. Gram-negative aerobic bacteria were typed biochemically and analysed for the production of heat-labile and heat-stable enterotoxin. Enteropathogenic Escherichia coli (EPEC) strains of serogroups 0111, 055 and 0127 were detected in the stools of nine patients and the respective strains concomitantly in the upper jejunum (10(3)-10(8) bact/ml) in 7 patients with diarrhoea. In 6 patients from whom isolates of enterotoxigenic E. coli (ETEC) were obtained, there were high total viable counts of non-enterotoxigenic bacteria in the upper jejunum and ETEC were recovered from this location in 3 cases. Enterotoxigenic Klebsiella was recovered from faeces but not from upper jejunum in one case. Compared to the controls, the total number of bacteria in the upper jejunum were 100-1000 times higher in patients with enteropathogenic E. coli (EPEC) or enterotoxigenic E. coli (ETEC). In another 11 cases with diarrhoea caused by Shigella, rotavirus or of unknown aetiology, the total viable counts of bacteria were similar to those of the controls. Five patients with severe EPEC diarrhoea received antibodies for 5 days. The patients improved clinically, and the EPEC strain had disappeared from the upper jejunum when they were reexamined. In conclusion, in EPEC diarrhoea a colonization of the upper jejunum by the causative organism seemed to take place, while in ETEC diarrhoea, there appeared to be a nonspecific contamination by enteric bacteria.