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Am. J. Trop. Med. Hyg., 77(3), 2007, pp. 571-582
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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Etiology of Acute Diarrhea in Children and Adults in Tunis, Tunisia, with Emphasis on Diarrheagenic Escherichia coli: Prevalence, Phenotyping, and Molecular Epidemiology

Nazek Al-Gallas, Olfa Bahri, Aida Bouratbeen, Assia Ben Haasen, AND Ridha Ben Aissa*
Laboratoire de Contrôle des Eaux et Denrées Alimentaires, Laboratoire de Virologie Clinique, et Laboratoire de Parasitologie Clinique, Institut Pasteur de Tunis, Tunis, Tunisia; Centre National de Greffe de Moelle Osseuse, Tunis, Tunisia

A total of 271 stool specimens were collected from children (diarrheagenic, n = 115 and control, n = 54) and adults (diarrheagenic, n = 73 and control, n = 29) from Tunis, Tunisia, and processed to detect bacterial enteropathogens, parasites, and viruses. Diarrheagenic Escherichia coli (DEC) were identified by their virulence genes (polymerase chain reaction) and adherence patterns (tissue culture assays). The most frequently isolated enteric pathogens from diarrheagenic children were enterotoxigenic E. coli (ETEC, 32.3%), enteroaggregative E. coli (EAEC, 11.3%), enteroinvasive E. coli (EIEC, (11.3%), adenovirus (10.4%), enterohemorrhagic E. coli (EHEC, 10.4%), and Salmonella spp. (9.5%). For children in the control group, ETEC (37%), EAEC (15%), EHEC (11.1%), and typical enteropathogenic E. coli (EPEC, 11.1%) were the most common enteric pathogens. In adults in the diarrheagenic group, Salmonella spp. (34.2%), ETEC (12.3%), adenovirus (7%), and Shigella spp. (4%) were the most common enteric pathogens. In adults in the control group, ETEC (31%) was the most common enteric pathogen. Multiple pathogens were recovered from 22% of the diarrheagenic children and 7% of the diarrheagenic adults. Escherichia coli strains showed high resistance rates to tetracycline, streptomycin, and ß-lactams. The most frequent combinations were ETEC-rotavirus and ETEC-adenovirus. Pulsed-field gel electrophoresis for DEC indicated a large number of DEC clones (five major clones) persistent in the community reservoir for a considerable period of time that caused diarrhea in the population. This suggests the confluence of small epidemics by clonally related DEC strains circulating in this region.

Received August 4, 2006. Accepted for publication January 8, 2007.

Acknowledgments: We thank Dr. Fessi Safwan (Service Régional de l’Hygiène du Ben Arous), the late Dr. Chadlia Koubaa (PMI Mellassine), Dr. Noureddine Ben Jemmaa (CSB du Gouvernorat de Ben Arous), Professor Amel Kechrid (Hôpital d’Enfants), and Professor Taoufik Ben Chaâbane (Hôpital la Rabta-Service Infectieux) for their contributions and help in collecting samples; the staffs of the Service Régional de l’Hygiène du Ben Arous and Hygiene de la Direction Regional de la Sauté Publique de Tunis for collecting samples; and Dr. Francine Grimont (Directeur Adjoint du Centre National de Référence des Escherichia coli et Shigella, Unité Biodi-versité des Bactéries Pathogènes Emergentes, Paris, France) for supplying reference strains. This work was conducted in the Laboratoire de Contrôle des Eaux et Denrées Alimentaires de l’Institut Pasteur de Tunis in Tunis, Tunisia. The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.

* Address correspondence to Ridha Ben Aissa, Laboratoire de Contrôle des Eaux et Denrées Alimentaires, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, Tunis 1002, Belvedere, Tunisia. E-mail: ridha.benaissa{at}pasteur.rns.tn

Authors’ addresses: Nazek Al-Gallas and Ridha Ben Aissa, Laboratoire de Contrôle des Eaux et Denrées Alimentaires, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, Tunis 1002, Belvedere, Tunisia, E-mail: ridha.benaissa{at}pasteur.rns.tn. Olfa Bahri, Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, Tunis 1002, Belvedere, Tunisia. Aida Bouratbeen, Laboratoire de Parasitology Clinique, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, Tunis 1002, Belvedere, Tunisia. Assia Ben Hassan, Centre National de Greffe de Moelle Osseuse, Tunis, Tunisia.






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