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J Med Microbiol 56 (2007), 1086-1096; DOI: 10.1099/jmm.0.47093-0
© 2007 Society for General Microbiology
ISSN 1473-5644

Diarrhoeagenic Escherichia coli and other causes of childhood diarrhoea: a case–control study in children living in a wastewater-use area in Hanoi, Vietnam

Bui Thi Thu Hien1,2, Do Thuy Trang1, Flemming Scheutz3, Phung Dac Cam1, Kåre Mølbak4 and Anders Dalsgaard2

1 Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

2 Department of Veterinary Pathobiology, Faculty of Life Science, Copenhagen University, Frederiksberg, Denmark

3 International Escherichia and Klebsiella Centre (WHO), Department of Bacteriology, Mycology, and Parasitology, Statens Serum Institut, Copenhagen, Denmark

4 Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark

Correspondence
Bui Thi Thu Hien
hien.nihe{at}gmail.com

Received 23 November 2006
Accepted 10 April 2007

A case–control study was conducted to identify the aetiology of diarrhoeal diseases in pre-school children in a suburban area of Hanoi where the use of untreated wastewater in agriculture and aquaculture is a common practice. Stool specimens and clinical information were collected from 111 pairs of children with diarrhoea and healthy controls. A total of 73 cases (66 %) and 41 controls (36 %) had an enteric pathogen. The pathogens most often associated with diarrhoea were rotavirus (17 % of cases) and Entamoeba histolytica (15 %), followed by Shigella (5 %). Diarrhoeagenic Escherichia coli (DEC) was found in 23 % of both patients and controls. Characterization of DEC by serotyping, antimicrobial susceptibility test and PFGE showed that DEC represented by different pathotypes belonged to various serotypes. Except for three enterotoxigenic E. coli strains, typing by PFGE revealed no correlation between pathotype and serotype of DEC strains. This suggests a high prevalence of a variety of DEC subtypes in this area. For this particular region, vaccine development strategies targeting rotavirus and Shigella are likely to be of public health benefit, whereas the role of DEC and preventive measures need to be further elaborated.

Abbreviations: A/EEC, attaching and effacing Escherichia coli; DEC, diarrhoeagenic E. coli; EAF, EPEC adherence factor; EAggEC, enteroaggregative E. coli; EIEC, enteroinvasive E. coli; EPEC, enteropathogenic E. coli; ETEC, enterotoxigenic E. coli; NIHE, National Institute of Hygiene and Epidemiology; VTEC, Vero cytotoxin-producing E. coli.




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B. T. T. Hien, F. Scheutz, P. D. Cam, O. Serichantalergs, T. T. Huong, T. M. Thu, and A. Dalsgaard
Diarrheagenic Escherichia coli and Shigella Strains Isolated from Children in a Hospital Case-Control Study in Hanoi, Vietnam
J. Clin. Microbiol., March 1, 2008; 46(3): 996 - 1004.
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