Enterotoxigenic Escherichia coli Heat-Labile Toxin Seroconversion in US Travelers to Mexico

Enterotoxigenic Escherichia coli (ETEC) is the most common bacterial pathogen isolated from travelers suffering of diarrhea. Exposure to heat-labile toxin (LT) produces a high rate of seroconversion. However, the role of LT-producing ETEC (LT-ETEC) as a cause of diarrhea is controversial. We conduct...

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Bibliographic Details
Published in:Journal of travel medicine 2008-05, Vol.15 (3), p.156-161
Main Authors: FLORES, Jose, DUPONT, Herbert L, OKHUYSEN, Pablo C, JIANG, Zhi-Dong, BELKIND-GERSON, Jaime, MOHAMED, Jamal A, CARLIN, Lily G, PADDA, Ranjit S, PAREDES, Mercedes, MARTINEZ-SANDOVAL, Jose Francisco, VILLA, Nicolas A
Format: Article
Language:English
Subjects:
Adult
Age Factors
Bacterial Toxins - isolation & purification
Biological and medical sciences
Diarrhea - epidemiology
Diarrhea - microbiology
Enterotoxins - isolation & purification
Enzyme-Linked Immunosorbent Assay
Escherichia coli
Escherichia coli Infections - epidemiology
Escherichia coli Infections - microbiology
Escherichia coli Proteins
Feces - microbiology
Female
General aspects
Humans
Immunoglobulin G - blood
Male
Medical sciences
Mexico
Middle Aged
Polymerase Chain Reaction
Risk Factors
Seasons
Serologic Tests
Sex Factors
Students - statistics & numerical data
Travel - statistics & numerical data
United States - epidemiology
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Summary:Enterotoxigenic Escherichia coli (ETEC) is the most common bacterial pathogen isolated from travelers suffering of diarrhea. Exposure to heat-labile toxin (LT) produces a high rate of seroconversion. However, the role of LT-producing ETEC (LT-ETEC) as a cause of diarrhea is controversial. We conducted a cohort study in US students traveling to Mexico to assess the ETEC-LT seroconversion rate after natural exposure. Participants provided a serum sample on arrival and departure and a stool sample when ill. ETEC-LT immunoglobulin G antibodies were measured by enzyme-linked immunosorbent assay, and LT-ETEC were detected by means of polymerase chain reaction done on fecal DNA. A total of 422 participants with a mean age of 34.5 years were followed a mean of 19.9 days; 304 were females (72.0%), and 319 (75.6%) traveled during the summer months. In total, 177 individuals (41.9%) developed travelers' diarrhea and 33.9% had LT-ETEC identified in their stools. Among individuals having an LT-ETEC strain, 74% seroconverted compared to 11% of those not having diarrhea (p < 0.0001). When analyzed with a logistic regression model, the odds of seroconversion were significantly reduced in participants not having LT-ETEC in their stool (odds ratio = 0.1, p < 0.0001) after adjusting for season, length of stay, age, gender, race, and ethnicity. In US young adults traveling to Mexico, ETEC-LT seroconversion reliably identifies individuals naturally exposed to ETEC and correlates with symptomatic illness, length and season of travel.
ISSN:1195-1982
1708-8305
DOI:10.1111/j.1708-8305.2008.00187.x