Enterotoxigenic Escherichia coli isolated from patients at a hospital in Dacca

Enterotoxigenic strains of Escherichia coli, a significant cause of acute, watery, cholera like diarrhea, were isolated from 23 of 65 patients with diarrhea in whom no other enteric pathogens were found during one week (November 1974) at the Cholera Research Hospital, Dacca, Bangladesh. Diarrhea associated with enterotoxigenic strains of E. coli occurred primarily in adults but affected persons of all age groups and could not be distinguished from cholera or from other cholera like diarrhea on clinical grounds. Routine bacteriologic methods were inadequate for identification of enterotoxigenic E. coli as the etiologic agent of the diarrhea. The enterotoxigenic E. coli, producing heat stable and/or heat labile enterotoxin, were detected by use of assays in the Y1 adrenal cell, the Chinese hamster ovary cell, the rabbit ileal loop, and the infant mouse. The two tissue culture assays yielded comparable results in tests with 640 (193 positive, 447 negative) of 643 isolates of E. coli. The results of this study support the idea that enterotoxigenic E. coli play a significant role as pathogens in the etiology of acute watery diarrhea.