Epidemiology of Diarrheagenic Enteroaggregative and Enterotoxigenic Escherichia coli and their Prevalence in Children under Five in Western Rajasthan

Parvinder Kumar¹ , Sweta Barupal¹, Chetna Aggarwal¹, Jyoti Lakhani² , Sanjay Kochar³ and Dharmesh Harwani^1*

DOI : http://dx.doi.org/10.13005/bbra/3447

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To better understand circulating diarrheagenic pathotypes, researchers often focus on investigating the fimbrial profiles, toxin subtypes, and dominant colonization factors of Escherichia coli (E. coli) in specific geographic areas. Few studies have evaluated the health outcomes of children in western Rajasthan. Bikaner has a high prevalence of diarrhea, according to surveys on waterborne illnesses. It is crucial to understand the distribution and variability of these components, as their frequency can vary temporally and across regions, with direct implications for epidemiological surveillance and tailored intervention strategies. However, many studies focusing on ETEC (Enterotoxigenic E. coli) and EAEC (Enteroaggregative E. coli) do not conduct in-depth genotyping or phenotyping. For EAEC, there is a need to determine which virulence factors, such as plasmid-encoded genes, toxins, and aggregative adherence fimbriae, are linked to more severe disease, as well as to understand the differences between persistent and self-limiting diarrhea. Due to the variability of EAEC strains, it remains unclear which subsets pose a "high risk." Furthermore, data on antibiotic susceptibility for EAEC and ETEC in many regions are limited. The focus is particularly on diarrheagenic E. coli strains, such as EAEC and ETEC, as opposed to extraintestinal strains. The resistance mechanisms of these pathogens, such as extended-spectrum beta-lactamases (ESBLs) and plasmids, have not been extensively studied among EAEC and ETEC. There are still interrogations regarding how often EAEC and ETEC lead to severe disease outcomes, such as dehydration and hospitalization, compared to mild illness. It is also imperative to investigate how EAEC and ETEC co-infection with other enteric pathogens and to consider the impact of host factors such as nutrition, microbiome composition, immunity, previous exposures, and age. The present review highlights and analyses how monitoring changes over time in prevalence, virulence factors, and resistance is crucial for understanding the dynamics of EAEC and ETEC.

Diarrheagenic Escherichia coli; EAEC; Epidemiology; ETEC; Prevalence