Association of Enterotoxigenic Bacteroides fragilis Infection with Inflammatory Diarrhea (original) (raw)

Journal Article

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1

Johns Hopkins University School of Medicine

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Baltimore, Maryland

Reprints or correspondence: Dr. Cynthia L. Sears, Divisions of Infectious Diseases and Gastroenterology, Johns Hopkins University School of Medicine, 1550 Orleans St., CRB2 Bldg., Ste. 1M.05, Baltimore, MD 21231 (csears@jhmi.edu).

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3

International Centre for Diarrheal Diseases Research

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Dhaka, Bangladesh

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3

International Centre for Diarrheal Diseases Research

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Dhaka, Bangladesh

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3

International Centre for Diarrheal Diseases Research

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Dhaka, Bangladesh

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International Centre for Diarrheal Diseases Research

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Dhaka, Bangladesh

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3

International Centre for Diarrheal Diseases Research

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Dhaka, Bangladesh

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3

International Centre for Diarrheal Diseases Research

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Dhaka, Bangladesh

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Johns Hopkins University School of Medicine

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Baltimore, Maryland

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Loyola University Medical Center

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Maywood, Illinois

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Karolinska Institute

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Stockholm, Sweden

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Published:

15 September 2008

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Cynthia L. Sears, Salequl Islam, Amit Saha, Maleka Arjumand, Nur Haque Alam, A. S. G. Faruque, M. A. Salam, Jai Shin, David Hecht, Andrej Weintraub, R. Bradley Sack, Firdausi Qadri, Association of Enterotoxigenic Bacteroides fragilis Infection with Inflammatory Diarrhea, Clinical Infectious Diseases, Volume 47, Issue 6, 15 September 2008, Pages 797–803, https://doi.org/10.1086/591130
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Abstract

**Background.**Diarrheal illnesses remain a leading cause of morbidity and mortality globally, with increasing recognition of long-term sequelae, including postinfectious irritable bowel syndrome and growth faltering, as well as cognitive deficits in children. Identification of specific etiologic agents is often lacking. In vitro and in vivo data suggest that enterotoxigenic Bacteroides fragilis (ETBF) may contribute to the burden of colonic inflammatory diarrheal disease. The study goal was to investigate the pathogenesis of ETBF diarrheal illnesses.

**Methods.**We performed an observational study of children and adults with acute diarrheal illnesses in Dhaka, Bangladesh, from January 2004 through November 2005, to define the clinical presentation, intestinal inflammatory responses, and systemic and intestinal antibody responses to ETBF. Other enteric pathogens were also evaluated.

**Results.**ETBF was identified to cause a clinical syndrome with marked abdominal pain and nonfebrile inflammatory diarrhea in both children (age, >1 year) and adults. Fecal leukocytes, lactoferrin, and proinflammatory cytokines (interleukin 8, tumor necrosis factor–α)—as well as B. fragilis toxin systemic antitoxin responses—increased rapidly in ETBF-infected patients. Evidence of intestinal inflammation often persisted for at least 3 weeks, despite antibiotic therapy.

**Conclusions.**ETBF infection is a newly recognized cause of inflammatory diarrhea in children and adults. Future studies are needed to evaluate the role of ETBF in persistent colonic inflammation and other morbid sequelae of acute diarrheal disease.

© 2008 Infectious Diseases Society of America.

Topic:

• cytokine
• tumor necrosis factors
• abdominal pain
• inflammation
• diarrhea
• adult
• antibody formation
• antitoxins
• bacteroides fragilis
• bangladesh
• child
• interleukin-8
• intestines
• lactoferrin
• toxins
• infections
• colon
• morbidity
• mortality
• irritable bowel syndrome
• inflammatory diarrhea
• persistence
• pathogenic organism
• antibiotic therapy
• cognitive impairment
• stool leukocytes
• inflammatory response
• bacteroides fragilis infections

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