High prevalence of atypical enteropathogenic Escherichia coli (EPEC) in Norwegian children with diarrhoea

The aim of the present study was to investigate the relative contribution of enteropathogenic Escherichia coli (EPEC) as a cause of infectious diarrhoea in Norwegian children. Data from faecal specimens from children <2 years old with diarrhoea during the year 2001 were analysed. E coli isolates with the attaching and effacing genotype (eae(+)) were examined for the presence of the bundle-forming pilus (bfpA) and Shiga toxin genes by PCR, and for genetic relatedness by PFGE. During the 1-year period, 598 specimens from 440 patients <2 years old were analysed. Potential enteric pathogens were identified in 124 patients (28.2%). EPEC was the most frequently identified agent (44 patients), followed by rotavirus (41 patients), Campylobacter jejuni (117 patients) and adenovirus (117 patients). All other agents were detected in five patients or less. Only one of the eae+ E coli isolates was classified as typical EPEC (bfpA(+)). Among the 43 isolates that were classified as atypical EPEC (bfpA(-)), eight strains belonged to EPEC serogroups, whereas the majority of strains (n = 35) were not agglutinated by EPEC antisera. None of the EPEC isolates were genetically related. This study demonstrates that atypical EPEC of non-EPEC serogroups is highly prevalent among Norwegian children with diarrhoea.