Comparative analysis of virulence determinants, phylogroups, and antibiotic susceptibility patterns of typical versus atypical Enteroaggregative E. coli in India

• Published in: PLoS neglected tropical diseases 2020-11, Vol.14 (11), p.e0008769-e0008769
• Main Authors: Modgil, Vinay, Mahindroo, Jaspreet, Narayan, Chandradeo, Kalia, Manmohit, Yousuf, Md, Shahi, Varun, Koundal, Meenakshi, Chaudhary, Pankaj, Jain, Ruby, Sandha, Kawaljeet Singh, Tanwar, Seema, Gupta, Pratima, Thakur, Kamlesh, Singh, Digvijay, Gautam, Neha, Kakkar, Manish, Bharti, Bhavneet, Mohan, Balvinder, Taneja, Neelam
• Format: Article
• Language: English
• Subjects: Age; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antisera; Bacterial Outer Membrane Proteins - genetics; Biofilms; Biology and Life Sciences; Child; Child, Preschool; Children; Comparative analysis; Computer and Information Sciences; Cytokines; Cytotoxicity; Diarrhea; Diarrhea - epidemiology; Disk Diffusion Antimicrobial Tests; DNA, Bacterial - genetics; E coli; Epidemiology; Escherichia coli - drug effects; Escherichia coli - genetics; Escherichia coli - isolation & purification; Escherichia coli - pathogenicity; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Escherichia coli Proteins - genetics; Feces - microbiology; Female; Gene expression; Health care facilities; Hospitals; Humans; India - epidemiology; Infant; Infections; Inflammation; Inflammatory response; Intestine; Ionization; Laboratories; Lasers; Male; Malnutrition; Medical science; Medical sciences; Medicine and Health Sciences; Microbiological strains; Molecular Diagnostic Techniques; Mucosa; Mucus; Pathogenesis; Pathogens; People and Places; Phylogenetics; Pili; Receptors, Cell Surface - genetics; Research and Analysis Methods; Serotyping; Strains; Trans-Activators - genetics; Tropical diseases; Virulence; Virulence Factors - genetics
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0008769

Enteroaggregative Escherichia coli (EAEC) is an evolving enteric pathogen that causes acute and chronic diarrhea in developed and industrialized nations in children. EAEC epidemiology and the importance of atypical EAEC (aEAEC) isolation in childhood diarrhea are not well documented in the Indian setting. A comparative analysis was undertaken to evaluate virulence, phylogeny, and antibiotic sensitivity among typical tEAEC versus aEAEC. A total of 171 EAEC isolates were extracted from a broad surveillance sample of diarrheal (N = 1210) and healthy children (N = 550) across North India. Polymerase chain reaction (PCR) for the aggR gene (master regulator gene) was conducted to differentiate tEAEC and aEAEC. For 21 virulence genes, we used multiplex PCR to classify possible virulence factors among these strains. Phylogenetic classes were identified by a multiplex PCR for chuA, yjaA, and a cryptic DNA fragment, TspE4C2. Antibiotic susceptibility was conducted by the disc diffusion method as per CLSI guidelines. EAEC was associated with moderate to severe diarrhea in children. The prevalence of EAEC infection (11.4%) was higher than any other DEC group (p = 0.002). tEAEC occurrence in the diarrheal group was higher than in the control group (p = 0.0001). tEAEC strain harbored more virulence genes than aEAEC. astA, aap, and aggR genes were most frequently found in the EAEC from the diarrheal population. Within tEAEC, this gene combination was present in more than 50% of strains. Also, 75.8% of EAEC strains were multidrug-resistant (MDR). Phylogroup D (43.9%) and B1 (39.4%) were most prevalent in the diarrheal and control group, respectively. Genetic analysis revealed EAEC variability; the comparison of tEAEC and aEAEC allowed us to better understand the EAEC virulence repertoire. Further microbiological and epidemiological research is required to examine the pathogenicity of not only typical but also atypical EAEC.