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1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea
BACKGROUND: Biofire FilmArray multiplexed nucleic acid amplification tests (NAAT) for bacterial diarrhea include probes specific for EPEC. However, the platform does not differentiate typical EPEC (tEPEC, defined as carrying eaeA and bfp) which have strong epidemiologic associations with diarrhea fr...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254949/ http://dx.doi.org/10.1093/ofid/ofy210.935 |
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author | Okhuysen, Pablo Olvera, Adilene Carlin, Lily |
author_facet | Okhuysen, Pablo Olvera, Adilene Carlin, Lily |
author_sort | Okhuysen, Pablo |
collection | PubMed |
description | BACKGROUND: Biofire FilmArray multiplexed nucleic acid amplification tests (NAAT) for bacterial diarrhea include probes specific for EPEC. However, the platform does not differentiate typical EPEC (tEPEC, defined as carrying eaeA and bfp) which have strong epidemiologic associations with diarrhea from atypical EPEC (aEPEC, carrying eaeA but not bfp) for which there is a weaker association. Nevertheless, emerging data suggest that aEPEC subsets carrying efa1/lifA which encodes for adherence factor 1/lymphocyte inhibitory factor A, are associated with diarrhea. The role of EPEC and its subtypes as agents of bacterial diarrhea have not been well defined in immunosuppressed and cancer patients. METHODS: We characterized EPEC subtypes in stools from healthy individuals with no diarrhea (HI, N = 21), cancer patients with diarrhea and negative NAAT (DN, N = 25) and patients with diarrhea positive NAAT for EPEC (DP, N = 54). EPEC isolated from stool cultures were tested for eaeA and bfp, stx and other E. coli pathotypes. We estimated the number of fecal EPEC using a qPCR for eaeA, efa1/lifA that detected 5.6 × 10(1) to 5 × 10(7) cfu/mg of stool. RESULTS: Demographic characteristics and underlying malignancy were similar between DN and DP groups. DP were more likely to have diarrhea on admission than DN [46/52 (88%) vs. 13/25 (52%), P < 0.01]. Stool cultures confirmed EPEC in 24/52 (60%) DP of which 23/24 (96%) were aEPEC. Fecal qPCR for eaeA confirmed EPEC in 43/52 (83%) of DP, 0/25 DN and in 3/21 (14%) of HI (P < 0.001). DP excreted a higher number of EPEC cfu/mg of stool than HI (median 168 vs. 1.18 cfu/mg, P < 0.001) and only DP excreted EPEC efa1/lifA (+) [14/52 DP (27%) vs. 0/25 DN and 0/21 HI; P < 0.001]. When compared with DP EPEC efa1/lifA (-), DP EPEC efa1/lifA (+) had a longer median duration of illness (3 days vs. 1 days, P < 0.05); more likely to be hematopoietic stem cell transplant recipients [7/14 (50%) vs. 7/38 (18%), P < 0.05] and had a higher EPEC eaeA fecal burden (median 3885 vs. 84 cfu/mg, P < 0.05). Co-infections with other pathogens were equally represented in efa1/lifA (−) and efa1/lifA (+) DP subgroups [8/14 (57%) vs. 21/38 (55%) P = NS]. CONCLUSION: Most EPEC in cancer patients with diarrhea are aEPEC acquired in the community and when carrying efa1/lifA (+), are associated with more severe disease. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6254949 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62549492018-11-28 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea Okhuysen, Pablo Olvera, Adilene Carlin, Lily Open Forum Infect Dis Abstracts BACKGROUND: Biofire FilmArray multiplexed nucleic acid amplification tests (NAAT) for bacterial diarrhea include probes specific for EPEC. However, the platform does not differentiate typical EPEC (tEPEC, defined as carrying eaeA and bfp) which have strong epidemiologic associations with diarrhea from atypical EPEC (aEPEC, carrying eaeA but not bfp) for which there is a weaker association. Nevertheless, emerging data suggest that aEPEC subsets carrying efa1/lifA which encodes for adherence factor 1/lymphocyte inhibitory factor A, are associated with diarrhea. The role of EPEC and its subtypes as agents of bacterial diarrhea have not been well defined in immunosuppressed and cancer patients. METHODS: We characterized EPEC subtypes in stools from healthy individuals with no diarrhea (HI, N = 21), cancer patients with diarrhea and negative NAAT (DN, N = 25) and patients with diarrhea positive NAAT for EPEC (DP, N = 54). EPEC isolated from stool cultures were tested for eaeA and bfp, stx and other E. coli pathotypes. We estimated the number of fecal EPEC using a qPCR for eaeA, efa1/lifA that detected 5.6 × 10(1) to 5 × 10(7) cfu/mg of stool. RESULTS: Demographic characteristics and underlying malignancy were similar between DN and DP groups. DP were more likely to have diarrhea on admission than DN [46/52 (88%) vs. 13/25 (52%), P < 0.01]. Stool cultures confirmed EPEC in 24/52 (60%) DP of which 23/24 (96%) were aEPEC. Fecal qPCR for eaeA confirmed EPEC in 43/52 (83%) of DP, 0/25 DN and in 3/21 (14%) of HI (P < 0.001). DP excreted a higher number of EPEC cfu/mg of stool than HI (median 168 vs. 1.18 cfu/mg, P < 0.001) and only DP excreted EPEC efa1/lifA (+) [14/52 DP (27%) vs. 0/25 DN and 0/21 HI; P < 0.001]. When compared with DP EPEC efa1/lifA (-), DP EPEC efa1/lifA (+) had a longer median duration of illness (3 days vs. 1 days, P < 0.05); more likely to be hematopoietic stem cell transplant recipients [7/14 (50%) vs. 7/38 (18%), P < 0.05] and had a higher EPEC eaeA fecal burden (median 3885 vs. 84 cfu/mg, P < 0.05). Co-infections with other pathogens were equally represented in efa1/lifA (−) and efa1/lifA (+) DP subgroups [8/14 (57%) vs. 21/38 (55%) P = NS]. CONCLUSION: Most EPEC in cancer patients with diarrhea are aEPEC acquired in the community and when carrying efa1/lifA (+), are associated with more severe disease. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254949/ http://dx.doi.org/10.1093/ofid/ofy210.935 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Okhuysen, Pablo Olvera, Adilene Carlin, Lily 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea |
title | 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea |
title_full | 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea |
title_fullStr | 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea |
title_full_unstemmed | 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea |
title_short | 1100. Characterization of Enteropathogenic Escherichia coli (EPEC) in Cancer Patients With Diarrhea |
title_sort | 1100. characterization of enteropathogenic escherichia coli (epec) in cancer patients with diarrhea |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254949/ http://dx.doi.org/10.1093/ofid/ofy210.935 |
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