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Bacterial diarrhea among infants in developing countries: An overview of diarrheagenic Escherichia coli (DEC)

Many cases of diarrhea are due to an infection in the gastrointestinal tract caused by microorganisms such as bacteria, viruses and parasites. This may be present alone or can be together with different symptoms, such as vomiting, abdominal pain, nausea and weight loss. There is an estimate of 2 billion cases of diarrhea disease globally that happens yearly. Also, approximately 1.9 million children globally below the age of 5 years die from diarrhea every year mostly in the developing countries making it the second leading cause of mortality in children of this age group. Recurring and regular diarrhea can affect growth of children and cognitive development and increase their vulnerability to different communicable diseases. About 89% of diarrhea related deaths are caused by insufficient hygiene, bad water, and inadequate sanitation. Major cause of diarrhea in children is Diarrheagenic Escherichia coli (DEC) which is acquired through water and food that is contaminated. There are 6 main pathotypes:, diffusely adherent E. coli (DAEC), enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), shiga toxin–producing E. coli (STEC),  enteroinvasive E. coli (EIEC), and enteroaggregative E. coli (EAEC).  Adherent invasive E. coli (AIEC) is is the new pathotype that has been recently reported. Biochemical tests, culture and modern methods like Polymerase Chain Reaction are the conventional techniques carried out in the identification of E. coli species. Preventive measures and treatment includes proper sanitation, improved hygeine, access to safe drinking-water, exclusive breastfeeding of the babies for the first 6 months of life, proper rehydration with oral rehydration salts (ORS) or intravenous fluids in case of shock, early hospitalization for children who are extremely malnourished, zinc supplementation, and in some circumstances, the use of antibiotics which should be implemented to reduce the burden of diarrhea among children.