The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition

Diarrheal disease is still the most prevalent and important public health problem in developing countries, despite advances in knowledge, understanding, and management that have occurred over recent years. Diarrhea is the leading cause of death in children under 5 years of age. The impact of diarrheal diseases is more severe in the earliest periods of life, when taking into account both the numbers of episodes per year and hospital admission rates. This narrative review focuses on one of the major driving forces that attack the host, namely the enteropathogenic Escherichia coli (EPEC) and the consequences that generate malnutrition in an early phase of life. EPEC serotypes form dense microcolonies on the surface of tissue-culture cells in a pattern known as localized adherence (LA). When EPEC strains adhere to epithelial cells in vitro or in vivo they cause characteristic changes known as Attaching and Effacement (A/E) lesions. Surface abnormalities of the small intestinal mucosa shown by scanning electron microscopy in infants with persistent diarrhea, although non-specific, are intense enough to justify the severity of the clinical aspects displayed in a very young phase in life. Decrease in number and height of microvilli, blunting of borders of enterocytes, loss of the glycocalyx, shortening of villi and presence of a mucus pseudomembrane coating the mucosal surface were the abnormalities observed in the majority of patients. These ultrastructural derangements may be due to an association of the enteric enteropathogenic agent that triggers the diarrheic process and the onset of food intolerance responsible for perpetuation of diarrhea. An aggressive therapeutic approach based on appropriate nutritional support, especially the utilization of human milk and/or lactose-free protein hydrolyzate-based formulas and the adequate correction of the fecal losses, is required to allow complete recovery from the damage caused by this devastating enteropathogenic agent

Study of microflora in well-nourished and mal-nourished children in relation to dental caries.

Forty-five children in the age group of 2-12 years comprising 20 well-nourished (W.N.), 20 malnourished (M.N.) (both groups having DMFS of > or = 5) and 5 caries free well nourished children (control group) were studied to find out the oral microflora in these groups S. mutans was present in 55%, 20% and 0% in W.N., M.N., and control groups while S. Salivarius was isolated in 45%, 80% and 40% in the three groups respectively. There was no significant difference in the prevalence of Lactobacillus and C. albicans in the three groups. The correlation between means DMFS and the prevalence of S. mutans in W.N. and M.N. groups was highly significant (P < 0.001). Nutritional status including different grades of malnutrition had no significant bearing on the prevalence of micro-organisms isolated. The caries prevalence was higher in the W.N. group (P) while the gingival index was higher in M.N. group.

Bacterial flora in malnourished children

in an attempt to find out the relation between malnutrition and bacterial flora. This work had been carried out on 40 children: 22 of them were manlnourished and 18 control. 280 samples were taken from mouth, ear, nose, skin, anal canal, anterior urethral meatus and conjunctiva of each of them. This study showed that the body flora of malnourished children differs from that of control case at certain sites of isolation with predominance of pathogenic and opportunistic pathogenic organism in malnourished children which may be the source of fulminating infections known to affect these children