Diarrheagenic Escherichia coli in Human Immunodeficiency Virus (HIV) Pediatric Patients in Lima, Perú

Anicia M. Medina Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Fulton P. Rivera Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Liliana M. Romero Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Lenka A. Kolevic Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Maria E. Castillo Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Eduardo Verne Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Roger Hernandez Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Yovanna E. Mayor Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Francesca Barletta Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Erik Mercado Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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Theresa J. Ochoa Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectology, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, Hospital Nacional Cayetano Heredia, Lima, Peru; Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas

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We conducted a prospective study in three hospitals in Lima in human immunodeficiency virus (HIV) children to determine the frequency of diarrheagenic Escherichia coli. Five E. coli colonies/patients were studied by a multiplex real-time polymerase chain reaction to identify the six currently recognized groups of diarrhea-associated E. coli. We have analyzed 70 HIV-associated diarrheal and 70 control samples from HIV-infected children without diarrhea. Among the diarrheal episodes 19% were persistent, 3% dysenteric, and 33% were associated with moderate or severe dehydration. The diarrheagenic E. coli were the most commonly isolated pathogens in diarrhea (19%) and control samples (26%) (P = 0.42), including enteroaggregative (6% versus 10%), enteropathogenic (6% versus 10%), and enterotoxigenic E. coli (4% versus 3%), respectively. The HIV-infected children with diarrhea had the worse age-related immunosuppression, higher viral loads, and were on highly active antiretroviral treatment (HAART) less often than HIV-infected children without diarrhea. Diarrheagenic E. coli were highly resistant to ampicillin (74%) and cotrimoxazole (70%).

Author Notes

*Address correspondence to Theresa J. Ochoa, Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 31, Perú. E-mail: Theresa.J.Ochoa@uth.tmc.edu

Financial support: This work was funded by Public Health Service award 1K01TW007405 (T.J.O) from the National Institutes of Health.

Authors' addresses: Anicia M. Medina, Fulton P. Rivera, Liliana M. Romero, Francesca Barletta, Erik Mercado, and Theresa J. Ochoa, Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Perú, E-mails: anim56@hotmail.com, Fulton.Rivera@upch.pe, tecmedmaya@hotmail.com, francescabarletta@yahoo.es, crikme84@yahoo.es, and Theresa.J.Ochoa@uth.tmc.edu. Lenka A. Kolevic and Maria E. Castillo, Instituto Nacional de Salud del Niño, Lima, Perú, E-mails: lkolevic@gmail.com and castilloequal@gmail.com. Eduardo Verne and Roger Hernandez, Hospital Nacional Cayetano Heredia, Lima, Perú, E-mails: eduardo.verne@gmail.com and rogerahd@gmail.com. Yovanna E. Mayor, Hospital Nacional Hipólito Unanue, Lima, Perú, E-mail: yovannamayor@yahoo.com.

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