Journal Article

Association of Enterotoxigenic <i>Bacteroides fragilis</i> Infection with Inflammatory Diarrhea

Cynthia L. Sears, Salequl Islam, Amit Saha, Maleka Arjumand, Nur Haque Alam, A. S. G. Faruque, M. A. Salam, Jai Shin, David Hecht, Andrej Weintraub, R. Bradley Sack and Firdausi Qadri

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 6, pages 797-803
Published in print September 2008 | ISSN: 1058-4838
Published online September 2008 | e-ISSN: 1537-6591 | DOI:
Association of Enterotoxigenic Bacteroides fragilis Infection with Inflammatory Diarrhea

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Background.Diarrheal illnesses remain a leading cause of morbidity and mortality globally, with increasing recognition of long-term sequelae, including postinfectious irritable bowel syndrome and growth faltering, as well as cognitive deficits in children. Identification of specific etiologic agents is often lacking. In vitro and in vivo data suggest that enterotoxigenic Bacteroides fragilis (ETBF) may contribute to the burden of colonic inflammatory diarrheal disease. The study goal was to investigate the pathogenesis of ETBF diarrheal illnesses.

Methods.We performed an observational study of children and adults with acute diarrheal illnesses in Dhaka, Bangladesh, from January 2004 through November 2005, to define the clinical presentation, intestinal inflammatory responses, and systemic and intestinal antibody responses to ETBF. Other enteric pathogens were also evaluated.

Results.ETBF was identified to cause a clinical syndrome with marked abdominal pain and nonfebrile inflammatory diarrhea in both children (age, >1 year) and adults. Fecal leukocytes, lactoferrin, and proinflammatory cytokines (interleukin 8, tumor necrosis factor–α)—as well as B. fragilis toxin systemic antitoxin responses—increased rapidly in ETBF-infected patients. Evidence of intestinal inflammation often persisted for at least 3 weeks, despite antibiotic therapy.

Conclusions.ETBF infection is a newly recognized cause of inflammatory diarrhea in children and adults. Future studies are needed to evaluate the role of ETBF in persistent colonic inflammation and other morbid sequelae of acute diarrheal disease.

Journal Article.  5034 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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