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Concomitant enterotoxigenic Escherichia coli infection induces increased immune responses to Vibrio cholerae O1 antigens in patients with cholera in Bangladesh.

Journal article
Authors Fahima Chowdhury
Yasmin A Begum
Mohammad Murshid Alam
Ashraful I Khan
Tanvir Ahmed
M Saruar Bhuiyan
Jason B Harris
Regina C LaRocque
Abu S G Faruque
Hubert Endtz
Edward T Ryan
Alejandro Cravioto
Ann-Mari Svennerholm
Stephen B Calderwood
Firdausi Qadri
Published in Infection and immunity
Volume 78
Issue 5
Pages 2117-24
ISSN 1098-5522
Publication year 2010
Published at Institute of Biomedicine
Pages 2117-24
Language en
Keywords Adolescent, Adult, Antibodies, Bacterial, blood, Antigens, Bacterial, immunology, Bangladesh, Child, Child, Preschool, Cholera, complications, immunology, Enterotoxigenic Escherichia coli, immunology, Escherichia coli Infections, complications, immunology, Female, Humans, Infant, Male, Vibrio cholerae O1, immunology, Young Adult
Subject categories Microbiology in the medical area


Vibrio cholerae O1 and enterotoxigenic Escherichia coli (ETEC) are major bacterial pathogens that cause dehydrating disease requiring hospitalization of children and adults. The cholera toxin (CT) produced by V. cholerae O1 and the heat-labile toxin (LT) and/or heat-stable toxin (ST) of ETEC are responsible for secretory diarrhea. We have observed that about 13% of hospitalized diarrheal patients are concomitantly infected with V. cholerae O1 and ETEC. In order to understand the outcome of such dual infections on the clinical and immunological responses in cholera patients, we studied patients infected with V. cholerae O1 (group VC; n = 25), those infected with both V. cholerae O1 and ETEC (group VCET; n = 25), and those infected with ETEC only (group ET; n = 25). The VCET group showed more severe dehydration and had a higher intake of intravenous fluid and more vomiting than the ETEC group (P = 0.01 to 0.003). The VCET patients showed higher vibriocidal responses and increased antibody titers to cholera toxin and lipopolysaccharide (LPS) in plasma than did the V. cholerae O1 patients (P = 0.02 to <0.001). All responses in the V. cholerae O1 and in the VCET groups were more robust than those seen in the group infected with ETEC only (P = 0.01 to <0.001). We thus show that concomitant colonization with ETEC induces immune responses to V. cholerae antigens that are more robust than those seen with V. cholerae O1 infection alone. It is possible that LT or other factors expressed by ETEC may play a role as a mucosal adjuvant in enhancing the immune responses to V. cholerae O1.

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