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a pass between mountain peaks (同)gap
a genus of enteric bacteria

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(山脈の)鞍部(あんぶ),山あい

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/12/14 15:20:25」(JST)

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Enterotoxigenic Escherichia coli (ETEC) is a type of Escherichia coli and the leading bacterial cause of diarrhea in the developing world, as well as the most common cause of travelers' diarrhea.^[1] Insufficient data exist, but conservative estimates suggest that each year, approximately 210 million cases and 380,000 deaths occur, mostly in children, from ETEC.^[2]^[3] A number of pathogenic isolates are termed ETEC, but the main hallmarks of this type of bacteria are expression of one or more enterotoxins and presence of fimbriae used for attachment to host intestinal cells.

Enterotoxins

Enterotoxins produced by ETEC include heat-labile enterotoxin (LT) and heat-stable enterotoxin (ST).^[4]

LT is similar to cholera toxin; it increases the level of cAMP in intestinal cells, and this causes an increase in electrolyte and water excretion (diarrhea).

ST stimulates production of cGMP, also leading to increased fluid excretion and diarrhea.

Mnemonic: Labile like the Air (cAMP), Stable like the Ground(cGMP).

Presentation

Because enterotoxic E. coli strains are non-invasive, they do not cause inflammation. Infection with ETEC can cause profuse watery diarrhea with no blood nor leukocytes and abdominal cramping. Fever, nausea with or without vomiting, chills, loss of appetite, headache, muscle aches and bloating can also occur but are less common.^[5]

Prevention and treatment

There are currently available treatment options against travelers' diarrhea, specifically against illness due to cholera. To date, no vaccines have been approved to specifically target ETEC.^[6] Data from natural history studies of ETEC infections in children in developing countries suggest that immunization against ETEC early in life may be an effective preventive strategy.^[7] Prevention through vaccination is a critical part of the strategy to reduce the incidence and severity of diarrheal disease due to ETEC, particularly among children in low-resource settings. The development of a vaccine against this infection has been hampered by technical contraints, insufficient support for coordination, and a lack of market forces for research and development. Most vaccine development efforts are taking place in the public sector or as research programs within biotechnology companies. Several vaccine candidates against ETEC are currently in various phases of research and development, including a number of ongoing clinical trials.^[8] The World Health Organization recommends further research into the development of a vaccine against ETEC.^[1]

Treatment for ETEC infection includes rehydration therapy and antibiotics, although ETEC is frequently resistant to common antibiotics.^[5] Improved sanitation is also key, since the transmission of this bacterium is fecal contamination of food and water supplies, one way to prevent infection is by improving public and private health facilities. Another simple prevention of infection is by drinking factory bottled water, this is especially important for travelers and traveling military.

References

^ ^a ^b World Health Organization. Enterotoxigenic Escherichia coli (ETEC).
^ Gupta, SK; Keck J, Ram PK, et al. (2008). "Analysis of Data Gaps Pertaining to Enterotoxigenic Escherichia coli Infections in Low and Medium Human Development Index Countries, 1984-2005". Epidemiology and Infection 136 (6): 721–738. doi:10.1017/S095026880700934X.
^ World Health Organization. Institute for Vaccine Research. Enterotoxigenic escherichia coli (ETEC).
^ Qadri, F.; Svennerholm, A. M.; Faruque, A. S. G.; Bradley Sack, R. (2005). "Enterotoxigenic Escherichia coli in Developing Countries: Epidemiology, Microbiology, Clinical Features, Treatment, and Prevention". Clinical Microbiology Reviews 18 (3): 465–483. doi:10.1128/CMR.18.3.465-483.2005. PMID 16020685.
^ ^a ^b US Centers for Disease Control and Prevention. Enterotoxigenic Escherichia coli (ETEC)
^ World Health Organization. "nterotoxigenic Escherichia coli (ETEC)". http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index4.html#Introduction. Retrieved 2 May 2012.
^ Girard, M.; Steele, D.; Chaignat, C. L.; Kieny, M. P. (2006). "A review of vaccine research and development: human enteric infections". Vaccine 24 (15): 2732–2750. doi:10.1016/j.vaccine.2005.10.014. PMID 16483695.
^ PATH, bvgh (March 2011). The Case for Investment in Enterotoxigenic Escherichia coli Vaccines. http://www.path.org/publications/files/VAC-etec-investment-rpt.pdf. Retrieved 2 May 2012.

External links

Centers for Disease Control and Prevention: Enterotoxigenic Escherichia coli
Vaccine Resource Library: Shigellosis and enterotoxigenic Escherichia coli (ETEC)
World Health Organization: Enterotoxigenic Escherichia coli

UpToDate Contents

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1. 病原性大腸菌 pathogenic escherichia coli
2. 旅行者下痢症 travelers diarrhea
3. 発展途上国における成人の急性下痢に対するアプローチ approach to the adult with acute diarrhea in developing countries
4. 微生物による食中毒疾患の鑑別診断 differential diagnosis of microbial foodborne disease
5. 先進国における急性下痢の疫学および原因 epidemiology and causes of acute diarrhea in developed countries

English Journal

Distribution of Classical and Non-Classical Virulence Genes in Enterotoxigenic Escherichia coli Isolated from Chilean Children and tDNA Screening for Putative Insertion Sites for Genomic Islands.

Del Canto F, Valenzuela P, Cantero L, Bronstein J, Blanco JE, Blanco J, Prado V, Levine M, Nataro J, Sommerfelt H, Vidal R.SourceFacultad de Quimica y Biologia, Departamento de Biologia, Universidad de Santiago de Chile.
Journal of clinical microbiology.J Clin Microbiol.2011 Jul 20. [Epub ahead of print]
Enterotoxigenic Escherichia coli (ETEC) are an important cause of diarrhea. Three adhesins (Tia, TibA, EtpA), an iron acquisition system (Irp1, Irp2 and FyuA), a GTPase (LeoA) and an autotransporter (EatA) are ETEC virulence-related proteins that, in contrast to the classical virulence factors (ente
PMID 21775541

The heat-resistant agglutinin family includes a novel adhesin from enteroaggregative Escherichia coli strain 60A.

Mancini J, Weckselblatt B, Chung YK, Durante JC, Andelman S, Glaubman J, Dorff JD, Bhargava S, Lijek RS, Unger KP, Okeke IN.SourceDepartment of Biology, Haverford College, PA 19041, USA.
Journal of bacteriology.J Bacteriol.2011 Jul 15. [Epub ahead of print]
Heat-resistant agglutinin 1 (Hra1) is an accessory colonization factor of enteroaggregative Escherichia coli (EAEC) strain 042. Tia, a close homolog of Hra1, is an invasin and adhesin that has been described in enterotoxigenic E. coli. We devised a PCR-restriction fragment length polymorphism screen
PMID 21764925

Japanese Journal

Vibrio parahaemolyticus, enterotoxigenic Escherichia coli, enterohemorrhagic Escherichia coli and Vibrio cholerae

TAKEDA Yoshifumi
Proceedings of the Japan Academy, Series B 87(1), 1-12, 2011
… Vibrio parahaemolyticus, especially on its cardiotoxicity, (ii) heat-labile and heat-stable enterotoxins produced by enterotoxigenic Escherichia coli, especially structure–activity relationship of heat-stable enterotoxin, (iii) RNA N-glycosidase activity of Vero toxins (VT1 and VT2) produced by enterohemorrhagic Escherichia coli O157:H7, (iv) discovery of Vibrio cholerae O139, (v) isolation of new variant of Vibrio cholerae O1 El Tor that …
NAID 130000442362