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Bonkoungou et al., Afr., J. Infect. Dis. (2021) 15(1): 53-58
https://doi.org/10.21010/ajid v15i1.7
53
DETECTION OF DIARRHEAGENIC ESCHERICHIA COLI IN HUMAN DIARRHEIC STOOL AND
DRINKING WATER SAMPLES IN OUAGADOUGOU, BURKINA FASO.
Isidore Juste Ouindgueta Bonkoungou1*, Namwin Siourimè Somda2,Oumar Traoré1,3, Barthelemy
Sibiri Zoma4,5 Zakaria Garba1,6, Koine Maxime Drabo7, Nicolas Barro1.
1Département de Biochimie-Microbiologie. UFR- Sciences de la vie et de la terre. Université Joseph Ki-Zerbo, 03 BP
7021 Ouagadougou 03, Burkina Faso. 2Département Technologie Alimentaire (DTA) / IRSAT / CNRST, Burkina Faso,
03 BP 7047 Ouagadougou 03. 3Unité de Formation et de Recherche en Sciences Appliquées à la Technologie
(UFR/SAT). Université de Dédougou, BP 176 Dédougou. 4Laboratoire National de Santé Publique (LNSP), 09 BP 24
Ouagadougou 09, Burkina Faso.5Polygon Bio Services SARL,09 BP 969 Ouagadougou 09, Ouagadougou, Burkina
Faso 969. 6Unité de Recherche Clinique de NANORO, IRSS-CNRST, BP: 218 Ouaga 11 Burkina Faso, 7Institut de
Recherche en Sciences de la santé, CNRST, 03 B.P. 7192 Ouagadougou 03 Burkina Faso,
*Corresponding author E-mail: ouindgueta@gmail.com
Abstract
Background: The presence of diarrheagenic Escherichia coli (DEC) in drinking water, is a grave public health
problem. This study was aimed at characterization of diarrheagenic Escherichia coli isolated from drinking water and
faecal samples from diarrheic patients in Ouagadougou, Burkina Faso.
Materials and Methods: A total of 242 water samples consisting of 182 potable sachets and 60 from boreholes were
collected in the period between October 2018 and April 2019 in the city of Ouagadougou. Faecal samples were also
collected from 201 diarrheic patients visiting National Public Health Laboratory for a biological diagnosis by
coproculture. The presence of virulence genes associated with DEC was determined by 16-plex polymerase chain
reaction from bacteria culture.
Results: From drinking water, we found 17% (42/242) Escherichia coli isolates in which 1% (2/242) DEC were
detected. Among analyzed samples (182 sachet water versus 60 borehole water), the two DEC (01 ETEC and 01 EPEC)
were detected in sachet water. DEC were detected in 20% (40/201) of patients. Enteroaggregative Escherichia coli
(EAEC) were mostly detected in 10% followed by Enteropathogenic Escherichia coli (EPEC) in 4%, Enteroinvasive
Escherichia coli (EIEC) in 2%, and Shiga toxin-producing Escherichia coli (STEC) 0.5%. However, Enterotoxigenic
Escherichia coli (ETEC) was not detected alone, but in co-infections with EAEC.
Conclusion: The present study documented the prevalence of Escherichia coli pathovars associated in patients with
diarrhea, and shows that drinking water might be a source of DEC transmission in human.
Keywords: 16-plex PCR; drinking water; diarrhoeagenic Escherichia coli; Burkina Faso.
List of Abbreviations: DEC = Diarrheagenic Escherichia coli., LNSP = National Public Health Laboratory
BF = Burkina Faso., BICC = Cervel Heart Infusion Broth, EAEC =Enteroaggregative Escherichia coli, EPEC =
Enteropathogenic Escherichia coli, ETEC = Enterotoxigenic Escherichia coli, STEC = Shiga toxin-producing
Escherichia coli, EIEC = Enteroinvasive Escherichia coli, PCR = polymerase chain reaction
Introduction
Diarrheal diseases are among the main causes of morbidity and mortality in Africa and mainly affect children
under 5 years old (Adjuik et al., 2006). They are usually caused by at least one bacterial, viral or parasitic agent. These
infections are often linked to non-compliance with the conditions of good hygiene practices during foods processing
and especially poor quality of drinking water. According to World Health Organization (WHO), better access to
drinking water is a key factor in the reduction of diarrheal diseases. However, access to water is poor the cities of sub-
Saharan Africa where only 20% of the population is supplied by an unimproved source of water (Aubry and Gaüzère,
Article History
Received: July 21st 2020
Revised Received: Nov. 30th 2020
Accepted: Dec. 1st 2020.
Published Online: Dec. 14th 2020
54
2012). Water sources can be investigated for detection of fecal contamination; high fecal levels can mean that water
contains pathogens by testing for the presence of Escherichia coli (Cowan, 2018). Escherichia coli is a member of the
faecal coliform group that is mostly considered as a specific indicator of faecal pollution. They are normally found in
the feces of humans or other warm-blooded animals. Most strains of Escherichia coli are harmless, and their presence
in the water only suggests that faecal contamination may have occurred and that disease-causing organisms may be
present (Aubry and Gaüzère, 2012). According to their virulence properties, symptoms of the disease that they cause,
species and age group wherethey are found, Escherichia coli is classified into: enteropathogenic E. coli (EPEC),
enterotoxigenic E. coli (ETEC), Shiga toxin-producing E. coli (STEC), enteroinvasive E. coli (EIEC) and
enteroaggregative E. coli (EAEC) being the most important (Kaper et al., 2004). Presence of DEC in drinking water
has been mentioned by previous studies (Hunter, 2003) and all are known to be endemic in essentially all developing
countries (Jafari et al., 2012). Its presence is therefore important to assess the prevalence of diarrheal diseases and
identify the associated risk factors, in particular, those linked to the consumption of water and sanitation. Over the past
decade, researchers have focused studies on Escherichia coli pathovars of clinical and environmental origin, which are
responsible for diarrhea in children under 5 years old and adults in Burkina Faso (Bonkoungou et al., 2011; Kagambèga
et al., 2013; Somda et al., 2017). However, up to date, no study to our knowledge has characterized the Escherichia
coli pathovars in drinking water, in order to establish the role of drinking water in development of diarrhea diseases in
Burkina Faso.
In this study, virulence genes of DEC were detected in drinking water for the first time in Burkina Faso
through potable sachets and boreholes water. Also, DEC prevalence were investigated in stools samples from diarrheic
patients in the same city (Ouagadougou), Burkina Faso.
Materials and Methods
Sample collection
In this study, sampling considered the fact that potable sachets and boreholes water have emerged as an
alternative source of drinking water in the capital city, Ouagadougou in Burkina Faso. We included stool samples in
order to update DEC prevalence in the area and during the period of drinking water sampling.
The study was conducted at the National Public Health Laboratory (LNSP) in the capital city of Ouagadougou,
Burkina Faso. LNSP is a multidisciplinary institute with the following departments: Environment, Food, Drugs and
Medical Biology departments.
This study was part of LNSP routine activities in which diarrheic stool samples were collected from patients
visiting the Medical Biology department for a biological diagnosis by coproculture prescribed by a health worker as
described in our previous study (Somda et al., 2017). Stool samples were collected from October 2018 to April 2019
from 201 patients visiting a health worker due to gastroenteritis. All samples used in this study had been anonymized
and made untraceable before storage. The study received permission from the LNSP authorities of Burkina Faso and
verbal informed consent was acquired from patients or parents/legal guardian prior to enrollment.
For drinking water, a total of 242 samples from LNSP’s Environment Control Department collected during
routine analysis (from October 2018 to April 2019) of drilling water and sachet water were included. Samples of sachet
water were taken randomly in their original packaging on the storage site according to LNSP water routine activities
sampling plan and sent to the laboratory for analysis. The sampling of drilling (borehole) water was exhaustive,
involving all the companies which were the subject of a quality control request. The samples were taken directly at the
source in an aseptic manner in sterile bottles, placed in coolers, and sent immediately to the laboratory for analysis.
Microbiological analysis
Drinking water samples: The membrane filtration method was used: 100 ml of drilling water and 250 ml of sachet
water were homogenized and filtered through a cellulose nitrate filtration membrane with a porosity of 0.45 µm and
then placed on an Extra Selective Chromocult Agar and incubated at 37° C for 24 hours. After incubation, suspected
colonies (dark blue to purple) were scraped with sterile Pasteur pipette and put in sterile cryotubes containing brain-
heart infusion broth added 15% glycerol and conserved at -20° C for molecular analysis.
Clinical samples: All collected stool samples were cultured on MacConkey Sorbitol agar (HIMEDIA, M298I-500G,
India) and incubated at 37° C for 24 hours. After incubation, bacterial mass was scraped using steriled Pasteur pipette
and put in sterile cryotubes containing Cervel Heart Infusion Broth (BICC) added 15% glycerol and conserved at -20°
C for E. coli pathovars detection.
16-plex PCR assay
DEC pathovars Shiga toxin-producing Escherichia coli, Enteropathogenic Escherichia coli, Enterotoxigenic
Escherichia coli, Enteroinvasive Escherichia coli, and Enteroaggregative Escherichia coli (STEC, EPEC, ETEC, EIEC,
and EAEC) were detected by using 16-plex PCR technique as described by (Antikainen et al., 2009). Principal genes
detected were uidA, pic, bfp, invE, elt, ent, escV, aggR, stx1, stx2, estIa, estIb, and ast (Müller et al., 2007), hlyA
55
(Antikainen et al., 2009), eaeA (Vidal et al., 2005), ipaH (Brandal et al., 2007)using specific primers as previously
described (Bonkoungou et al., 2011; Somda et al., 2017).
Extraction: DNA was extracted by thermal shock. For this, suspected colonies stored at -30 °C were transplanted on a
MacConkey Sorbitol agar and incubated at 37° C for 18 to 24 hours. After incubation time, with a sterile loop, a
bacterial mass was added to 250 μL of sterile distilled water and heated to 100º C for 10 min and centrifuged (11337g
for 10 min). The supernatant was then collected in a new sterile 1.5 ml Eppendorf tube and stored at -20 °C for
molecular studies.
Amplification: PCR was performed by using optimized ready-to-use PCR master mix (Solis Biodyne) with 16 primers
pairs listed above in a single PCR reaction, as described previously (Bonkoungou et al., 2011; Somda et al., 2017). The
criteria to determine DEC were as described previously (Bonkoungou et al., 2011; Somda et al., 2017)
Electrophoresis: The five E. coli pathovars were determined by their specific size on 2% agarose gel and visualized
under UV light after staining with ethidium bromide. Reference strains and previous studies isolated as used as positive
controls strains as described previously (Bonkoungou et al., 2011; Somda et al., 2017). Distilled water was used as
negative control. Single PCRs were used to confirm all PCR positive results.
Data analysis: All data were stored and analyzed using Excel 2016 software.
Results
Quality of drinking water and and prevalence of DEC
A total of 17% (42/242) E. coli isolates were isolated from drinking water among analyzed samples (182
sachet water versus 60 drilling water). Out of 42 E. coli, 24 (13%) were from sachet water and 18 (30%) from drilling
water.
Of 42 isolates analyzed, 2 (1%) DEC were detected as 1 EPEC and 1 ETEC. All 2 DEC were from water in
sachet.
E. coli was more prevalent in drilling water than sachet water (30% versus 13%) but no DEC was detected in drilling
water (figure 1).
Distribution of diarrheal stool samples collected and prevalence of DEC
Out of 201 stools analyzed, 105 samples (52 %) were from male patients. Stratified by age, 90 samples (45 %)
were from children under 5 years old, 30 samples (15 %) were from patients aged between 6 and 18 years old, and 81
samples (40%) were from patients over 18 years old.
Out of 201 stool samples analyzed, a total 40 DEC (20%) were detected. All the 5 pathovars were detected
either alone or in coinfections. EAEC was the most commonly detected 10 % (21/201) following by EPEC 4% (08/201),
EIEC 2 % (05/201) and STEC 1 % (01/201). However, ETEC were not detected alone, but in co-infections with others
pathovars. More than one DEC was detected in 5 samples (2%). (Table 1).
Prevalence of diarrheal Escherichia coli according age and sex
Out of 40 DEC detected, 17% (18/105) were from males and 23% (22/96) were from females. Of the 40 DEC
detected 26 (29 %) were from children under 5 years old, 9 (30 %) in patients aged between 6 and 18 years old, and 5
(6%) from patients over age 19 years old. Among the 26 cases detected in children under 5 years, the composition was
as follows: EAEC, 14 %; EPEC, 7%; EIEC, 3 %; STEC, 1 %; and 3 co-infections EAEC + ETEC, EAEC+ STEC,
EAEC+EPEC at 1 % in each of the cases (Table 1). In patients aged between 6 and 18 years old, EAEC were found in
17% followed by EPEC in 7%, EIEC in 3%, and 3% of 1 co-infection of EAEC+EIEC. Among patients aged over 19
years old, EAEC were detected in 4% followed by EIEC in 1% and 1% of co-infection of EAEC+STEC.
Table 1: Distribution of the different DECs detected according to age
Pathovars/ages (years)
Ages groups
Total
n=201 (%)
[0 - 5]
n=90 (%)
[6 - 18]
n=30 (%)
> 19 years n=81
(%)
EAEC
13 (14)
05 (17)
03 (4)
21 (10)
EPEC
06 (7)
02 (7)
00
08 (4)
EIEC
03 (3)
01 (3)
01 (1)
05 (2)
STEC
01 (1)
00
00
01 (1)
EAEC + EIEC
00
01 (3)
00
01 (1)
EAEC + ETEC
01 (1)
00
00
01 (1)
EAEC + STEC
01 (1)
00
01 (1)
02 (1)
EAEC + EPEC
01 (1)
00
00
01 (1)
TOTAL
26 (29)
09 (30)
05 (6)
40 (20)
Legend: EAEC = Enteroaggregative Escherichia coli, EIEC = Enteroinvasive Escherichia coli, STEC =
Shigatoxinogenic Escherichia coli, ETEC = Enterotoxinogenic Escherichia coli, EPEC= Enteropathogenic Escherichia
coli, n = number
56
Figure 1: Electrophoresis gel of DEC detection in drinking water
Legend: MP = ladder, bp = base pairs, L1, L2, L4 = positive control, L3 = negative control, L9 = positive to EPEC
(Enteropathogenic Escherichia coli); L10 = positive to ETEC (Enterotoxinogenic Escherichia coli).
Discussion
In this present study, E. coli pathovars were detected in the first time in drinking water in Burkina Faso.
Escherichia coli were isolated in 17% and DEC in 1% of drinking water analyzed. This finding could be because sachet
water is generally packaged and stored in unsanitary conditions, which allows the contamination and proliferation of
bacteria. The lack of safe drinking water is one of the leading causes of death especially in children under 5 years old
(WHO, 2008).
The E. coli pathovars detected in drinking (sachet water) were mainly composed of EPEC and ETEC.
Previous studied in Egypt (Ahmed et al., 2014), Bangladesh (Talukdar et al., 2013) and Brazil (Lascowski et
al., 2013) reported the presence of DEC in drinking water in these countries. In Burkina Faso, packaged water is
generally intended for direct consumption since they have a reputation to be potable. Sachet water is the most
commonly consumed packaged water due to their low prices which made them more affordable than bottled water.
They are often obtained from drilling water, but sometimes obtained from surface water after treatment. It is
supposed to be free of pathogenic germs and therefore suitable for consumption. Nowadays, many sachet water
conditioning companies have emerged in Burkina Faso. However, some owners ignore the rules of good manufacturing
and hygiene practices. Some are produced directly at home without any recipient of hygiene. All these facts could be at
the origin of the contamination of these waters by Escherichia coli diarrhea. Others studies shown that water from
public standpipes, and wells is collected at the source, carried to, and stored in the household affording multiple
opportunities for contamination such that final water quality is often worse than in the associated source (Lascowski et
al., 2013; Hunter, 2003)
The DEC prevalence in patients with diarrhea (20%) was lower than that (45%) found in our previous study in
2011 in Burkina Faso (Bonkoungou et al., 2011; Bonkoungou et al., 2013). Overall, the decrease in DEC cases over the
years in Burkina Faso might be explained by the fact that population has adopted better hygiene measures since the
recent Ebola epidemic in west Africa in 2014. In accordance, other studies carried out elsewhere have shown that these
pathogens are indicators of poor compliance to hygiene standards (Gomes et al., 2016).
Of the patients participating in this study, children under the age of 5 years were the most likely to have
diarrhea caused by DEC, 65% (26/40) of total DEC. This observation might be explained by the weak immune system
in children and supporting the well-documented role of DEC in childhood diarrhea in Burkina Faso (Bonkoungou et al.,
2011; Bonkoungou et al., 2013).
In our study, the most frequently detected DEC was EAEC. In recent years, EAEC although specific to
travelers' diarrhea, has mostly been identified as a diarrheal agent causing acute and chronic diarrhea in all age groups
and common infection primarily in newborns and immunocompromised patients (Gomes et al., 2016). In other studies,
EAEC was associated with diarrhea due to malnutrition in children living in developing countries and in HIV patients
(Kaur et al., 2010). Recent studies have shown high prevalence of EAEC in Burkina Faso and elsewhere, for example,
in Gambia and United States (Ikumapayi et al., 2017; Imdad et al., 2018; Konaté et al., 2017; Saka et al., 2019; Somda
et al., 2017). However, some studies have reported that EAEC is not associated with diarrhea (Bonkoungou et al., 2011;
Hien et al., 2008; Keskimäki et al., 2000), and that EAEC was probably endemic among people in local communities
and might not be a primary cause of diarrhea.
EPEC was found in 4% and only detected in children ≤ 5 years old. The EPEC prevalence was lower than
previous study in Burkina Faso (Bonkoungou et al., 2011; Bonkoungou et al., 2013). It was expected to find EPEC
57
children since it is known that EPEC are the leading cause of infantile diarrhea in developing countries (Trabulsi et al.,
2002). The low prevalence of STEC, 2%, is similar to a previous study in Burkina Faso (Bonkoungou et al., 2011).
Among the samples negative for DEC, other pathogens such as viruses, parasites or bacteria, which were not
investigated in this study might be responsible for diarrhea.
In Burkina, previous studies have reported the detection of ETEC in grilled chickens, cow dung and organic
manure in Burkina Faso (Bako et al., 2017; Kambire et al., 2017; Somda et al., 2018). The similarity of pathovars
found in human stool samples, drinking water, and in cow dung in Burkina Faso could be because the aquatic
environments are contaminated with animal fecal droppings. The use of new technologies such as Next-generation
sequencing will help researchers from developing countries like Burkina Faso to establish routes of transmission for
DEC by sequencing E. coli strains isolated from various samples in the future.
Conclusion
This study detected the presence of DEC, particularly ETEC and EPEC, in both diarrheal stool samples and
drinking water. These results suggest that routinely consumed water, which should be free of pathogens, is a potential
source of DEC contamination in humans with the greatest effect in children under the age of five years. From our
findings, drinking water is a potential source of transmission of DEC in Burkina Faso. Therefore, more effort must be
made by the public health participants involved in one health approach (environment, human and veterinary medicine)
to reduce food and water borne diseases.
Acknowledgement
This study was supported by the University Joseph KI-ZERBO (Burkina Faso), National Public Health
Laboratory in Burkina Faso and by Polygon Bio Services SARL in Burkina Faso. We thank the staff of National Public
Health Laboratory and all patients who participated in this research.
Conflict of interest: None.
Authors’ contributions: IJOB and NSS: Study concept and design, performing laboratory experiments and analysis,
acquisition of data and writing the manuscript. OT, SBZ and ZG: Specimens collection and laboratory experiments.
MKD and NB: study concept and design.
References
1. Adjuik, M., Smith, T., Clark, S., Todd, J., Garrib, A., Kinfu, Y., Kahn, K., Mola, M., Ashraf, A., and Masanja, H.
(2006). Cause-specific mortality rates in sub-Saharan Africa and Bangladesh. Bulletin of the World Health
Organization 84, 181-188.
2. Ahmed, A. M., Shimamoto, T., and Shimamoto, T. (2014). Characterization of integrons and resistance genes in
multidrug-resistant Salmonella enterica isolated from meat and dairy products in Egypt. International journal of
food microbiology 189, 39-44.
3. Antikainen, J., Tarkka, E., Haukka, K., Siitonen, A., Vaara, M., and Kirveskari, J. (2009). New 16-plex PCR
method for rapid detection of diarrheagenic Escherichia coli directly from stool samples. European journal of
clinical microbiology & infectious diseases 28, 899-908.
4. Aubry, P., and Gaüzère, B. (2012). Les maladies liées à l’eau. Médecine tropicale.
5. Bako, E., Kagambèga, A., Traore, K. A., Bagre, T. S., Ibrahim, H. B., Bouda, S. C., Bonkoungou, I. J. O., Kaboré,
S., Zongo, C., and Traore, A. S. (2017). Characterization of Diarrheagenic Escherichia coli Isolated in Organic
Waste Products (Cattle Fecal Matter, Manure and, Slurry) from Cattle’s Markets in Ouagadougou, Burkina Faso.
International journal of environmental research and public health 14, 1100.
6. Bonkoungou, I. J., Damanka, S., Sanou, I., Tiendrébéogo, F., Coulibaly, S. O., Bon, F., Haukka, K., Traoré, A. S.,
Barro, N., and Armah, G. E. (2011). Genotype diversity of group A rotavirus strains in children with acute
diarrhea in urban Burkina Faso, 2008–2010. Journal of medical virology 83, 1485-1490.
7. Bonkoungou, I. J. O., Haukka, K., Österblad, M., Hakanen, A. J., Traoré, A. S., Barro, N., and Siitonen, A. (2013).
Bacterial and viral etiology of childhood diarrhea in Ouagadougou, Burkina Faso. BMC pediatrics 13, 1-6.
8. Brandal, L. T., Lindstedt, B.-A., Aas, L., Stavnes, T.-L., Lassen, J., and Kapperud, G. (2007). Octaplex PCR and
fluorescence-based capillary electrophoresis for identification of human diarrheagenic Escherichia coli and
Shigella spp. Journal of microbiological methods 68, 331-341.
9. Cowan, M. K. (2018). "Microbiology: a systems approach," McGraw-Hill.
10. Gomes, T. A., Elias, W. P., Scaletsky, I. C., Guth, B. E., Rodrigues, J. F., Piazza, R. M., Ferreira, L. C., and
Martinez, M. B. (2016). Diarrheagenic Escherichia coli.brazilian journal of microbiology 47, 3-30.
11. Hien, B. T. T., Scheutz, F., Cam, P. D., Serichantalergs, O., Huong, T. T., Thu, T. M., and Dalsgaard, A. (2008).
Diarrheagenic Escherichia coli and Shigella strains isolated from children in a hospital case-control study in
Hanoi, Vietnam. Journal of clinical microbiology 46, 996-1004.
58
12. Hunter, P. R. (2003). Drinking water and diarrhoeal disease due to Escherichia coli.Journal of water and health 1,
65-72.
13. Ikumapayi, U. N., Boisen, N., Hossain, M. J., Betts, M., Lamin, M., Saha, D., Kwambana-Adams, B., Dione, M.,
Adegbola, R. A., and Roca, A. (2017). Identification of subsets of enteroaggregative Escherichia coli associated
with diarrheal disease among under 5 years of age children from Rural Gambia. The American journal of tropical
medicine and hygiene 97, 997-1004.
14. Imdad, A., Foster, M. A., Iqbal, J., Fonnesbeck, C., Payne, D. C., Zhang, C., Chappell, J. D., Halasa, N., and
Gómez-Duarte, O. G. (2018). Diarrheagenic Escherichia coli and acute gastroenteritis in children in Davidson
County, Tennessee, United States: a case-control study. The Pediatric infectious disease journal 37, 543.
15. Jafari, A., Aslani, M., and Bouzari, S. (2012). Escherichia coli: a brief review of diarrheagenic pathotypes and
their role in diarrheal diseases in Iran. Iranian journal of microbiology 4, 102.
16. Kagambèga, A., Lienemann, T., Aulu, L., Traoré, A. S., Barro, N., Siitonen, A., and Haukka, K. (2013).
Prevalence and characterization of Salmonella enterica from the feces of cattle, poultry, swine and hedgehogs in
Burkina Faso and their comparison to human Salmonella isolates. BMC microbiology 13, 253.
17. Kambire, O., Adingra, A. A., Yao, K. M., and Koffi-Nevry, R. (2017). Prevalence of virulence genes associated
with diarrheagenic pathotypes of Escherichia coli isolates from water, sediment, fish, and crab in Aby Lagoon,
Côte d’Ivoire. International journal of microbiology 2017, 1-8. https: // doi.org/10.1155/2017/9532170
18. Kaper, J. B., Nataro, J. P., and Mobley, H. L. (2004). Pathogenic Escherichia coli.Nature reviews microbiology 2,
123-140.
19. Kaur, P., Chakraborti, A., and Asea, A. (2010). Enteroaggregative Escherichia coli: an emerging enteric food
borne pathogen. Interdisciplinary perspectives on infectious diseases 2010, 1-10. doi:10.1155/2010/254159
20. Keskimäki, M., Mattila, L., Peltola, H., and Siitonen, A. (2000). Prevalence of diarrheagenic Escherichia coli in
Finns with or without diarrhea during a round-the-world trip. Journal of clinical microbiology 38, 4425-4429.
21. Konaté, A., Dembélé, R., Kagambèga, A., Soulama, I., Kaboré, W. A., Sampo, E., Cissé, H., Sanou, A., Serme, S.,
and Zongo, S. (2017). Molecular characterization of diarrheagenic Escherichia coli in children less than 5 years of
age with diarrhea in Ouagadougou, Burkina Faso. European Journal of Microbiology and Immunology 7, 220-228.
22. Lascowski, K., Guth, B., Martins, F., Rocha, S., Irino, K., and Pelayo, J. (2013). Shiga toxin‐producing
Escherichia coli in drinking water supplies of north P araná S tate, B razil. Journal of Applied Microbiology 114,
1230-1239.
23. Müller, D., Greune, L., Heusipp, G., Karch, H., Fruth, A., Tschäpe, H., and Schmidt, M. A. (2007). Identification
of unconventional intestinal pathogenic Escherichia coli isolates expressing intermediate virulence factor profiles
by using a novel single-step multiplex PCR. Applied and environmental microbiology 73, 3380-3390.
24. Saka, H. K., Dabo, N. T., Muhammad, B., García-Soto, S., Ugarte-Ruiz, M., and Alvarez, J. (2019).
Diarrheagenic Escherichia coli Pathotypes From Children Younger Than 5 Years in Kano State, Nigeria.
Frontiers in Public Health 7.
25. Somda, N., Bonkoungou, O., Zongo, C., Kpoda, D., Tapsoba, F., Bassolé, I., Traoré, Y., and Savadogo, A. (2017).
Prevalence of Escherichia coli virulence genes in patients with diarrhoea in Ouagadougou, Burkina Faso. African
Journal of Clinical and Experimental Microbiology 18, 179-185.
26. Somda, N. S., Bonkoungou, O. J., Zongo, C., Kagambèga, A., Bassolé, I. H., Traoré, Y., Mahillon, J., Scippo, M.
L., Hounhouigan, J. D., and Savadogo, A. (2018). Safety of ready‐to‐eat chicken in Burkina Faso:
Microbiological quality, antibiotic resistance, and virulence genes in Escherichia coli isolated from chicken
samples of Ouagadougou. Food science & nutrition 6, 1077-1084.
27. Talukdar, P. K., Rahman, M., Rahman, M., Nabi, A., Islam, Z., Hoque, M. M., Endtz, H. P., and Islam, M. A.
(2013). Antimicrobial resistance, virulence factors and genetic diversity of Escherichia coli isolates from
household water supply in Dhaka, Bangladesh. Plos one 8, e61090.
28. Trabulsi, L. R., Keller, R., and Gomes, T. A. T. (2002). 10.321/eid0805. Typical and Atypical Enteropathogenic
Escherichia coli.Emerging infectious diseases 8, 508.
29. Vidal, M., Kruger, E., Durán, C., Lagos, R., Levine, M., Prado, V., Toro, C., and Vidal, R. (2005). Single
multiplex PCR assay to identify simultaneously the six categories of diarrheagenic Escherichia coli associated
with enteric infections. Journal of clinical microbiology 43, 5362-5365.
30. World Health Organization: Guidelines for Drinking Water Quality. https://
www.who.int/water_sanitation_health/dwq/fulltext. pdf (2008). Accessed on May, 2020.
