Detection of enterotoxigenic E-coli in hospitalised children with and without diarrhoea in Blantyre, Malawi

Background: Enterotoxigenic E. coli (ETEC) is an important cause of diarrhoea among children in developing countries. The burden of ETEC infection was investigated for the first time in children in Malawi. Methods: Faecal samples obtained from children <5 years of age hospitalised with diarrhoea in Blantyre, Malawi over a 10-year period (1997-2007) before introduction of the rotavirus vaccine were examined by PCR for ETEC heat-labile (LT) and heat-stable (STh and STp) enterotoxins. Children hospitalised without diarrhoea were enrolled over a 2-year period as a comparison group. Results: ETEC was detected in 205 (10.6%) of 1941 children with diarrhoea. The most prevalent toxin type was STh (6.6%), followed by LT (2.1%) and STp (0.9%). ETEC infection was most prevalent in infants aged 6-11 months. Co-infection with rotavirus was common. ETEC was detected in 37 (7.3%) of 507 children without diarrhoea. Conclusion: The burden of ETEC infection in young Malawian children is substantial and should become a focus of diarrhoea prevention efforts in the post-rotavirus vaccine era.