The prevalence was greatest for EPEC. However, comparison of its prevalence with control children did not show any significant association of EPEC with diarrhoea. It is believed that EPEC would be associated with diarrhoea in

children up to two years of age only [13]. Comparison of prevalence of EPEC in children up to two years of age Proteasome assay also did not show significant difference between patients and controls. Other categories of DEC were present only in a small number of patients; none of the controls harboured these organisms. E. coli colony pools from some children were initially positive for a DEC. But a DEC could not be detected on subsequent testing of individual colonies. It is likely that DEC were present in very small numbers in these cases that were not detected on screening Selleck BMN 673 of individual colonies. Thus, PCR screening of entire bacterial growth from a plate is superior to other methods of detection of pathogens when the pathogens are swamped by normal flora. Thus, this case-control study suggested that DEC are not epidemiologically associated with Kuwaiti children hospitalised for diarrhoea. Nevertheless,

these organisms could still cause diarrhoea in some individual patients. In the previous study conducted in children in Kuwait, the prevalence of ETEC was 9% and EPEC 7% [3]. Compared to that study, the prevalence of ETEC was lower and that of EPEC was similar in the current study.

In studies of childhood diarrhoea from the surrounding region, varying prevalence for DEC was observed. In children in Egypt, ETEC contributed to a heavy burden of diarrhoea accounting for 1.5 episodes per child per year [14]. In a study conducted Tobramycin in Tehran, Iran [15], the prevalence of different categories of DEC varied from 7.3% to 44.5% in diarrhoeal cases. In a case-control study of diarrhoea in Tunisian children [16], both cases and controls had a high prevalence of DEC (up to 37%) making an association with diarrhoea difficult. In Bedouin infants in Southern Israel, the prevalence of various categories of DEC varied from 0.2% to 25.9%, but ETEC was the only pathotype significantly associated with diarrhoea [17]. EPEC are classified into two types. Type I or typical EPEC are positive for both eae gene and bfp gene and mostly belong to the traditional serotypes. Type II or atypical EPEC are positive for eae gene only and belong to non-traditional serotypes [18]. In several recent studies [7, 19–24], the prevalence of atypical EPEC seems to be on the rise. It is now considered to be an emerging pathogen.