{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:50:37Z","timestamp":1778860237134,"version":"3.51.4"},"reference-count":31,"publisher":"Microbiology Society","issue":"2","license":[{"start":{"date-parts":[[2017,2,28]],"date-time":"2017-02-28T00:00:00Z","timestamp":1488240000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,2,28]]},"abstract":"<jats:p>\n                  <jats:bold>Introduction.<\/jats:bold> Cytolethal distending toxins (CDTs), encoded by <jats:italic>cdt<\/jats:italic> genes, have DNase activity leading to cellular and nuclear distension, resulting in irreversible cell cycle arrest and apoptosis of target cells. <jats:italic>cdt<\/jats:italic>-positive <jats:italic>Escherichia coli<\/jats:italic> strains have been isolated from children with diarrhoea. There is, however, scant information on the prevalence and clinical presentation of diarrhoeal disease caused by these strains. Furthermore, toxin production of <jats:italic>cdt<\/jats:italic>-positive strains is rarely confirmed. We report five young children with diarrhoea caused by CDT-producing <jats:italic>E. coli<\/jats:italic> in whom stools were negative for other bacterial or enteric pathogens.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Case presentation.<\/jats:bold> On admission to hospital, all children presented watery diarrhoea with high stool output (range 7\u201320 stools\/24 h); five had fever of 38 \u00b0C or more and four presented vomiting. Dehydration was present in four patients, one of whom had hypovolaemic shock; one child also presented hyponatraemia and hypokalaemia. In two children, <jats:italic>cdt<\/jats:italic>-positive strains were classified as typical and atypical enteropathogenic <jats:italic>E. coli<\/jats:italic>, and the remaining three harboured <jats:italic>cdt<\/jats:italic>-positive strains that did not belong to any diarrhoeagenic pathogroup. One <jats:italic>cdt<\/jats:italic>-positive strain from each case was characterized by a CDT cytotoxic assay and a <jats:italic>cdt<\/jats:italic> type-specific PCR. All strains produced the characteristic cellular intoxication due to CDT. Two strains carried the <jats:italic>cdt<\/jats:italic>-<jats:italic>I<\/jats:italic>, one <jats:italic>cdt<\/jats:italic>-<jats:italic>III<\/jats:italic>, one <jats:italic>cdt<\/jats:italic>-<jats:italic>IV<\/jats:italic>, and one concurrently had <jats:italic>cdt-I, cdt-II<\/jats:italic> and <jats:italic>cdt<\/jats:italic>-<jats:italic>III<\/jats:italic> genes.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Conclusion.<\/jats:bold> Our results suggest that CDT-producing <jats:italic>E. coli<\/jats:italic> strains are an infrequent, albeit significant, cause of severe diarrhoeal illness in children. Future research should measure the true burden of <jats:italic>cdt<\/jats:italic>-positive <jats:italic>E. coli<\/jats:italic> diarrhoea among children.<\/jats:p>","DOI":"10.1099\/jmmcr.0.005079","type":"journal-article","created":{"date-parts":[[2017,1,2]],"date-time":"2017-01-02T09:12:27Z","timestamp":1483348347000},"source":"Crossref","is-referenced-by-count":10,"title":["Cytolethal distending toxin-producing Escherichia coli strains causing severe diarrhoea in young Mexican children"],"prefix":"10.1099","volume":"4","author":[{"given":"Mario","family":"Meza-Segura","sequence":"first","affiliation":[{"name":"Department of Molecular Biomedicine, CINVESTAV-IPN, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mussaret Bano","family":"Zaidi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Unit, Hospital General O\u2019Horan, Merida, Mexico"},{"name":"Department of Epidemiology and Biostatistics, Michigan State University, Lansing, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Maldonado-Puga","sequence":"additional","affiliation":[{"name":"Department of Molecular Biomedicine, CINVESTAV-IPN, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jazmin","family":"Huerta-Cantillo","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, CINVESTAV-IPN, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Chavez-Due\u00f1as","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, CINVESTAV-IPN, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Navarro-Garcia","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, CINVESTAV-IPN, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Estrada-Garcia","sequence":"additional","affiliation":[{"name":"Department of Molecular Biomedicine, CINVESTAV-IPN, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"345","reference":[{"key":"R1","article-title":"Estad\u00edsticas: Salud en N\u00fameros: DGIS","year":"2016"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.079830-0"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0119824"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003510"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X2002001100008"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.049536-0"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1111\/cmi.12028"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.3390\/biom5031762"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1128\/ecosalplus.ESP-0008-2016"},{"key":"R10","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/j.1348-0421.2009.00116.x","article-title":"Prevalence and characteristics of cytolethal distending toxin-producing Escherichia coli from children with diarrhea in Japan","volume":"53","author":"Hinenoya","year":"2009","journal-title":"Microbiol Immunol"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.46666-0"},{"key":"R12","article-title":"Prevenci\u00f3n, Diagn\u00f3stico y Tratamiento de la Diarrea Aguda en Ni\u00f1os de 2 Meses a 5 A\u00f1os en el Primero y Segundo Nivel de Atenci\u00f3n \u2013 GPC-SNS","year":"2016"},{"key":"R13","volume-title":". 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