Faith Wallace-Gadsden
"Drug resistant bacteria and childhood diarrhea in Africa"

In developing countries, diarrhea is the cause of an estimated 2 million deaths a year. It is the leading cause of death in children under the age of five and in Sub-Saharan Africa alone, it is estimated that 800,000 children die from diarrhea and consequent dehydration annually. Infectious diarrhea is caused by many different viruses, bacteria and parasites. Escherichia coli, E. coli, bacteria are a major cause of diarrhea and one sub-category, enteroaggregative E. coli (EAEC) has recently been identified as a significant cause of persistent and acute diarrhea worldwide and particularly in Africa. Persistent, or chronic, diarrhea lasts more than 14 days and increases the risk of growth impairment and death for susceptible individuals. Those at greatest risk are children under five, adults over 50, the malnourished, and the immunocompromised. While the World Health Organization recommends that both acute and persistent infections are treated with hydration, salt and proper nutrition, some persistent and severe infections have to be treated with antimicrobials. Persistent diarrhea caused by EAEC strains pose an increased risk because these strains are resistant to a number of important antimicrobials including: trimethoprim, ampicillin, and tetracycline, with prevalence in excess of 50%. The threat from EAEC has only been recently identified and their resistance to antimicrobials is the focus of my thesis research. Through laboratory analyses, we have found that a subset of EAEC, which are predominant in Nigeria, carry a recently acquired but now stably inherited block of genes encoding resistance to multiple antimicrobials. In this paper, I will review the current problem of resistant enteroaggregative Escherichia coli in Africa and discuss the implications of these findings.