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Free access | 10.1172/JCI106560

Acute undifferentiated human diarrhea in the tropics: I. Alterations in intestinal microflora

S. L. Gorbach, J. G. Banwell, B. D. Chatterjee, B. Jacobs, and R. B. Sack

Johns Hopkins University Center for Medical Research and Training, School of Tropical Medicine, Infectious Diseases Hospital, Calcutta, India

Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois 60680

Find articles by Gorbach, S. in: PubMed | Google Scholar

Johns Hopkins University Center for Medical Research and Training, School of Tropical Medicine, Infectious Diseases Hospital, Calcutta, India

Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois 60680

Find articles by Banwell, J. in: PubMed | Google Scholar

Johns Hopkins University Center for Medical Research and Training, School of Tropical Medicine, Infectious Diseases Hospital, Calcutta, India

Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois 60680

Find articles by Chatterjee, B. in: PubMed | Google Scholar

Johns Hopkins University Center for Medical Research and Training, School of Tropical Medicine, Infectious Diseases Hospital, Calcutta, India

Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois 60680

Find articles by Jacobs, B. in: PubMed | Google Scholar

Johns Hopkins University Center for Medical Research and Training, School of Tropical Medicine, Infectious Diseases Hospital, Calcutta, India

Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois 60680

Find articles by Sack, R. in: PubMed | Google Scholar

Published April 1, 1971 - More info

Published in Volume 50, Issue 4 on April 1, 1971
J Clin Invest. 1971;50(4):881–889. https://doi.org/10.1172/JCI106560.
© 1971 The American Society for Clinical Investigation
Published April 1, 1971 - Version history
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Abstract

The microflora of the small and large intestine was determined in 17 adults with acute undifferentiated diarrhea in Calcutta, India. On the basis of bacteriologic findings, the patients could be divided into two groups: those with a predominant flora of Escherichia coli (eight patients) and those with a mixed coliform flora (nine patients). In the former group, E. coli were distributed throughout the small and large bowel. Broth filtrates of these isolates contained an enterotoxin which caused fluid accumulation in the rabbit intestinal loop model. Toxigenic E. coli were cleared rapidly from the small bowel during the acute period; some patients only had the “hot” strains in their fecal effluent. During convalescence, the serotypes of E. coli changed and the new strains did not elaborate enterotoxin. Only one of the eight patients had a serotype previously associated with diarrhea. Acute undifferentiated diarrhea in the remaining cases was apparently caused by untypable E. coli or by typable strains not generally considered pathogenic.

Small bowel and fecal cultures from the mixed flora group revealed a heterogeneous mixture of Gram-negative enteric bacilli and a distinct pattern could not be discerned. Further study will be needed to elucidate the cause of diarrhea in these cases.

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