Diarrhea caused by Escherichia coli that produce only heat-stable enterotoxin

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Abstract
To determine the role of E. coli heat-stable enterotoxin (ST) as a virulence factor in human diarrhea, a strain that elaborates only ST (E. coli 214-4) was fed to free-living volunteers in doses of 106, 108 and 1010 organisms. Short-lived (1 day) mild illness consisting of abdominal cramps with vomiting or diarrhea occurred in 3 of 5 individuals fed 108. Typical travelers'' diarrhea (loose stools, abdominal cramps and low-grade fever for 2-3 days) was seen in 4 of 5 volunteers given 1010; 2 had brief cholera-like purging of rice-water stools. Despite fever, there was no evidence of mucosal invasion. E. coli 214-4 became the predominant coliform in stools; coproculture isolates were uniformly negative for heat-labile enterotoxin (LT), but most produced ST. Ten of 13 individuals developed rises in antibody to somatic E. coli antigen, and none had rises in LT antitoxin. E. coli that elaborate only ST can cause diarrheal disease in adults.