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Enteroaggregative Escherichia coli (EAEC) is an emerging pathogen associated with acute and persistent diarrhea in children and adults. EAEC strains are very heterogeneous and the pathogenesis of EAEC diarrhea is complex and not completely understood. Studies have suggested three major features of EAEC pathogenesis: abundant adherence to the intestinal mucosa, elaboration of enterotoxins and cytotoxins, and induction of mucosal inflammation. Here, we discuss the role of the virulence factors involved in these three major features, focusing in the EAEC adhesion including fimbrial and afimbrial factors, EAEC toxins and autotransporter proteins, such as Pet (plasmid encoded toxin) and Pic (protein involved in colonization); both proteins play a role in two EAEC pathogenic features: cytotoxicity and mucosal colonization, including the bacterium-mucus biofilm. Finally we discuss relevant factors involved in the inflammatory process induce by EAEC, such as flagellin, fimbria and regulator factors (AggR). Interestingly, all these factors are not present in all EAEC strain, contributing to EAEC heterogeneity.
Navarro‐García et al. (Sat,) studied this question.