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.  Cytolethal distending toxins (CDTs), encoded by  cdt  genes, have DNase activity leading to cellular and nuclear distension, resulting in irreversible cell cycle arrest and apoptosis of target cells.  cdt -positive  Escherichia coli  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  cdt -positive strains is rarely confirmed. We report five young children with diarrhoea caused by CDT-producing  E. coli  in whom stools were negative for other bacterial or enteric pathogens.   Case presentation.  On admission to hospital, all children presented watery diarrhoea with high stool output (range 7–20 stools/24 h); five had fever of 38 °C 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,  cdt -positive strains were classified as typical and atypical enteropathogenic  E. coli , and the remaining three harboured  cdt -positive strains that did not belong to any diarrhoeagenic pathogroup. One  cdt -positive strain from each case was characterized by a CDT cytotoxic assay and a  cdt  type-specific PCR. All strains produced the characteristic cellular intoxication due to CDT. Two strains carried the  cdt - I , one  cdt - III , one  cdt - IV , and one concurrently had  cdt-I, cdt-II  and  cdt - III  genes.   Conclusion.  Our results suggest that CDT-producing  E. coli  strains are an infrequent, albeit significant, cause of severe diarrhoeal illness in children. Future research should measure the true burden of  cdt -positive  E. coli  diarrhoea among children.

Cytolethal distending toxin-producing Escherichia coli strains causing severe diarrhoea in young Mexican children