Enterohemorrhagic E. coli

Aka: Enterohemorrhagic E. coli, EHEC, E. coli 0157, Shiga Toxin-producing E. coli, STEC

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II. Pathophysiology

  1. Enterohemorrhagic E. coli (EHEC) causes bloody Diarrhea
  2. More than 60% of E. coli EHEC strains release Shiga-like toxin (e.g. 0157:H7, 0104:H4)

III. Causes: Foodborne Illness (Shiga-toxin producing E. coli)

  1. Meat products
    1. Bovine (Most common)
      1. Undercooked hamburger (often commercial source)
    2. Pork
    3. Poultry
    4. Lamb
  2. Mayonnaise
  3. Sausage
  4. Salami
  5. Raw milk
  6. Alfalfa sprouts
  7. Unpasteurized apple cider and apple juice

IV. Symptoms

  1. Rapid onset in 12-72 hours
  2. Enterohemorrhagic E. coli (EHEC) causes an acute hemorrhagic colitis

V. Signs

  1. Bloody Diarrhea in 95%

VI. Complications: Shiga-toxin producing EHEC Strains

  1. Hemolytic Uremic Syndrome (HUS)
  2. Thrombotic Thrombocytopenic Purpura (TTP)

VII. Labs

  1. See Hemolytic Uremic Syndrome (HUS)
  2. Complete Blood Count
    1. White Blood Cell Count is variably increased in EHEC
    2. Hemoglobin may be decreased to <9 mg/dl in HUS
    3. Platelet Count may be decreased to <150,000 in HUS
  3. Metabolic panel
    1. Electrolyte abnormalities (related to severe Diarrhea)
      1. Hyponatremia
      2. Hypokalemia
    2. Serum Creatinine and Blood Urea Nitrogen
      1. Increased in Dehydration as well as HUS
  4. Urinalysis
    1. Microscopic Hematuria and Proteinuria with HUS
  5. Shiga-Toxin Producing E. coli Diagnosis
    1. Specific E.Coli 0157:H7 Culture
    2. Shiga-Toxin ELISA Assay
    3. Shiga-Toxin 1 and 2 DNA PCR

VIII. Management

  1. See Acute Diarrhea
    1. Includes general measures including hydration
  2. Avoid antidiarrheal agents such as Loperamide (Imodium)
  3. Avoid Antibiotics in most cases (esp. under age 10 years old)
    1. Antibiotics increase risk of Hemolytic Uremic Syndrome (to as much as 25% Incidence)
      1. Wong (2012) Clin Infect Dis 55(1): 33-41 +PMID:22431799 [PubMed]
    2. In some STEC epidemics, Antibiotics have been used with decreased adverse outcomes
      1. If used, Azithromycin appears least likely to cause HUS
      2. Nitschke (2012) JAMA 307(10): 1046-52 +PMID:22416100 [PubMed]

IX. Resources

  1. CDC E. coli outbreaks (primarily 0157:H7)
    1. http://www.cdc.gov/ecoli/outbreaks.html
  2. WHO Enterohemorrhagic E. coli
    1. http://www.who.int/mediacentre/factsheets/fs125/en/

X. References

  1. (2015) Sanford Guide to Antimicrobials, accessed IOS app 5/7/2016
  2. Bower (1999) Pediatr Infect Dis J 18:909-10 [PubMed]
  3. Page (2013) Med Clin North Am 97(4):681-95 +PMID:23809720 [PubMed]

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Related Studies

Ontology: Escherichia coli O157:H7 (bacteria) (C0376624)

Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Escherichia coli and strain O157:H7.
Definition (NCI) A species of facultatively anaerobic, Gram negative, rod shaped bacterium assigned to the phylum Proteobacteria. This species develops flagella and pili based on its environmental needs. Belongs to the class of enterohemorrhagic E. coli which produces Shiga-like toxins causing hemorrhagic diarrhea which can occasionally develop into kidney failure, most commonly affecting young children and elderly. This serotype differs from other pathogenic E. coli as it is negative for invasiveness (Sereny test), adheres through E. coli common pilus, and doesn't produce heat stable or heat labile toxins. Human infection is commonly caused by the consumption of undercooked ground beef or unpasteurized milk or juice or exposure to contaminated lakes, pools or drinking water.
Concepts Bacterium (T007)
MSH D019453
SnomedCT 103429008, 457914007
LNC LP14899-6, MTHU002138
English E coli O157-H7, E COLI O 157 H 007, ESCHERICHIA COLI O 157 H 007, Escherichia coli O157:H7 (bacteria), Escherichia coli, serotype 0157:H7, Escherichia coli, serotype O157:H7, E. coli 0157:H7, Escherichia coli strain O157:H7, Escherichia coli serotype O157:H7, E. coli serotype O157:H7, E. coli O157:H7, Escherichia coli serotype O157:H7 (organism), Serotype O157:H7, Escherichia coli O157:H7, ESCHERICHIA COLI O157:H7, Escherichia coli, serotype O157:H7 (organism), EHEC, serotype O157:H7, Enterohaemorrhagic Escherichia coli, serotype O157:H7, Enterohemorrhagic Escherichia coli, serotype O157:H7 (organism), Enterohemorrhagic Escherichia coli, serotype O157:H7, Escherichia coli O157-H7
French E coli O157-H7, Escherichia coli O157-H7
Spanish Escherichia coli, serotipo 0157:H7 (organismo), Escherichia coli O157-H7, Escherichia coli enterohemorrágica, serotipo 0157:H7 (organismo), Escherichia coli enterohemorrágica, serotipo O157:H7, EHEC, serotipo O157:H7, Escherichia coli, serotipo 0157:H7, Escherichia coli enterohemorrágica, serotipo O157:H7 (organismo), E. coli serotipo O157:H7, E. coli O157:H7, Escherichia coli enterohemorrágica, serotipo 0157:H7, Escherichia coli serotipo O157:H7, Escherichia coli O157:H7, Escherichia coli serotipo O157:H7 (organismo), E coli O157-H7
Portuguese Escherichia coli O157-H7, E coli O157-H7
German Escherichia coli O157-H7, ESCHERICHIA COLI O 157 H 007, E COLI O 157 H 007, E. coli O157-H7
Italian Escherichia coli O157-H7
Dutch E coli O157-H7, Escherichia coli O157-H7
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Enterohemorrhagic Escherichia coli (C0600414)

Definition (MSH) Strains of ESCHERICHIA COLI that are a subgroup of SHIGA-TOXIGENIC ESCHERICHIA COLI. They cause non-bloody and bloody DIARRHEA; HEMOLYTIC UREMIC SYNDROME; and hemorrhagic COLITIS. An important member of this subgroup is ESCHERICHIA COLI O157-H7.
Concepts Bacterium (T007)
MSH D054324 , D019453
SnomedCT 116395006
LNC LP18956-0
Spanish Escherichia coli, cepa enterohemorrágica (organismo), Escherichia coli, cepa enterohemorrágica, EHEC, Escherichia coli, E coli Enterohemorrágica, Escherichia coli Enterohemorrágica, ECEH, Escherichia coli enterohemorrágica (organismo), Escherichia coli enterohemorrágica
English E coli, Enterohemorrhagic, Enterohemorrhagic E coli, Escherichia coli, Enterohemorrhagic, EHEC, Enterohemorrhagic E. coli, Escherichia coli, enterohemorrhagic strain, Escherichia coli, enterohaemorrhagic strain, Escherichia coli verotoxic, enterohemorrhagic e coli, coli e enterohemorrhagic, Enterohemorrhagic Escherichia coli, Escherichia coli, verotoxic, Enterohemorrhagic Escherichia coli (organism), Escherichia coli, enterohemorrhagic strain (organism), Enterohaemorrhagic Escherichia coli, EHEC, Escherichia coli
Portuguese EHEC, Escherichia coli Êntero-Hemorrágica, E coli Entero-hemorrágica, ECEH
Finnish Enterohemorraginen Escherichia coli
French E. coli entérohémorragique, EHEC (Enterohemorrhagic Escherichia coli), Escherichia coli entérohémorrhagique, Escherichia coli entéro-hémorragique, ECEH
German EHEC, Enterohämorrhagische Escherichia coli, E. coli, enterohämorrhagische, Enterohämorrhagische E. coli, Escherichia coli, enterohämorrhagische
Italian Escherichia coli enteroemorragico
Russian E COLI ЭНТЕРОГЕМОРРАГИЧЕСКАЯ, ЭНТЕРОГЕМОРРАГИЧЕСКАЯ ESCHERICHIA COLI, ESCHERICHIA COLI ENTEROGEMORRAGICHESKAIA, ENTEROGEMORRAGICHESKAIA ESCHERICHIA COLI, E COLI ENTEROGEMORRAGICHESKAIA, ESCHERICHIA COLI ЭНТЕРОГЕМОРРАГИЧЕСКАЯ, EHEC
Japanese 腸管出血性大腸菌, 大腸菌-腸管出血性
Swedish Enterohemorragisk E coli
Czech enterohemoragická E coli, enterohemoragická Escherichia coli, enterohemoragická E. coli
Polish Escherichia coli enterokrwotoczne, Enterokrwotoczne szczepy Eschericia coli
Dutch Entero-hemorragische E coli
Derived from the NIH UMLS (Unified Medical Language System)

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