II. Epidemiology
-
Foodborne Illness
- See Traveler's Diarrhea
- See Enterohemorrhagic E. coli (EHEC)
-
Waterborne Illness
- Outbreak at Rockford, IL lake swimming area (n=12)
- References
III. Pathophysiology
- Escherichia coli is a human colonizer, normal colonic flora
- Strains become pathogenic when they acquire DNA from other organisms (see Bacteria for mechanisms)
- Virulence factors (dependent on strain)
- Intestinal epithelial cell invasion
- Mucosal adherence via Pili (colonization factor)
- E. coli 0157:H7 and various other serotypes (over 200)
- Iron-binding siderophore
- E. coli can harvest iron from human Transferrin or lactoferrin
- Exotoxins
- Heat labile toxin (LT, similar to Cholera toxin)
- Heat stable toxin (ST)
- Shiga-like toxin (e.g. 0157:H7)
- Endotoxins
- Lipid A
- Lipopolysaccharide (LPS) layer subcomponent
- Lipid A
- Conditions caused by E. coli
- Acute Diarrhea (see types below)
- Neonatal Meningitis (first month of life)
- Nosocomial Pneumonia
- Gram NegativeSepsis (esp. hospitalized patients)
- Urinary Tract Infections (Acute Cystitis, Pyelonephritis)
- Increased virulence with mucosal adherence via Pili (colonization factor)
IV. Types
- Enterotoxigenic E. coli (ETEC)
- Most common pathogen in Traveler's Diarrhea (Cholera-like rice water Diarrhea)
- Mucosal adherence to intestinal epithelial cells via Pili (colonization factor)
- Releases exotoxins, heat labile (LT) and heat stable (ST)
- Exotoxins inhibit intestinal Sodium and chloride reabsorption
- Exotoxins promote chloride and bicarbonate excretion from intestinal mucosa
- Results in osmotic water losses, which can be severe (liters of fluid losses/day)
- Enteroinvasive E. coli (EIEC)
- Enteroadherent E. coli (EAEC)
- Causes Diarrhea in infants
-
Enterohemorrhagic E. coli (EHEC)
- See Enterohemorrhagic E. coli (EHEC)
- Causes bloody Diarrhea and abdominal cramping
- Includes a subset of Shiga Toxin-producing E. coli (e.g. 0157:H7) with a risk of Hemolytic Uremic Syndrome
- Rapid onset in 12-72 hours
V. Findings
- See Traveler's Diarrhea
- See Enterohemorrhagic E. coli (EHEC)
VI. Management
- See Acute Diarrhea
- See Traveler's Diarrhea
- Supportive Care
- Oral Rehydration
- Avoid anti-motility (e.g. Imodium may worsen disease)
-
Antibiotics
- Indications
- Severe cases
- Contraindications
- Disadvantages of Antibiotics
- Antibiotics do not alter disease course
- May increase Hemolytic Uremic Syndrome risk
- Course
- Enterotoxigenic E. coli: Treat for 3 days
- Enteroinvasive E. coli: Treat for 5 days
- Adults - first line
- Ciprofloxacin 500 mg twice daily for 3 days
- Adults - second line
- Trimethoprim-Sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days
- Azithromycin 500 mg daily for 3 days (ETEC only)
- Children
- Trimethoprim-Sulfamethoxazole (Bactrim) 10 mg Trimethoprim/kg/day orally divided twice daily for 3 days
- Azithromycin (ETEC only)
- Indications
VII. Prevention
VIII. Resources
- CDC E. coli
IX. References
- Gladwin, Trattler and Mahan (2014) Clinical Microbiology, Medmaster, Fl, 74-5
- Bower (1999) Pediatr Infect Dis J 18:909-10 [PubMed]
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| Definition (NCI) | A common, gram negative gut bacterium that has been studied intensively by geneticists because of its small genome size, normal lack of pathogenicity, and ease of growth in the laboratory. |
| Definition (NCI_CDISC) | Any bacterial organism that can be assigned to the species Escherichia coli. |
| Definition (CSP) | species of gram negative, facultatively anaerobic, rod shaped bacteria commonly found in the lower part of the intestine of warm blooded animals; usually nonpathogenic, but some strains are known to produce diarrhea and pyogenic infections. |
| Definition (MSH) | A species of gram-negative, facultatively anaerobic, rod-shaped bacteria (GRAM-NEGATIVE FACULTATIVELY ANAEROBIC RODS) commonly found in the lower part of the intestine of warm-blooded animals. It is usually nonpathogenic, but some strains are known to produce DIARRHEA and pyogenic infections. Pathogenic strains (virotypes) are classified by their specific pathogenic mechanisms such as toxins (ENTEROTOXIGENIC ESCHERICHIA COLI), etc. |
| Concepts | Bacterium (T007) |
| MSH | D004926 |
| SnomedCT | 112283007 |
| LNC | LP19605-2, MTHU009335 |
| English | Escherichia coli, Enterococcus coli, Escherichia coli (Migula 1895) Castellani and Chalmers 1919, bacterium E3, escherichia coli (E coli) bacteria, escherichia coli (E coli), e coli, E coli, ESCHERICHIA COLI, escherichia coli, Bacillus coli, Bacterium coli commune, Escherichia/Shigella coli, E. COLI, Bacterium coli, EC - Escherichia coli, E. coli, Escherichia coli (organism), E.COLI |
| Swedish | Kolibakterie |
| Czech | Escherichia coli, E coli |
| Finnish | Escherichia coli |
| French | E. coli, Escherichia coli |
| Russian | KOLIBAKTERIIA, KISHECHNAIA PALOCHKA, ESCHERICHIA COLI, ALKALESCENS-DISPAR GROUP, КИШЕЧНАЯ ПАЛОЧКА, КОЛИБАКТЕРИЯ |
| Japanese | エシェリキアコリ, エシェリキア･コリ, 大腸菌, アルカレッセンスジスパール群 |
| Croatian | ESCHERICHIA COLI |
| Polish | Escherichia coli, Pałeczki okrężnicy, Pałeczka okrężnicy |
| Spanish | E. coli, E.coli, ECAD (E. coli de Adherencia Difusa), ECEA (E coli Enteroadherente), ECEA (Escherichia coli Enteroadherente), ECEAgg (Escherichia coli Enteroagregativa), E. coli de Adhesión Difusa, ECEI (E. coli Enteroinvasiva), Escherichia coli de Adhesión Difusa, ECAD (E coli de Adherencia Difusa), ECAD (E. coli con Adherencia Difusa), ECAD (Escherichia coli Adherencia Difusa), ECEAgg, ECEI (Escherichia coli Enteroinvasiva), E. coli Enteroagregativa, ECAD (Escherichia coli con Adherencia Difusa), ECEA (E. coli Enteroadherente), E coli Enteroagregativa, ECAD (E coli con Adherencia Difusa), E coli de Adhesión Difusa, ECAD (E coli Adherencia Difusa), ECAD (E. coli Adherencia Difusa), ECAD (Escherichia coli de Adherencia Difusa), ECEI (E coli Enteroinvasiva), Escherichia coli Difusamente Adherente, Escherichia coli Difusamente Adherida, Escherichia coli (organismo), Escherichia coli, E coli |
| Portuguese | Escherichia coli Difusamente Aderente, Escherichia coli Difusamente Aderida, E. coli, Escherichia coli de Adesão Difusa, E. coli de Adesão Difusa, E.coli, ECAD (E. coli Alcalescência Díspar), ECEA (E. coli Enteroaderente), ECAD (Escherichia coli Alcalescência Díspar), ECEI (E coli Enteroinvasiva), ECAD (E coli Aderência Difusa), ECEA (Escherichia coli Enteroaderente), ECEAgg, E coli de Adesão Difusa, ECAD (E coli Alcalescência Díspar), ECAD (E. coli Aderência Difusa), ECEI (E. coli Enteroinvasiva), ECEI (Escherichia coli Enteroinvasiva), ECEA (E coli Enteroaderente), ECEAgg (Escherichia coli Enteroagregativa), E coli, Escherichia coli |
| German | Escherichia coli, E. coli |
| Italian | Escherichia coli |
| Dutch | Escherichia coli, E. coli |
Ontology: Enteroinvasive Escherichia coli (bacteria) (C0580795)
| Definition (MSH) | A pathotype (virotype) of E. coli capable of invading and multiplying in the intestinal epithelial cells of the distal large intestines in humans. |
| Concepts | Bacterium (T007) |
| MSH | D004926 |
| SnomedCT | 116396007 |
| LNC | LP18335-7, MTHU030255 |
| English | E coli enteroinvasive, Enteroinvasive E. coli, Enteroinvasive Escherichia coli, Enteroinvasive Escherichia coli (bacteria), Escherichia coli enteroinvasive, EIEC, Escherichia coli, enteroinvasive strain, Enteroinvasive Escherichia coli (organism), enteroinvasive Escherichia coli, Escherichia coli, enteroinvasive strain (organism) |
| French | EIEC (Enteroinvasive Escherichia coli), Escherichia coli entéroinvasive, E. coli entéroinvasive, ECEI, Escherichia coli entéro-invasive |
| German | Enteroinvasive Escherichia coli, Enteroinvasive E. coli, EIEC |
| Spanish | Escherichia coli, cepa enteroinvasiva (organismo), Escherichia coli, cepa enteroinvasiva |
Ontology: Enteroadherent Escherichia coli (C0580796)
| Concepts | Bacterium (T007) |
| SnomedCT | 303349001 |
| English | E coli enteroadherent, Escherichia coli enteroadherent (organism), Escherichia coli enteroadherent, Enteroadherent Escherichia coli |
| Spanish | Escherichia coli enteroadherente (organismo), Escherichia coli enteroadherente |
Ontology: Enterotoxigenic Escherichia coli (C0580797)
| Definition (MSH) | Strains of ESCHERICHIA COLI that produce or contain at least one member of either heat-labile or heat-stable ENTEROTOXINS. The organisms colonize the mucosal surface of the small intestine and elaborate their enterotoxins causing DIARRHEA. They are mainly associated with tropical and developing countries and affect susceptible travelers to those places. |
| Concepts | Bacterium (T007) |
| MSH | D054307 |
| SnomedCT | 116394005 |
| Spanish | Escherichia coli, cepa enterotoxígena, Escherichia coli Enterotoxigénica, E coli Enterotoxigénica, ECET, Escherichia coli enterotoxígena, Escherichia coli, cepa enterotoxígena (organismo), Escherichia coli enterotoxigénica (organismo), Escherichia coli enterotoxigénica |
| English | E coli enterotoxigenic, Enterotoxigenic E. coli, ETEC, Enterotoxigenic Escherichia coli, E coli, Enterotoxigenic, Escherichia coli, Enterotoxigenic, Escherichia coli, enterotoxigenic strain, enterotoxigenic escherichia coli, enterotoxigenic escherichia coli (ETEC), etec, Escherichia coli enterotoxigenic, Enterotoxigenic Escherichia coli (organism), enterotoxigenic Escherichia coli, Escherichia coli, enterotoxigenic strain (organism) |
| Portuguese | E coli Enterotoxigênica, Escherichia coli Enterotoxigênica, ETEC, ECET |
| Finnish | Enterotoksigeeninen Escherichia coli |
| French | ETEC (Enterotoxigenic Escherichia coli), Escherichia coli entérotoxigène, E. coli entérotoxigène |
| German | Enterotoxische Escherichia coli, E. coli, Enterotoxische, Enterotoxigene E. coli, Escherichia coli, Enterotoxigene, E. coli, Enterotoxigene, Enterotoxische E. coli, Escherichia coli, Enterotoxische, Enterotoxigene Escherichia coli, ETEC |
| Italian | ETEC, E. coli enterotossigeno, Escherichia coli enterotossigeno |
| Russian | E COLI ЭНТЕРОТОКСИКОГЕННАЯ, E COLI ENTEROTOKSIKOGENNAIA, ЭНТЕРОТОКСИКОГЕННАЯ ESCHERICHIA COLI, ESCHERICHIA COLI ЭНТЕРОТОКСИКОГЕННАЯ, ESCHERICHIA COLI ENTEROTOKSIKOGENNAIA, ENTEROTOKSIKOGENNAIA ESCHERICHIA COLI, ETEC |
| Japanese | 毒素原性大腸菌, 大腸菌-毒素原性 |
| Swedish | Enterotoxigen E coli |
| Czech | enterotoxigenní Escherichia coli, enterotoxigenní E coli, enterotoxigenní E. coli |
| Polish | Escherichia coli enterotoksyczne |
Ontology: Enteroaggregative Escherichia coli (C0872165)
| Definition (MSH) | A pathotype (virotype) of E. coli characterized by a distinct aggregative adherence pattern to HEp-2 cells. |
| Concepts | Bacterium (T007) |
| MSH | D004926 |
| SnomedCT | 116397003 |
| Spanish | Escherichia coli, cepa enteroagregadora, EAEC, Escherichia coli Enteroagregativa, EAggEC, Escherichia coli, cepa enteroagregante (organismo), Escherichia coli, cepa enteroagregante |
| English | EAggEC, Enteroaggregative E. coli, Enteroaggregative Escherichia coli, Escherichia coli, enteroaggregative strain, enteroaggregative Escherichia coli, EggEC, Enteroaggregative Escherichia coli (organism), Escherichia coli, enteroaggregative strain (organism), EAEC |
| Portuguese | Escherichia coli Enteroagregativa, EAggEC |
| French | Escherichia coli entéroagrégative, EAEC (Enteroaggregative Escherichia coli), E. coli entéroagrégative, ECEA, Escherichia coli entéro-agrégative |
| German | EAEC, EAggEC, Enteroaggregative E. coli, Enteroaggregative Escherichia coli |
