Escherichia coli

Aka: Escherichia coli, E. coli, Enterotoxigenic E. coli, ETEC, Enteroinvasive E. coli, EIEC, Enteroadherent E. coli, EAEC

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II. Types

  1. Enterotoxigenic E. coli (ETEC)
    1. Most common pathogen in Traveler's Diarrhea
  2. Enteroinvasive E. coli (EIEC)
    1. Causes acute Dysentery-like Diarrhea
  3. Enteroadherent E. coli (EAEC)
    1. Causes Diarrhea in infants
  4. Enterohemorrhagic E. coli (EHEC)
    1. See Enterohemorrhagic E. coli (EHEC)
    2. Bloody Diarrhea
    3. Includes a subset of Shiga Toxin-producing E. coli (e.g. 0157:H7)
    4. Rapid onset in 12-72 hours

III. Pathophysiology

  1. Some strains release Shiga-like toxin (e.g. 0157:H7)
    1. See Enterohemorrhagic E. coli (EHEC)
  2. Certain E. coli strains have unique adherent ability
    1. E. coli 0157:H7
    2. E. coli various serotypes (over 200)

IV. Epidemiology

  1. Foodborne Illness
    1. See Traveler's Diarrhea
    2. See Enterohemorrhagic E. coli (EHEC)
  2. Waterborne Illness
    1. Outbreak at Rockford, IL lake swimming area (n=12)
    2. References
      1. MMWR (1996) 45:437-9 [PubMed]

V. Findings

  1. See Traveler's Diarrhea
  2. See Enterohemorrhagic E. coli (EHEC)

VI. Management

  1. See Acute Diarrhea
  2. See Traveler's Diarrhea
  3. Supportive Care
    1. Oral Rehydration
    2. Avoid anti-motility (e.g. Imodium may worsen disease)
  4. Antibiotics
    1. Indications
      1. Severe cases
    2. Contraindications
      1. Enterohemorrhagic E. coli (EHEC, E. coli 0157:H7)
        1. Risk of Hemolytic Uremic Syndrome
    3. Disadvantages of Antibiotics
      1. Antibiotics do not alter disease course
      2. May increase Hemolytic Uremic Syndrome risk
    4. Course
      1. Enterotoxigenic E. coli: Treat for 3 days
      2. Enteroinvasive E. coli: Treat for 5 days
    5. Adults - first line
      1. Ciprofloxacin 500 mg twice daily for 3 days
    6. Adults - second line
      1. Trimethoprim-Sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days
      2. Azithromycin 500 mg daily for 3 days (ETEC only)
    7. Children
      1. Trimethoprim-Sulfamethoxazole (Bactrim) 10 mg Trimethoprim/kg/day orally divided twice daily for 3 days
      2. Azithromycin (ETEC only)

VII. Prevention

  1. See Water Disinfection
  2. See Traveler's Diarrhea Prevention
  3. See Foodborne Illness Prevention

VIII. Resources

  1. CDC E. coli
    1. http://www.cdc.gov/ecoli/

IX. References

  1. Bower (1999) Pediatr Infect Dis J 18:909-10 [PubMed]

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