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Enterohemorrhagic E. coli
Aka: Enterohemorrhagic E. coli, EHEC, E. coli 0157, Shiga Toxin-producing E. coli, STEC
- See Also
- Escherichia coli (E. coli)
- Diarrhea
- Infectious Diarrhea
- Pathophysiology
- Enterohemorrhagic E. coli (EHEC) causes bloody Diarrhea
- More than 60% of E. coli EHEC strains release Shiga-like toxin (e.g. 0157:H7, 0104:H4)
- Causes: Foodborne Illness (Shiga-toxin producing E. coli)
- Meat products
- Bovine (Most common)
- Undercooked hamburger (often commercial source)
- Pork
- Poultry
- Lamb
- Mayonnaise
- Sausage
- Salami
- Raw milk
- Alfalfa sprouts
- Unpasteurized apple cider and apple juice
- Symptoms
- Rapid onset in 12-72 hours
- Enterohemorrhagic E. coli (EHEC) causes an acute hemorrhagic colitis
- Signs
- Bloody Diarrhea in 95%
- Complications: Shiga-toxin producing EHEC Strains
- Hemolytic Uremic Syndrome (HUS)
- Thrombotic Thrombocytopenic Purpura (TTP)
- Labs
- See Hemolytic Uremic Syndrome (HUS)
- Complete Blood Count
- White Blood Cell Count is variably increased in EHEC
- Hemoglobin may be decreased to <9 mg/dl in HUS
- Platelet Count may be decreased to <150,000 in HUS
- Metabolic panel
- Electrolyte abnormalities (related to severe Diarrhea)
- Hyponatremia
- Hypokalemia
- Serum Creatinine and Blood Urea Nitrogen
- Increased in Dehydration as well as HUS
- Urinalysis
- Microscopic Hematuria and Proteinuria with HUS
- Shiga-Toxin Producing E. coli Diagnosis
- Specific E.Coli 0157:H7 Culture
- Shiga-Toxin ELISA Assay
- Shiga-Toxin 1 and 2 DNA PCR
- Management
- See Acute Diarrhea
- Includes general measures including hydration
- Avoid antidiarrheal agents such as Loperamide (Imodium)
- Avoid antibiotics in most cases (esp. under age 10 years old)
- Antibiotics increase risk of Hemolytic Uremic Syndrome (to as much as 25% Incidence)
- Wong (2012) Clin Infect Dis 55(1): 33-41 +PMID:22431799 [PubMed]
- In some STEC epidemics, antibiotics have been used with decreased adverse outcomes
- If used, Azithromycin appears least likely to cause HUS
- Nitschke (2012) JAMA 307(10): 1046-52 +PMID:22416100 [PubMed]
- Resources
- CDC E. coli outbreaks (primarily 0157:H7)
- http://www.cdc.gov/ecoli/outbreaks.html
- WHO Enterohemorrhagic E. coli
- http://www.who.int/mediacentre/factsheets/fs125/en/
- References
- (2015) Sanford Guide to Antimicrobials, accessed IOS app 5/7/2016
- Bower (1999) Pediatr Infect Dis J 18:909-10 [PubMed]
- Page (2013) Med Clin North Am 97(4):681-95 +PMID:23809720 [PubMed]