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Escherichia coli

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

  • 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
  • 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)
  • 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]
  • 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)
  • Resources