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]

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)

VIII. Resources

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Ontology: Escherichia coli (C0014834)

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
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
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
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