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. Bloody Diarrhea
    2. Includes serotype 0157:H7 (Shiga-toxin producer)
    3. Rapid onset in 12-72 hours

III. Pathophysiology

  1. Some strains release Shiga-like toxin (e.g. 0157:H7)
  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 (Shiga-toxin producing E. coli)
    1. Meat products
      1. Bovine (Most common)
        1. Undercooked hamburger (often commercial source)
      2. Pork
      3. Poultry
      4. Lamb
    2. Mayonnaise
    3. Sausage
    4. Salami
    5. Raw milk
    6. Alfalfa sprouts
    7. Unpasteurized apple cider and apple juice
  2. Waterborne Illness
    1. Outbreak at Rockford, IL lake swimming area (n=12)
    2. References
      1. MMWR (1996) 45:437-9 [PubMed]

V. Symptoms

  1. Enterohemorrhagic E. coli (EHEC)
    1. Acute hemorrhagic colitis

VI. Signs

  1. Enterohemorrhagic E. coli (EHEC)
    1. Bloody Diarrhea in 95%

VII. Complications

  1. Enterohemorrhagic E. coli (EHEC)
    1. Hemolytic Uremic Syndrome (HUS)
    2. Thrombotic Thrombocytopenic Purpura (TTP)

VIII. Labs

  1. Specific E.Coli 0157:H7 Culture

IX. Management

  1. Supportive Care
    1. Oral Rehydration
    2. Avoid anti-motility (e.g. Imodium may worsen disease)
  2. 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)

X. Prevention

  1. Meat irradiation

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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: Escherichia coli O157:H7 (bacteria) (C0376624)

Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Escherichia coli and strain O157:H7.
Definition (NCI) A species of facultatively anaerobic, Gram negative, rod shaped bacterium assigned to the phylum Proteobacteria. This species develops flagella and pili based on its environmental needs. Belongs to the class of enterohemorrhagic E. coli which produces Shiga-like toxins causing hemorrhagic diarrhea which can occasionally develop into kidney failure, most commonly affecting young children and elderly. This serotype differs from other pathogenic E. coli as it is negative for invasiveness (Sereny test), adheres through E. coli common pilus, and doesn't produce heat stable or heat labile toxins. Human infection is commonly caused by the consumption of undercooked ground beef or unpasteurized milk or juice or exposure to contaminated lakes, pools or drinking water.
Concepts Bacterium (T007)
MSH D019453
SnomedCT 103429008, 457914007
LNC LP14899-6, MTHU002138
English E coli O157-H7, E COLI O 157 H 007, ESCHERICHIA COLI O 157 H 007, Escherichia coli O157:H7 (bacteria), Escherichia coli, serotype 0157:H7, Escherichia coli, serotype O157:H7, E. coli 0157:H7, Escherichia coli strain O157:H7, Escherichia coli serotype O157:H7, E. coli serotype O157:H7, E. coli O157:H7, Escherichia coli serotype O157:H7 (organism), Serotype O157:H7, Escherichia coli O157:H7, ESCHERICHIA COLI O157:H7, Escherichia coli, serotype O157:H7 (organism), EHEC, serotype O157:H7, Enterohaemorrhagic Escherichia coli, serotype O157:H7, Enterohemorrhagic Escherichia coli, serotype O157:H7 (organism), Enterohemorrhagic Escherichia coli, serotype O157:H7, Escherichia coli O157-H7
French E coli O157-H7, Escherichia coli O157-H7
Spanish Escherichia coli, serotipo 0157:H7 (organismo), Escherichia coli O157-H7, Escherichia coli enterohemorrágica, serotipo 0157:H7 (organismo), Escherichia coli enterohemorrágica, serotipo O157:H7, EHEC, serotipo O157:H7, Escherichia coli, serotipo 0157:H7, Escherichia coli enterohemorrágica, serotipo O157:H7 (organismo), E. coli serotipo O157:H7, E. coli O157:H7, Escherichia coli enterohemorrágica, serotipo 0157:H7, Escherichia coli serotipo O157:H7, Escherichia coli O157:H7, Escherichia coli serotipo O157:H7 (organismo), E coli O157-H7
Portuguese Escherichia coli O157-H7, E coli O157-H7
German Escherichia coli O157-H7, ESCHERICHIA COLI O 157 H 007, E COLI O 157 H 007, E. coli O157-H7
Italian Escherichia coli O157-H7
Dutch E coli O157-H7, Escherichia coli O157-H7

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: Enterohemorrhagic Escherichia coli (C0600414)

Definition (MSH) Strains of ESCHERICHIA COLI that are a subgroup of SHIGA-TOXIGENIC ESCHERICHIA COLI. They cause non-bloody and bloody DIARRHEA; HEMOLYTIC UREMIC SYNDROME; and hemorrhagic COLITIS. An important member of this subgroup is ESCHERICHIA COLI O157-H7.
Concepts Bacterium (T007)
MSH D054324 , D019453
SnomedCT 116395006
LNC LP18956-0
Spanish Escherichia coli, cepa enterohemorrágica (organismo), Escherichia coli, cepa enterohemorrágica, EHEC, Escherichia coli, E coli Enterohemorrágica, Escherichia coli Enterohemorrágica, ECEH, Escherichia coli enterohemorrágica (organismo), Escherichia coli enterohemorrágica
English E coli, Enterohemorrhagic, Enterohemorrhagic E coli, Escherichia coli, Enterohemorrhagic, EHEC, Enterohemorrhagic E. coli, Escherichia coli, enterohemorrhagic strain, Escherichia coli, enterohaemorrhagic strain, Escherichia coli verotoxic, enterohemorrhagic e coli, coli e enterohemorrhagic, Enterohemorrhagic Escherichia coli, Escherichia coli, verotoxic, Enterohemorrhagic Escherichia coli (organism), Escherichia coli, enterohemorrhagic strain (organism), Enterohaemorrhagic Escherichia coli, EHEC, Escherichia coli
Portuguese EHEC, Escherichia coli Êntero-Hemorrágica, E coli Entero-hemorrágica, ECEH
Finnish Enterohemorraginen Escherichia coli
French E. coli entérohémorragique, EHEC (Enterohemorrhagic Escherichia coli), Escherichia coli entérohémorrhagique, Escherichia coli entéro-hémorragique, ECEH
German EHEC, Enterohämorrhagische Escherichia coli, E. coli, enterohämorrhagische, Enterohämorrhagische E. coli, Escherichia coli, enterohämorrhagische
Italian Escherichia coli enteroemorragico
Japanese 腸管出血性大腸菌, 大腸菌-腸管出血性
Swedish Enterohemorragisk E coli
Czech enterohemoragická E coli, enterohemoragická Escherichia coli, enterohemoragická E. coli
Polish Escherichia coli enterokrwotoczne, Enterokrwotoczne szczepy Eschericia coli
Dutch Entero-hemorragische E coli

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