References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | BACTERIUM. Escherichia coli. A facultative gram-negative bacillus |
| Reservoir | Human Mammal |
| Vector | None |
| Vehicle | Food Water Fecal-oral |
| Incubation Period | 1 to 3 days (As early or late as 12 hours to 10 days) |
| Diagnostic Tests | Stool culture Request characterization of E. coli isolates |
| Typical Adult Therapy | Supportive therapy. Avoid anti-motility drugs and antimicrobial agents. Plasma exchange may be effective in HUS Note that antimicrobial agents may increase risk for hemolytic-uremic syndrome when used in cases of E. coli O157:H7 infection |
| Typical Pediatric Therapy | As for adult |
| Clinical Hints | Watery diarrhea or dysentery - common among travelers and infants; hemorrhagic colitis and hemolytic uremic syndrome are associated with type O157:H7 (& occasionally other types). |
| Synonyms | DAEC (Diffusely Adherent E. coli), E. coli diarrhea, EAEC (Enteroadherent E. coli), EAggEC (Enteroaggregative E. coli), EHEC (Enterohemorrhagic E. coli), EIEC (Enteroinvasive E. coli), EPEC (Enteropathogenic E. coli), Escherichia albertii, ETEC (Enterotoxic E. coli), Hamolytisch-uramisches Syndrome, Hemolytic Uremic Syndrome, HUS. |
Enterotoxic Escherichia coli (ETEC) infection is characterized by a short incubation period, and watery diarrhea without blood or mucus.
- Fever and vomiting occur in a minority of patients.
- The disease may be life-threatening in infants.
Types of E. coli
- Enteropathogenic E. coli (EPEC) causes watery diarrhea with fever and vomiting, primarily among children under age 2 years.
- Enteroinvasive E. coli (EIEC) causes watery diarrhea; only a minority of patients experience dysentery.
- Enterohemorrhagic E. coli (EHEC) causes diarrhea without fever, often with blood and cramps at all ages.
- Rare instances of toxic megacolon have been reported 3
- One strain of EHEC, O157:H7 is an important cause of hemolytic-uremic syndrome (HUS). 4
- Approximately 6% to 10% of patients infected by this strain develop HUS • with an overall mortality rate of 0.6% for STEC O157 infections and 4.6% for HUS. 5
- Nearly 40% of patients with STEC-HUS require at least temporary renal replacement therapy and up to 20% will have permanent residual kidney dysfunction.
- Hemolytic-uremic syndrome can also follow infection by Clostridium difficile 7 and by non-O157 strains of E. coli. 8
- Reactive arthritis is reported in 10% of cases
- Enteroaggregative E. coli (EAggEC) causes watery, persistent diarrhea (over 2 weeks) without vomiting.
- Low-grade fever may be observed, and gross blood may occasionally be present in stools.