Gastroenteritis, Escherichia coli

E coli causes gastroenteritis by growth of the organism in the gut with invasion of the mucosa or toxin production

Enterotoxin causes hypersecretion in the small intestine

Enterotoxigenic E coli (ETEC)

• Elaborates either a heat-stable or a heat-labile toxin that mediates diarrhea, including traveler's diarrhea

Enteroinvasive E coli (EIEC)

• Invades cells, causing bloody diarrhea and dysentery similar to infection with Shigella species

Shiga-toxin producing E coli (STEC)

• Can result in asymptomatic carriage stage, nonbloody diarrhea, hemorrhagic colitis, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura

• Serotype O157:H7 is responsible for most cases in the United States; recently in Europe, serotype O104:H4 has been reported to cause severe disease

• Elderly individuals and young children are most severely affected

• Hemolytic-uremic syndrome is more common in young children

Recommendations from the Centers for Disease Control and Prevention

• All stools submitted for routine testing from patients with acute community-acquired diarrhea be simultaneously cultured for E coli O157:H7 and tested for Shiga toxins to detect non-O157 STEC, such as E coli O145

Antimicrobial therapy against Salmonella and Shigella, such as ciprofloxacin 500 mg orally twice daily, shortens the clinical course, but the disease is self-limited

Antimicrobial therapy does not alter the course of the disease and may increase the risk of hemolytic-uremic syndrome

Hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura occurring in association with a diarrheal illness suggests the diagnosis and should prompt evaluation for STEC

Treatment is primarily supportive (eg, oral or intravenous hydration, antipyretics, etc)

Confirmed infections should be reported to public health officials