Gastroenteritis, Escherichia coli

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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