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For further information, see CMDT Part 33-19: Gastroenteritis Caused by 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


  • 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 with an assay that detects Shiga toxins to detect non-O157 STEC, such as E coli O145


  • Primarily supportive; 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

  • Confirmed infections should be reported to public health officials

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