Escherichia Coli Diarrhea

Escherichia Coli diarrhea is caused by four different strains of the Escherichia Coli bacteria and is characterized most commonly by rapid onset of diarrhea and is seen in individuals ranging from infants to adults.

The four common strains that cause illness in adults are the enterohemorrhagic strain (E. coli 0157:H7) which commonly cause bloody diarrhea, the enterotoxigenic & enteroaggregative strain which are the most common causes of travelers diarrhea and the enteroinvasive strain which commonly causes symptoms of abdominal cramps as well as diarrhea.

Where does it occur?

It occurs worldwide but strains differ in their prevalence as described below.

Enterohemorrhagic (0157:H7) – North America, Europe, Japan, South Africa, and southern South America

Enterotoxigenic – developing nations

Enteroaggregative – developing nations

Enteroinvasive – developing nations

How is it transmitted?

It is transmitted through the ingestion of contaminated food or water.

Is it contagious from person to person?

It is not usually contagious from person to person, however if hands are not washed thoroughly after contact with feces of an infected individual, there is a risk of spreading the illness.

What is the risk for travelers?

The risk of becoming infected with the enterotoxigenic or enteroaggregative strain is high for travelers to developing nations. It can occur in 40-60% of travelers to these regions.

How soon after exposure will I develop symptoms?

Symptoms are seen from 10 hours to 4 days after exposure as described below.

Enterohemmorhagic strain 3-4 days

Enterotoxigenic strain 24-72 hours

Enteroaggregative strain 24-72 hours

Enteroinvasive strain 10-12 hours

What are the signs and symptoms?

Enterohemmorhagic – One can develop mild to moderate to severe watery stools, occasionally bloody, usually without fever. Severe cases develop kidney failure and destruction of red blood cells; a syndrome called hemolytic uremic syndrome or HUS.

Enterotoxigenic – One can develop mild to moderate to severe watery diarrhea, abdominal cramps, a minority with vomiting and low-grade fever. There is usually no blood or pus in stool.

Enteroaggregative – One can develop mild to moderate to severe watery diarrhea, abdominal cramps, a minority with vomiting and low-grade fever. There is usually no blood or pus in stool.

Enteroinvasive – One can develop severe cramps, watery stools, and low-grade fever. Blood and or pus are seen in the stools.

Are there any lab tests to diagnose the illness?

Bacteria can be cultured from stool, isolated by PCR methods or the toxin can be isolated from stool.

Is there any treatment?

Antibiotics like ciprofloxacin, levofloxacin, moxifloxicin or azithromycin are effective for the enterotoxigenic and enteroinvasive illnesses.

Antibiotics could potentially worsen or precipitate the hemolytic uremic syndrome in those infected with the enterohemorrhagic strain((0157:H7)

What preventive measures can be taken?

Practice food safety and water safety precautions

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