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Foodborne Illness
- See Traveler's Diarrhea
- See Enterohemorrhagic E. coli (EHEC)
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Waterborne Illness
- Outbreak at Rockford, IL lake swimming area (n=12)
- References
- Escherichia coli is a human colonizer, normal colonic flora
- Strains become pathogenic when they acquire DNA from other organisms (see Bacteria for mechanisms)
- Virulence factors (dependent on strain)
- Intestinal epithelial cell invasion
- Mucosal adherence via Pili (colonization factor)
- E. coli 0157:H7 and various other serotypes (over 200)
- Iron-binding siderophore
- E. coli can harvest iron from human Transferrin or lactoferrin
- Exotoxins
- Heat labile toxin (LT, similar to Cholera toxin)
- Heat stable toxin (ST)
- Shiga-like toxin (e.g. 0157:H7)
- Endotoxins
- Lipid A
- Lipopolysaccharide (LPS) layer subcomponent
- Lipid A
- Conditions caused by E. coli
- Acute Diarrhea (see types below)
- Neonatal Meningitis (first month of life)
- Nosocomial Pneumonia
- Gram NegativeSepsis (esp. hospitalized patients)
- Urinary Tract Infections (Acute Cystitis, Pyelonephritis)
- Increased virulence with mucosal adherence via Pili (colonization factor)
- Enterotoxigenic E. coli (ETEC)
- Most common pathogen in Traveler's Diarrhea (Cholera-like rice water Diarrhea)
- Mucosal adherence to intestinal epithelial cells via Pili (colonization factor)
- Releases exotoxins, heat labile (LT) and heat stable (ST)
- Exotoxins inhibit intestinal Sodium and chloride reabsorption
- Exotoxins promote chloride and bicarbonate excretion from intestinal mucosa
- Results in osmotic water losses, which can be severe (liters of fluid losses/day)
- Enteroinvasive E. coli (EIEC)
- Enteroadherent E. coli (EAEC)
- Causes Diarrhea in infants
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Enterohemorrhagic E. coli (EHEC)
- See Enterohemorrhagic E. coli (EHEC)
- Causes bloody Diarrhea and abdominal cramping
- Includes a subset of Shiga Toxin-producing E. coli (e.g. 0157:H7) with a risk of Hemolytic Uremic Syndrome
- Rapid onset in 12-72 hours
- See Traveler's Diarrhea
- See Enterohemorrhagic E. coli (EHEC)
- See Acute Diarrhea
- See Traveler's Diarrhea
- Supportive Care
- Oral Rehydration
- Avoid anti-motility (e.g. Imodium may worsen disease)
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Antibiotics
- Indications
- Severe cases
- Contraindications
- Disadvantages of Antibiotics
- Antibiotics do not alter disease course
- May increase Hemolytic Uremic Syndrome risk
- Course
- Enterotoxigenic E. coli: Treat for 3 days
- Enteroinvasive E. coli: Treat for 5 days
- Adults - first line
- Ciprofloxacin 500 mg twice daily for 3 days
- Adults - second line
- Trimethoprim-Sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days
- Azithromycin 500 mg daily for 3 days (ETEC only)
- Children
- Trimethoprim-Sulfamethoxazole (Bactrim) 10 mg Trimethoprim/kg/day orally divided twice daily for 3 days
- Azithromycin (ETEC only)
- Indications
- CDC E. coli
- Gladwin, Trattler and Mahan (2014) Clinical Microbiology, Medmaster, Fl, 74-5
- Bower (1999) Pediatr Infect Dis J 18:909-10 [PubMed]