Presentation
Enteroinvasive forms are clinically similar to Shigella infections and can present with … [pedsinreview.aappublications.org]
Clinical presentation Watery to bloody diarrhea, possibly with mucus (dysentery) Fever, chills, malaise Abdominal cramps Possibly vomiting Symptoms similar to shigellosis Treatment : See antibiotic therapy for E. coli. References: [23] [amboss.com]
The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable. Borborygmi are present even without diarrhea (an important differential feature from paralytic ileus). [deadlydeceit.com]
Genetic tests A negative result for a genetic test suggests that STEC was not present. A positive result suggests that STEC was present. Non- pathogenic E. coli are a normal part of a healthy human digestive system. [labtestsonline.org]
Entire Body System
- Malaise
Malaise, myalgias, and prostration may occur. The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable. [deadlydeceit.com]
Clinical presentation Watery to bloody diarrhea, possibly with mucus (dysentery) Fever, chills, malaise Abdominal cramps Possibly vomiting Symptoms similar to shigellosis Treatment : See antibiotic therapy for E. coli. References: [23] [amboss.com]
Decreased appetite, fever, jaundice, nausea, right upper-quadrant abdominal pain, vomiting CBC, C-reactive protein level, liver function testing, right upper-quadrant ultrasonography Acute hepatitis Abdominal pain, arthralgias, arthritis, fever, jaundice, malaise [aafp.org]
The clinical presentation of EIC consists of mild watery diarrhea, fatigue, malaise, fever and anorexia during the early stages of infection. This is followed by dehydration, abdominal cramps, tenesmus, stools with blood and mucus ( 102 ). [antimicrobe.org]
Respiratoric
- Pneumonia
NDM-1) The production of MBLs of the IMP and VIM types, have mostly been detected in P. aeruginosa and remain relatively rare in members of the Enterobacteriaceae except for K. pneumoniae and E. coli present in Mediterranean Europe (VIM-producing K. pneumoniae [antimicrobe.org]
Mukoide Kolon Page 33 and 34: Klebsiella pneumoniae Page 35 and 36: Intra-abdominale Infektionen Freie Page 37 and 38: FIGURE 25-1 Virulence mechanisms of Page 39 and 40: Pathogene E. coli Stämme-1 ETEC (e Page 41 and 42: ETEC Fig.4.26 Enterotoxigenic [yumpu.com]
Tests to be done include: Stool sample testing for E. coli O157:H7 and other prevalent strains with culture and PCR Serum antibody testing for O157 antigen Culture of sterile body fluids if S. pneumoniae infection is suspected In children with the above [news-medical.net]
Although it is an essential component of the bacterial gut flora, disease may be caused by direct intake of a pathogenic E. coli subtype (e.g., in contaminated food) or spreading of the intestinal bacteria to another organ ( cystitis, pneumonia ). [amboss.com]
Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Public Health. 2011;11(Suppl 3):S23. doi: 10.1186/1471-2458-11-S3-S23. [ncbi.nlm.nih.gov]
Gastrointestinal
- Diarrhea
The resulting diarrhea contains WBCs and RBCs and sometimes gross blood. Several different subtypes of E. coli cause diarrhea. Enterohemorrhagic E. coli is the most clinically significant subtype in the US. [deadlydeceit.com]
[…] therapy, traveler's diarrhea, and bloody diarrhea. [aafp.org]
ETEC → "T" as in “ Traveler's diarrhea ” References: [8] [17] [18] [19] [20] [21] Enteropathogenic Escherichia coli (EPEC) Epidemiology Enteropathogenic Escherichia coli ( EPEC ) leads to infantile diarrhea. [amboss.com]
Enterotoxigenic forms can cause infantile diarrhea and traveler’s diarrhea in all ages and is usually self-limited. Enteroinvasive forms are clinically similar to Shigella infections and can present with … [pedsinreview.aappublications.org]
Enteropathogenic E. coli (EPEC) EPEC induce a profuse watery, sometimes bloody, diarrhea. They are a leading cause of infantile diarrhea in developing countries. [textbookofbacteriology.net]
- Food Poisoning
Food safety: foodborne illness, foodborne disease, (sometimes called “food poisoning”). http://www.cdc.gov/foodsafety/facts.html. Accessed May 15, 2014. 3. U.S. Food and Drug Administration. [aafp.org]
Differential diagnosis : See food poisoning, bacterial gastroenteritis, norovirus infection, and rotavirus infection. [amboss.com]
Some other interesting methods of prevention include knowing your susceptibility to food poisoning by age or health condition, cooking meat thoroughly, maintaining a clean kitchen, avoiding the consumption of raw or unpasteurized food items like milk [microbewiki.kenyon.edu]
- Chronic Diarrhea
Enteropathogenic E coli is a cause of chronic diarrhea that can lead to growth retardation in neonates and children younger than 2 years of age. [pedsinreview.aappublications.org]
[…] levels, hepatitis panel, liver biopsy, liver function testing, ultrasonography Diverticular disease Fever, left lower-quadrant abdominal pain Abdominal CT, CBC; contrast enema and colonoscopy may be considered Inflammatory bowel disease Abdominal pain, chronic [aafp.org]
[…] to the consumption of sprouts. [11] Reported were 3816 cases, which included 54 deaths; 22% involved hemolytic uremic syndrome, which occurred predominantly in female adults. [12] Mortality/Morbidity Several E coli pathotypes have been implicated in chronic [emedicine.medscape.com]
Neurologic
- Irritability
Irritable Bowel Syndrome A recently-published study surveyed the extant scientific literature and noted that post-infectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon first-described over five decades ago. [62] The Walkerton Health [ecoliblog.com]
Patients present with pallor, weakness, irritability, and oliguria or anuria. EPEC also produce AE lesions; however, it does so in the absence of Shiga toxin production. [emedicine.medscape.com]
Urogenital
- Oliguria
Oliguria, severe dehydration and frank blood in stool were not encountered at all amongst E. coli strains not causing dysentery. Biochemically, all the three EIEC strains were non lactose fermenting and non motile. [ijpmonline.org]
Patients present with pallor, weakness, irritability, and oliguria or anuria. EPEC also produce AE lesions; however, it does so in the absence of Shiga toxin production. [emedicine.medscape.com]
The case definition also includes persons with compatible clinical symptoms without laboratory-confirmation if they are epidemiologically linked to a laboratory-confirmed case (these cases represent 3 ), or acute renal dysfunction, defined as either oliguria [journals.plos.org]
Workup
Colonoscopy
- Colitis
A severe outbreak of Escherichia coli 0157:H7-associated hemorrhagic colitis in a nursing home. N. Engl. J. Med. 317 : 1496 – 1500. 13.. Centers for Disease Control and Prevention. 1995. [asmscience.org]
Because bloody diarrhea and severe abdominal pain without fever suggest various noninfectious etiologies, EHEC infection should be considered in suspected cases of ischemic colitis, intussusception, and inflammatory bowel disease. [merckmanuals.com]
[…] shiga like exotoxin causes hemorrhagic colitis (inflammation of the colon with bleeding) inflammation of the colon with bleeding where was the Shiga toxin acquired from Shigella during conjugation lesions in the epithelial mucosa lining of the large intestine [quizlet.com]
Riley, et al., Hemorrhagic Colitis Associated with a Rare Escherichia coli Serotype, 308 New. Eng. – J. [marlerblog.com]
Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-5. Griffin PM, Ostroff SM, Tauxe RV, et al. Illnesses associated with Escherichia coli O157:H7 infections. Ann Intern Med 1988;109:705-12. Griffin PM. [cdc.gov]
Treatment
but treatment was administered late in the course of illness. 11 In a child infected with E. coli O157:H7 who was treated with antibiotics before the onset of diarrhea, fecal shedding of the organisms ceased, but the treatment did not prevent the hemolytic–uremic [nejm.org]
The Connecticut AIDS Drugs Assistance Program The CT AIDS Drug Assistance Program provides eligible low-income residents with medications and health insurance premium assistance for the treatment of HIV and HIV-related conditions. [ct.gov]
See HUS for its specific treatment. Complications : hemolytic-uremic syndrome (particularly in infants /toddlers ) EHEC → " H " as in " Hemolytic-uremic syndrome " is an important complication! [amboss.com]
Treatment and antibiotic resistance: E. coli infections are in general self-limiting, lasting only a few days. However, for most hospital cases and more serious cases in the community, antibiotic treatment may be required. [healthcare.bioquell.com]
Alternative treatment modalities such as the use of monoclonal antibodies are ongoing ( 17 ). [antimicrobe.org]
Prognosis
The most important action to take is avoidance of any short-term intervention that may finally complicate the course of the disease or result in a worse prognosis. [news-medical.net]
Since the longest available follow-up studies of HUS victims are 25 years, an accurate lifetime prognosis is not really available and remains controversial. [marlerblog.com]
Garg, MD, MA, et al ., Long-term Renal Prognosis of Diarrhea-Associated Hemolytic Uremic Syndrome: A Systematic Review, Meta-Analysis, and Meta-regression, 290 JAMA (No. 10) 1360, 1360 (Sept. 10, 2003). [ecoliblog.com]
Etiology
[…] coli O157:H7 and other prevalent strains with culture and PCR Serum antibody testing for O157 antigen Culture of sterile body fluids if S. pneumoniae infection is suspected In children with the above risk factors, overlapping of infectious and genetic etiology [news-medical.net]
Etiology of diarrhoea in children less than five years of age in Ifakara, Tanzania. Am J Trop Med Hyg 2004;70:536-9. [ PUBMED ] [ FULLTEXT ] 9. Kehl KS, Havens P, Behnke CE, Acheson DW. [ijpmonline.org]
Because bloody diarrhea and severe abdominal pain without fever suggest various noninfectious etiologies, EHEC infection should be considered in suspected cases of ischemic colitis, intussusception, and inflammatory bowel disease. [merckmanuals.com]
Escherichia coli 0157:H7 and the hemolytic uremic syndrome: importance of early cultures in establishing the etiology. J. Infect. Dis. 162 : 553 – 556. 52. Watanabe, H.,, A. Wada,, Y. Inagaki,, K. Itoh,, and K. Tamura. 1996. [asmscience.org]
Etiology of acute diarrhea in children and adults in Tunis, Tunisia, with emphasis on diarrheagenic Escherichia coli: prevalence, phenotyping, and molecular epidemiology. Am J Trop Med Hyg. 2007 Sep. 77(3):571-82. [Medline]. [emedicine.medscape.com]
Epidemiology
Epidemiology of sporadic diarrhea due to verocytotox in -producing Escherichia coli: a two-year prospective study. J. Infect. Dis. 157 : 1054 – 1057. 36. Pai, C. H.,, R. Gordon,, H. V. Sims,, and L. E. Bryan. 1984. [asmscience.org]
The presence of the following risk factors should be noted: Relapsing D+HUS Family history of HUS Insidious onset of HUS Epidemiological data should also be gathered. [news-medical.net]
Sabat AJ, Budimir A, Nashev D, Sa-Leao R, van Dijl J, Laurent F, Grundmann H, Friedrich AW ; ESCMID Study Group of Epidemiological Markers (ESGEM). Overview of molecular typing methods for outbreak detection and epidemiological surveillance. [antimicrobe.org]
References: [10] [10] [3] [11] [12] [13] [14] [15] [16] Enterotoxigenic Escherichia coli (ETEC) Epidemiology ETEC is the most common pathogen causing traveler's diarrhea. [amboss.com]
Tauxe, The Epidemiology of Infections Caused by Escherichia coli O157:H7, Other Enterohemorrhagic E. coli, and the Associated Hemolytic Uremic Syndrome, 13 Epidemiologic Reviews 60, 73 (1991). – Peter Feng, Escherichia coli Serotype O157:H7: Novel Vehicles [marlerblog.com]
Pathophysiology
Pathophysiology : Invasion of gut epithelium leads to inflammation and necrosis. [amboss.com]
Pathophysiology In contrast to the essential and beneficial role of most E coli isolates in the human intestine, pathogenic E coli are responsible for a broad spectrum of human disease. [emedicine.medscape.com]
Shiga toxin-associated hemolytic uremic syndrome: pathophysiology of endothelial dysfunction. Pediatr Nephrol. 2010;25(11):2231–2240. doi: 10.1007/s00467-010-1522-1. [PubMed] [CrossRef] [Google Scholar] 45. [ncbi.nlm.nih.gov]
Several types of aggregative fimbrial adhesins and enterotoxins play important roles in the pathophysiology of the disease. [antimicrobe.org]
Prevention
IN CONTEXT : PERSONAL RESPONSIBILITY AND PREVENTION The U.S. [encyclopedia.com]
Pasteurization of milk and thorough cooking of beef prevent food-borne transmission. Reporting outbreaks of bloody diarrhea to public health authorities is important because intervention can prevent additional infections. [merckmanuals.com]
Understandably, the prevention of this chain of events is the key to lowering the incidence of HUS, however no specific antidote has yet been found. The measures listed below have been found useful in preventing HUS. [news-medical.net]
It is important that STEC infections be diagnosed quickly to prevent the bacteria from spreading throughout the community and so that interventions can be made, if necessary, to prevent HUS. [labtestsonline.org]
Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ecoli/june2008outbreak/. Accessed: September 30, 2008. Li F, Zhao C, Zhang W, et al. [emedicine.medscape.com]