Escherichia Coli and Other Enterobacteriaceae Infections

Enterobacteriaceae - a family of mostly aerobic, gram-negative bacilli - cause local and systemic infections, including an invasive diarrhea that resembles shigellosis and, more often, a noninvasive, toxin-mediated diarrhea that resembles cholera. With other bacilli of this family, Escherichia coli causes most nosocomial infections. Noninvasive, enterotoxin-producing E. coli infections may be a major cause of diarrheal illness in children in the United States.

The prognosis in mild to moderate infection is good. Severe infection requires immediate fluid and electrolyte replacement to avoid fatal dehydration, especially among children in whom the risk of death may be quite high.

The incidence of E. coli infection is highest among travelers returning from other countries, particularly Mexico (noninvasive), Southeast Asia (noninvasive), and South America (invasive). E. coli infection also causes other diseases, especially in people whose resistance is low.

Causes

Escherichia coli and other Enterobacteriaceae cause most nosocomial infections. Noninvasive, enterotoxin infections may be a major cause of diarrheal illness in children in the United States. Transmission may be occured directly from an infected person or indirectly by ingestion of contaminated food or water or contact with contaminated utensils. Incubation takes in between 12 to 72 hours.

Enterobacteriaceae are distributed worldwide. Their host range includes animals ranging from insects to humans, as well as fruits, vegetables, grains, flowering plants, and trees. E. coli, being a typical member of the Enterobacteriaceae, is presumed to have survival characteristics very similar to those of the well-known pathogenic members of the family, Salmonella and Shigella.

Symptoms and Signs

Effects of noninvasive diarrhea depend on the causative toxin. The symptoms of enterobacterial infections are sometimes classified according to the type of diarrhea they produce.

The symptoms of an E. coli infection may resemble other medical conditions. Always consult your physician for a diagnosis.

• chills
• acidosis
• shock
• severe bloody diarrhea
• non-bloody diarrhea
• severe abdominal cramps

Diagnostic tests

Because certain strains showing E. coli normally reside in the GI tract, culturing is of little value. However, blood cultures of E. coli point to systemic infection.

A firm diagnosis requires sophisticated identification procedures, such as bioassays, which are expensive, time-consuming and, consequently, not widely available. Diagnosis must rule out salmonella infection and shigellosis, other common infections that produce similar signs and symptoms.

Treatment

Appropriate treatment consists of enteric precautions, correction of fluid and electrolyte imbalances and, in an infant or immunocompromised patient, I.V. antibiotics based on the organism's drug sensitivity. For severe diarrhea that poses a risk of dehydration, bismuth subsalicylate or tincture of opium may be ordered.

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