Most
E. coli strains do not cause disease, naturally living in the gut, but virulent strains can cause
gastroenteritis,
urinary tract infections,
neonatal meningitis, hemorrhagic colitis, and
Crohn's disease. Common signs and symptoms include severe abdominal cramps, diarrhea, hemorrhagic colitis, vomiting, and sometimes fever. In rarer cases, virulent strains are also responsible for bowel necrosis (tissue death) and perforation without progressing to
hemolytic–uremic syndrome,
peritonitis,
mastitis,
sepsis, and gram-negative
pneumonia. Very young children are more susceptible to develop severe illness, such as hemolytic uremic syndrome; however, healthy individuals of all ages are at risk to the severe consequences that may arise as a result of being infected with
E. coli. Some strains of
E. coli, for example O157:H7, can produce
Shiga toxin. The Shiga toxin causes inflammatory responses in target cells of the gut, leaving behind lesions which result in the bloody diarrhea that is a symptom of a
Shiga toxin-producing E. coli (STEC) infection. This toxin further causes premature destruction of the red blood cells, which then clog the body's filtering system, the kidneys, in some rare cases (usually in children and the elderly) causing
hemolytic-uremic syndrome (HUS), which may lead to kidney failure and even death. Signs of hemolytic uremic syndrome include decreased frequency of urination, lethargy, and paleness of cheeks and inside the lower eyelids. In 25% of HUS patients, complications of the nervous system occur, which in turn causes
strokes. In addition, this strain causes the buildup of fluid (since the kidneys do not work), leading to
edema around the lungs, legs, and arms. This increase in fluid buildup, especially around the lungs, impedes the functioning of the heart, causing an increase in blood pressure. It is part of the normal microbiota in the gut and can be introduced in many ways. In particular for females, the direction of wiping after defecation (wiping back to front) can lead to fecal contamination of the urogenital orifices. Anal intercourse can also introduce this bacterium into the male urethra, and in switching from anal to vaginal intercourse, the male can also introduce UPEC to the female urogenital system.
Enterotoxigenic E. coli (ETEC) is the most common cause of
traveler's diarrhea, with as many as 840 million cases worldwide in developing countries each year. The bacteria, typically transmitted through contaminated food or drinking water, adheres to the
intestinal lining, where it secretes either of two types of
enterotoxins, leading to watery diarrhea. The rate and severity of infections are higher among children under the age of five, including as many as 380,000 deaths annually. In May 2011, one
E. coli strain,
O104:H4, was the subject of a
bacterial outbreak that began in
Germany. Certain strains of
E. coli are a major cause of
foodborne illness. The outbreak started when several people in Germany were infected with
enterohemorrhagic E. coli (EHEC) bacteria, leading to hemolytic-uremic syndrome (HUS), a medical emergency that requires urgent treatment. The outbreak spread to 15 other countries, including regions in North America. On 30 June 2011, the German
Bundesinstitut für Risikobewertung (BfR) (Federal Institute for Risk Assessment, a federal institute within the German
Federal Ministry of Food, Agriculture and Consumer Protection) announced that seeds of
fenugreek from
Egypt were likely the cause of the EHEC outbreak. Some studies have demonstrated an absence of
E. coli in the gut flora of subjects with the metabolic disorder
Phenylketonuria. It is hypothesized that the absence of these normal bacteria impairs the production of the key vitamins B2 (riboflavin) and K2 (menaquinone) – vitamins which are implicated in many physiological roles in humans such as cellular and bone metabolism – and so contributes to the disorder. '
Carbapenem-resistant E. coli
(carbapenemase-producing E. coli
)' that are resistant to the
carbapenem class of
antibiotics, considered the
drugs of last resort for such infections. They are resistant because they produce an
enzyme called a
carbapenemase that disables the drug molecule.
Incubation period The time between ingesting the STEC bacteria and feeling sick is called the "incubation period". The incubation period is usually 3–4 days after the exposure, but may be as short as 1 day or as long as 10 days. The symptoms often begin slowly with mild belly pain or non-bloody diarrhea that worsens over several days. HUS, if it occurs, develops an average 7 days after the first symptoms, when the diarrhea is improving.
Diagnosis Diagnosis of infectious diarrhea and identification of antimicrobial resistance is performed using a
stool culture with subsequent
antibiotic sensitivity testing. It requires a minimum of 2 days and maximum of several weeks to culture gastrointestinal pathogens. The sensitivity (true positive) and specificity (true negative) rates for stool culture vary by pathogen, although a number of
human pathogens can not be
cultured. For culture-positive samples, antimicrobial resistance testing takes an additional 12–24 hours to perform. Current
point of care molecular diagnostic tests can identify
E. coli and antimicrobial resistance in the identified strains much faster than culture and sensitivity testing. Microarray-based platforms can identify specific pathogenic strains of
E. coli and
E. coli-specific AMR genes in two hours or less with high sensitivity and specificity, but the size of the test panel (i.e., total pathogens and antimicrobial resistance genes) is limited. Newer
metagenomics-based infectious disease diagnostic platforms are currently being developed to overcome the various limitations of culture and all currently available molecular diagnostic technologies.
Treatment The mainstay of treatment is the assessment of
dehydration and replacement of fluid and electrolytes. Administration of
antibiotics has been shown to shorten the course of illness and duration of excretion of enterotoxigenic
E. coli (ETEC) in adults in endemic areas and in traveller's diarrhea, though the rate of resistance to commonly used antibiotics is increasing and they are generally not recommended. The antibiotic used depends upon susceptibility patterns in the particular geographical region. Currently, the antibiotics of choice are
fluoroquinolones or
azithromycin, with an emerging role for
rifaximin. Rifaximin, a semisynthetic rifamycin derivative, is an effective and well-tolerated antibacterial for the management of adults with non-invasive traveller's diarrhea. Rifaximin was significantly more effective than placebo and no less effective than
ciprofloxacin in reducing the duration of diarrhea. While rifaximin is effective in patients with
E. coli-predominant traveller's diarrhea, it appears ineffective in patients infected with inflammatory or invasive
enteropathogens.
Prevention ETEC is the type of
E. coli that most vaccine development efforts are focused on.
Antibodies against the LT and major CFs of ETEC provide protection against LT-producing, ETEC-expressing
homologous CFs. Oral inactivated vaccines consisting of toxin antigen and whole cells, i.e. the licensed recombinant cholera B subunit (rCTB)-WC cholera vaccine Dukoral, have been developed. There are currently no licensed vaccines for ETEC, though several are in various stages of development. In different trials, the rCTB-WC cholera vaccine provided high (85–100%) short-term protection. An oral ETEC vaccine candidate consisting of rCTB and formalin inactivated
E. coli bacteria expressing major CFs has been shown in clinical trials to be safe, immunogenic, and effective against severe
diarrhoea in American travelers but not against ETEC diarrhoea in young children in
Egypt. A modified ETEC vaccine consisting of recombinant
E. coli strains over-expressing the major CFs and a more LT-like hybrid toxoid called LCTBA, are undergoing clinical testing. Other proven prevention methods for
E. coli transmission include handwashing and improved sanitation and drinking water, as transmission occurs through fecal contamination of food and water supplies. Additionally, thoroughly cooking meat and avoiding consumption of raw, unpasteurized beverages, such as juices and milk are other proven methods for preventing
E. coli. Lastly, cross-contamination of utensils and work spaces should be avoided when preparing food. ==Model organism in life science research==