Esherichia coli

Alternative Names
Traveler's diarrhea - E. coli;
Food poisoning - E. coli; E. coli
diarrhea; Hamburger disease
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Esherichia coli
Gram-negative rod (Bacilli)
Facultative anaerobe
Named after Theodor Escherich
German physician (ca. 1885)
Demonstrated that particular strains were
responsible for infant diarrhea and
gastroenteritis
Normal flora of the mouth and intestine
Protects the intestinal tract from bacterial
infection
Assists in digestion
Produces small amounts of vitamins B12 and K

www3.niaid.nih.gov

Colonizes newborns GI tract within hours

after birth
There are more than 700 different serotypes
of E. coli
Distinguished by different surface proteins
and polysaccharides

Escherichia

Bergeys Manual of Systematic Bacteriology

Escherichia coli
coli- large intestine, colon
Mammalian large intestine

Escherichia blattae
blattae. L. n. blatta cockroach
Hindgut of cockroach Blatta orientalis

Escherichia coli K-12 strain

The original E. coli strain K-12 was
obtained from a stool sample of a
diphtheria patient in Palo Alto, CA in 1922
Strain K-12 was used for biochemical and
genetic studies for many years

Metabolism
F+ plasmids
Bacteriophages
Operons
Genome sequencing

Many strains

Serotypes
Antibody antigen rxn

O antigen

Somatic (on LPS)

171 antigens

H antigen

Flagella
56 antigens

K antigen

Capsule and or
fimbrial antigen
80 antigens

O18ac:H7:K1

18th O antigen
7th

1st K antigen
H antigen
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EPEC
Enteropathogenic E. coli

EIEC
Enteroinvasive E. coli

ETEC
Enterotoxigenic E. coli

Bergeys Manual of Systematic Bacteriology

Summary of the virulence factors of pathogenic

strains of E. coli
Thermolabile toxin (LT)

Fimbriae (Pili)
Thermostable toxin (ST)
Hemolysins
Siderophores
Found alone or together
Flagella
Toxins
Both are plasmid borne
Endotoxin LPS
Capsules
K antigens
LPS
Antigenic variation
Drug resistance plasmids
Toxin and other virulence plasmids
textbookofbacteriology.net

Pathogenic Agent
Urinary Tract Infections
Sepsis / neonatal meningitis
Enteric / diarrheal diseases

Uropathogenic E. coli

UPEC

Most common form of extraintestinal

E. coli infection
Acute symptomatic UTI
12% of all men
10-20% of women
100,000 patients hospitalized for renal
infections

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Symptoms
E. coli enteritis is swelling (inflammation) of the small
intestine from Escherichia coli ( E. coli ) bacteria. It is the
most common cause of travelers' diarrhea. Also the 3rd
leading cause of infant mortality.
Symptoms occur when E. coli bacteria enter the intestine. The time between
being infected and developing symptoms is usually 24 to 72 hours. The most
common symptom is sudden, severe diarrhea that is often bloody.
Other symptoms may include:
Fever
Gas
Loss of appetite
Stomach cramping
Vomiting (rare)
Symptoms of a rare but severe E. coli infection include:
Bruises that happen easily
Pale skin
Red or bloody urine
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Reduced amount of urine

Exams and Tests

A stool culture can be done to check for

disease-causing E.coli .
Toxicity testing by different in vivo, in vitro
and cell culture assay.

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TREATMENT
Most of the time, you will recover from the most common types of E. coli infection
within a couple of days. The goal of treatment is to make you feel better and avoid
dehydration. Getting enough fluids and learning what to eat will help keep you or your
child comfortable. *Avoid anti-diuretic (for toxin removal, Antibiotic - complications
You need to:
Manage the diarrhea
Control nausea and vomiting
Get plenty of rest
You can drink oral rehydration mixtures to replace fluids and minerals lost through
vomiting and diarrhea. Oral rehydration powder can be purchased from a pharmacy. Be
sure to mix the powder in safe water.
You can make your own mixture by dissolving teaspoonful each salt and baking soda
and 4 table spoonsful sugar in 4 cups (1 liter) water.
If you have diarrhea or vomiting and cannot drink or keep enough fluids in your body,
you may need fluids given through a vein (IV).You will need to go to your health care
provider's office or the emergency room.
If you take diuretics (water pills), talk to your health care provider. You may need to stop taking the
diuretic while you have diarrhea. Never stop or change medications without first talking to your
health care provider. You can buy medicines at the drugstore that can help stop or slow diarrhea.
Do not use these medicines without talking to your health care provider if you have bloody 13
diarrhea or a fever. Do not give these medicines to children.

Urovirulence Factors

Hemolysis

Adherence
Fimbriae

Capsule
K antigens

Resist phagocytosis
Resist complement proteins

Aerobactin
Siderophore

Endotoxin

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Neonatal Meningitis E. coli

NMEC

Meningitis in an infection of the fluid and membranes that cover the brain and
spinal cord
Bacteria
Viruses
Fungi

E. coli incites between 1/4 and 1/3 of meningitis cases in newborns

Less than 2% of cases of meningitis at all other ages
Approximately 1 out of 5 newborns with E. coli meningitis dies
Survivors frequently sustain permanent brain damage
The majority of cases occur in premature babies

K-1
80% of NMEC E. coli strains produce K-1 capsular antigens
K1 capsular polysaccharide
O18ac:H7:K1
Inhibits phagocytosis

Siderophore production

Endotoxin

Sequesters Fe

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Enteric / diarrheal diseases

E. coli can adhere to the mucosa of the

large intestine

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Combinations of the O & H antigens

identify the serotype

Clinical Microbiology
Reviews 1998 11:142-201

ETEC
Enterotoxigenic E. coli
EPEC
Enteropathogenic E. coli
EHEC
Enterohemorrhagic E. coli
EAEC
Enteroaggregative E. coli
EIEC
Enteroinvasive E. coli

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Enterotoxigenic E. coli ETEC

Adhere to intestinal mucosa by fimbriae
Produce enterotoxins
Plasmids contain genes for enterotoxins
Cause leakage of intestinal epithelial cells

Loss of electrolytes & water

Attach by fimbriae
Cause diarrhea in children & adults
Toxins increase intracellular levels of cAMP
Causes cell leakage
Travelers diarrhea
Weanling diarrhea
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Enteropathogenic E. coli EPEC

Attaching & effacing

Effacement of
microvilli
Adherence between
bacterium and
epithelial cells
Unique histopathology
Locus of enterocyte
effacement
Clinical Microbiology Reviews 1998 11:142-201

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Clinical Microbiology Reviews 1998 11:142-201

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Enteroaggregative E. coli EAEC

Adhere to HEp-2
cells
Human laryngeal
carcinoma cells

Bacterial cells
autoagglutinate
Stick to one
another
Do not secrete
enterotoxins
Clinical Microbiology Reviews 1998 11:142-201

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Clinical Microbiology Reviews 1998 11:142-201

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Enteroinvasive E. coli EIEC

Biochemically, genetically, and pathogenetically
closely related to Shigella spp.
Cause watery diarrhea
Not bloody

EIEC cells invade intestinal epithelial cells, lyse

the phagosomal vacuole, spread through the
cytoplasm and infect adjacent cell
Shigella does the same thing

Plasmid encoding a gene for a K surface antigen

Attach and invade mucosal cells
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Clinical Microbiology Reviews 1998 11:142-201

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Enterohemorrhagic E. coli EHEC

Severe gastrointestinal distress
Hemorrhagic colitis

Crampy abdominal pain

Watery diarrhea
Little or no fever
Bloody diarrhea

New serotype O157:H7

1983
Undercooked hamburgers
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E. coli 015:H7

Distinguished by serology
Cannot be
distinguished from
all other strains of
E. coli using other
standard
microbiological
tests

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E. coli 015:H7
157th somatic O antigen
7th flagellar H antigen
Hemorrhagic colitis

Abdominal cramps, blood stools, with

minor or no fever

Post diarrheal hemolytic ureamic

syndrome
Acute renal injury
Thrombocytopenia

The Lancet 1998 352:1207-1212

An abnormal decrease in the number of

platelets in circulatory blood.

Microangiopathic hemolytic anemia

The fragmentation of red blood cells

because of narrowing or obstruction of
small blood vessels.

Enterohemorrhagic E. coli
EHEC

Among the most dangerous enteric

pathogens
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Reservoir
Healthy cattle are the major reservoir
for human infection

Deer, sheep, goats, horses, dogs, birds and

flies

Bacterial cells can survive in manure and

water troughs
Infection is more common during the
summer in both the northern and
southern hemisphere

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 Transmitted via food

Ground beef
Raw milk
Lamb meat
Venison jerky
Salami and other fermented dried meat products
Lettuce, spinach, alfalfa sprouts
Unpasteurized apple cider

Transmitted via water

Drinking and swimming in unchlorinated water

Direct person to person contact

Diaper changing
Improper sanitation
Day care & chronic adult care facilities
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Clinical Features
Average interval between
exposure & illness is 3
days
Most patients recover
within 7 days
70% of patients report
bloody stools
30-60% of patients report
vomiting
Approx 5% of patients
develop HUS (Hemolytic Uremic
Syndrome)

The Lancet 1998 352:1207-1212

Sequelae
A condition following as a
consequence of a disease.
Proteinuria
Excess protein in the urine.

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Identification
MacConkey agar (SMAC)
Does not ferment sorbitol rapidly
Forms colorless colonies on sorbitol
containing MacConkey agar

Serology
Colorless colonies on SMAC are screened
for the 0157 antigen
Molecular
In vivo
In vito
Cell culture

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Shiga Like Toxins (SLT)

Exotoxin
Very similar to toxin produced by Shigella
dysenteriae

Inhibits protein synthesis in host cell

A subunit inactivates the 60S ribosomal subunit

Shiga toxin producing E. coli (STEC)

Verotoxins

Most OH157 strains produce Shiga toxin 2

25% produce Shiga toxin 1
Identical to Shigella toxin

A B exotoxin

A subunit exists on a temperate bacteriophage

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Cells leak Na+, Cl-, K+, HCO3- and water

Watery diarrhea
Cramps
Nausea
Vomiting
Bloody stool

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Virulence Factors
Virulence plasmid (pO157)
Encodes a hemolysin
O157 strains can use iron from blood
released into the intestine

Locus of enterocyte effacement

Adhesion proteins

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Non O157 Shiga Toxin Producing E. coli

Several other serotypes of E. coli produce
Shiga toxins
O111:nonmotile
O26:H11
O132:H2

Incite diarrhea, hemorrhagic colitis &

HUS
Labs generally not prepared to identify
these strains
Many times go undetected

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