Enteric Escherichia Coli infections

• Definition
• The E. coli that cause • 2 Enteroinvasive E. coli
(EIEC)produces a very similar
enteric diseases are of illness to bacilliary dysentery
different serotypes from (shigellosis).
those that cause diseases • 3 Enteropathogenic E. coli
elsewhere. (EPEC) causes an infantile
• Five main types are gastroenteritis
recognised • 4 Enterohaemorrhagic E. coli
(EHIC) includes verotoxin
• 1 Enterotoxogenic E. coli producing E. coli 0157:H7.
(ETECproduces a • 5 Enteroaggregative E. coli (EAEC
diarrhoeal illness. or EaggEC).
Aetiology/pathophysiolog • The toxins are coded for
y on plasmids and can
• 1 Enterotoxogenic E. coli therefore be transferred
between bacteria.
(ETEC) produces a
• The heat labile toxin
diarrhoeal illness.
resembles cholera toxin
• Pathogenesis: Two and acts in a similar way.
toxins are produced, • The heat stable toxin
one that activates guanylate cyclase
• is heat stable and one also resulting in secretory
that is heat labile. diarrhoea
• Clinically three • 2 Enteroinvasive E. coli
syndromes occur with (EIEC) produces a very
this infection: similar illness to
• Acholera-like illness, bacilliary dysentery
traveller’s diarrhoea (shigellosis).
and childhood
diarrhoea, which may
vary in severity.
• 3 Enteropathogenic E. coli
(EPEC) causes an infantile
gastroenteritis.
• Pathogenesis:Toxins are
thought to be involved, the
• bacteria attaches to and
damages intestinal
epithelium.
• Clinical: The condition causes
a diarrhoeal illness
• primarily in children below 2
years.
• 4 Enterohaemorrhagic E. coli
(EHIC) includes verotoxin
• producing E. coli 0157:H7.
• Pathogenesis: The bacteria
produce a shigella-like
• cytotoxin (Shiga toxin).
Infections are associated
• with contaminated food,
particularly hamburgers,
• only a small bacterial load is
required to cause disease.
• Clinical: Patients suffer • 5 Enteroaggregative E. coli
from bloody diarrhoea (EAEC or EaggEC).
and colitis. Haemolytic • Pathogenesis: The bacteria
uraemic syndrome may produce a cytotoxin and
stimulate IL-8 production.
complicate infections
• It is most common in the
with EHIC.
developing world but also
found in the United
Kingdom, especially in
immunocompromised
hosts.
• Clinical: Traveller’s • Management
diarrhoea which lasts • Patients require
up to 4 days, or adequate rehydration,
persistent diarrhoea in normally orally.
immunocompromised • Most infections are self-
limiting.
• In severe cases,
particularly if there are
systemic symptoms,
ciprofloxacin is used
• It has been suggested
from retrospective
studies that treatment of
E. coli 0157 with
antibiotics may result in
increased rates of
haemolytic uraemic
syndrome, but the
treated patients were
also more seriously
unwell.