Organisms that cause E. coli gastroenteritis are usually acquired from contaminated ground beef or water or unpasteurized milk.
Abdominal cramps and diarrhea that may be bloody are the usual symptoms.
The diagnosis is based on a doctor's evaluation and sometimes on the results of stool tests.
Preventive measures include thorough cooking of meat and thorough washing of hands.
Treatment involves drinking plenty of fluids.
(See also Overview of Gastroenteritis Overview of Gastroenteritis Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. It is usually caused by infection with a microorganism but can also be caused by ingestion of chemical... read more .)
There are many strains of Escherichia coli (E. coli) that cause diarrhea or bloody diarrhea (hemorrhagic colitis). In North America, the most common strain that causes bloody diarrhea is E. coli O157:H7 E. coli O157:H7 infection Escherichia coli (E. coli) are a group of gram-negative bacteria that normally reside in the intestine of healthy people, but some strains can cause infection in the digestive... read more . These bacteria naturally occur in the intestines of about 1% of healthy cattle. Outbreaks can be caused by eating undercooked ground beef or by drinking unpasteurized milk or juice. Consuming food or water contaminated with cow manure or raw ground beef can also spread the infection. The infection can be transmitted from person to person, particularly from children in diapers to other people. Inadequately chlorinated recreational water parks can be a source of infection.
E. coli sometimes leave the intestines and cause infections in other parts of the body, such as the urinary tract (see Escherichia coli infections Escherichia coli Infections Escherichia coli (E. coli) are a group of gram-negative bacteria that normally reside in the intestine of healthy people, but some strains can cause infection in the digestive... read more ).
Types of E. coli gastroenteritis
E. coli occur naturally and harmlessly in the digestive tract, but some strains have acquired genes that enable them to cause intestinal infection. The following subtypes of E. coli can cause diarrhea:
Enterohemorrhagic E. coli (also called Shiga toxin-producing E. coli) is the most significant subtype of E. coli in the United States and causes hemorrhagic colitis and hemolytic-uremic syndrome Overview of Thrombocytopenia Thrombocytopenia is a low number of platelets (thrombocytes) in the blood, which increases the risk of bleeding. Thrombocytopenia occurs when the bone marrow makes too few platelets or when... read more in 5 to 10% of people. E. coli O157:H7 is the most common strain of this subtype in the United States. Undercooked ground beef, unpasteurized milk and juice, and contaminated water are possible sources. Person-to-person transmission is common in day care centers. Outbreaks have occurred among people who have gone swimming in pools or lakes or at water parks (called recreational water illness). Hemorrhagic colitis can occur in people of all ages but is most common among children and older people.
Enterotoxigenic E. coli produces two toxins that cause watery diarrhea. This subtype of E. coli bacteria is the most common cause of traveler’s diarrhea Traveler’s Diarrhea Traveler’s diarrhea is an infection characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification. Traveler's diarrhea can... read more in people visiting low- and middle-income countries.
Enteropathogenic E. coli also causes watery diarrhea. It was once a common cause of diarrhea outbreaks in nurseries but is now rare.
Enteroinvasive E. coli causes bloody or nonbloody diarrhea, primarily in low- and middle-income countries. It is rare in the United States.
Enteroaggregative E. coli causes diarrhea that is not as severe but lasts longer than the other subtypes. As with some of the other subtypes, it is more common in low- and middle-income countries and can be a cause of traveler’s diarrhea Traveler’s Diarrhea Traveler’s diarrhea is an infection characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification. Traveler's diarrhea can... read more .
E. coli toxins damage the lining of the large intestine. If the toxins enter the bloodstream, they can also affect other organs, such as the kidneys.
Symptoms of E. coli Gastroenteritis
The most common symptoms of gastroenteritis are diarrhea and abdominal cramps. Although usually mild, the infection also can cause abdominal pain, abdominal expansion (distention) from gas, severe diarrhea, and dehydration Dehydration Dehydration is a deficiency of water in the body. Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration. People feel thirsty, and as dehydration... read more .
Hemorrhagic colitis due to E. coli infection causes severe abdominal cramps begin suddenly along with watery diarrhea, which may become bloody within 24 hours. The diarrhea usually lasts 1 to 8 days. Fever is usually absent or mild but occasionally can exceed 102° F (39° C).
About 5 to 10% of people with hemorrhagic colitis develop a severe complication called hemolytic-uremic syndrome Hemolytic-Uremic Syndrome (HUS) Hemolytic-uremic syndrome (HUS) is a serious disorder that usually occurs in children and involves the formation of small blood clots throughout the body that block the flow of blood to vital... read more . Symptoms include a low red blood cell count (anemia, characterized by fatigue, weakness, and pale skin color) caused by the destruction of red blood cells (hemolytic anemia), a low platelet count (thrombocytopenia Overview of Thrombocytopenia Thrombocytopenia is a low number of platelets (thrombocytes) in the blood, which increases the risk of bleeding. Thrombocytopenia occurs when the bone marrow makes too few platelets or when... read more ), and sudden kidney failure. Some people with hemolytic-uremic syndrome also develop complications of nerve or brain damage, such as seizures or strokes. Hemolytic-uremic syndrome typically develops in the second week of illness, sometimes preceded by an increasing fever. Hemolytic-uremic syndrome is more likely to occur in children under age 5 years and in people over age 60. Even without hemolytic-uremic syndrome and its complications, hemorrhagic colitis may cause death in older people.
Diagnosis of E. coli Gastroenteritis
Sometimes stool tests
Stool tests are not done in most people who have diarrhea because most infectious diarrhea goes away on its own and the symptoms are treated the same regardless of the cause. However, stool tests are done to look for strains of E. coli bacteria or the toxins they produce in certain people, including those who have the following:
Bloody stool (hemorrhagic colitis) or blood in the stool that is too small to see
Moderate to severe diarrhea
Diarrhea lasting more than 7 days
A weakened immune system caused by a disorder such as inflammatory bowel disease or HIV/AIDS
High risk of spreading the infection to others (for example, health care, day care, or food service workers)
Stool tests are also done in people who are 70 years old or older and during known or suspected outbreaks.
If E. coli O157:H7 is suspected, doctors do a stool test for Shiga toxins, which are produced by these bacteria. This test provides results quickly.
Other tests, such as sigmoidoscopy, may be done if a doctor suspects that other diseases may be causing the bloody diarrhea.
Prevention of E. coli Gastroenteritis
Thorough cooking of meat
Improved meat-processing procedures in the United States have helped reduce the rate of meat contamination with E. coli. Despite these measures, ground beef can still be contaminated. Thus, ground beef should be cooked to an internal temperature of 160° F (71° C) or until juices run clear. People should drink only pasteurized milk and milk products.
People should properly dispose of the stool of infected people, practice good hygiene, and wash their hands with soap to limit the spread of infection. Children should no longer have diarrhea and should have two negative stool tests before they are allowed to return to the child care center.
People should report outbreaks of bloody diarrhea to public health authorities, because intervention can prevent infection in other people. Reporting can be done by contacting the local county Department of Health via information found on the web site or in the phone book.
Treatment of E. coli Gastroenteritis
Sometimes fluids by vein
Usually the only treatment needed for E. coli gastroenteritis is getting bed rest and drinking an adequate amount of fluids. If diarrhea is prolonged or the person becomes severely dehydrated, fluids and electrolytes given by vein (intravenously) may be needed. Because children can become dehydrated more quickly, they should be given fluids with the appropriate mix of salts and sugars. Any of the commercially available solutions designed to replace lost fluids and electrolytes (called oral rehydration solutions Treatment Dehydration is loss of water from the body, usually caused by vomiting and/or diarrhea. Dehydration occurs when there is significant loss of body water and, to varying amounts, electrolytes... read more ) are satisfactory. Carbonated beverages, teas, sports drinks, beverages containing caffeine, and fruit juices are not appropriate. If the child is breastfed, breastfeeding Breastfeeding Breast milk is the ideal food for newborns. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend exclusive... read more should continue.
The doctor may prescribe a drug to control the diarrhea, such as diphenoxylate, or instruct the person to use an over-the-counter drug, such as loperamide. These drugs (called antidiarrheal drugs) are typically safe for adults who have watery diarrhea. These drugs are not given to children under 2 years of age, and their use is limited in children 2 to 18 years of age. Antidiarrheal drugs are also not given to people who have recently used antibiotics, who have bloody diarrhea, who have small amounts of blood in the stool that are too small to be seen, or who have diarrhea and fever.
The most important aspect of hemorrhagic colitis treatment is drinking enough fluids. Sometimes so much fluid is lost, however, that a doctor has to replace fluids intravenously. Antibiotics are not given because they do not lessen symptoms, they do not prevent spread of the infection, and they actually increase the risk of developing hemolytic-uremic syndrome Hemolytic-Uremic Syndrome (HUS) Hemolytic-uremic syndrome (HUS) is a serious disorder that usually occurs in children and involves the formation of small blood clots throughout the body that block the flow of blood to vital... read more . Hemorrhagic colitis eventually goes away on its own. However, people who develop complications are likely to require intensive care in the hospital and may need kidney dialysis Dialysis Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. There are a number of reasons... read more and other specific treatment.
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