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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.

Section 3. Summaries of Infectious Diseases

Escherichia coli Diarrhea

(Including Hemolytic-Uremic Syndrome)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: At least 5 pathotypes of diarrhea-producing Escherichia coli strains have been identified. Clinical features of disease caused by each pathotype are summarized as follows (see also Table 3.6, p 276):


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  		Table 3.6. Classification of Escherichia coli Associated With Diarrhea

  • Shiga toxin-producing E coli (STEC), formerly known as enterohemorrhagic E coli or verotoxin-producing E coli, strains are associated with diarrhea, hemorrhagic colitis, hemolytic-uremic syndrome (HUS), and postdiarrheal thrombotic thrombocytopenic purpura (TTP). Shiga toxin-producing E coli O157:H7 is the prototype and the most virulent member of this E coli pathotype. Illness caused by STEC often begins as nonbloody diarrhea but usually progresses to diarrhea with visible or occult blood. Severe abdominal pain is typical; fever occurs in fewer than one third of cases. Severe infection may result in hemorrhagic colitis.

  • Diarrhea caused by enteropathogenic E coli (EPEC) is watery and often is severe enough to result in dehydration. Severe EPEC diarrhea is characteristically persistent and leads to growth retardation. Illness occurs almost exclusively in neonates and children younger than 2 years of age and predominantly (but not exclusively) in resource-limited countries, either sporadically or in epidemics.

  • Diarrhea caused by enterotoxigenic E coli (ETEC) is a brief (1–5 days) self-limited illness of moderate severity with watery stools and abdominal cramps.

  • Diarrhea caused by enteroinvasive E coli (EIEC) is similar clinically to infection caused by Shigella species. Although dysentery can occur, diarrhea usually is watery without blood or mucus. Patients often are febrile, and stools may contain leukocytes.

  • Enteroaggregative E coli (EAEC) causes watery diarrhea, predominantly in infants and young children . . . [Go to Full Text]