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Section 3. Summaries of Infectious Diseases

Escherichia coli Diarrhea

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 292):

• Shiga toxin-producing E coli (STEC) organisms 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 less than one third of cases. Severe infection can result in hemorrhagic colitis.

• Diarrhea caused by enteropathogenic E coli (EPEC) is watery and often is severe enough to result in dehydration and even death. Chronic EPEC diarrhea characteristically is 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, typically 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) organisms cause watery diarrhea, predominantly in infants and young children in resource-limited countries, but all ages can be affected. Enteroaggregative E coli organisms have been associated with prolonged diarrhea (>14 days). Asymptomatic infection can be accompanied by a . . . [Go to Full Text]

This topic has been referenced by these articles:

• Robson, W. L. M., Tsai, H.-M. (2002). Thrombotic Thrombocytopenic Purpura Attributable to von Willebrand Factor-Cleaving Protease Inhibitor in an 8-Year-Old Boy. Pediatrics 109: 322-325 [Full Version]  
• Ake, J. A., Jelacic, S., Ciol, M. A., Watkins, S. L., Murray, K. F., Christie, D. L., Klein, E. J., Tarr, P. I. (2005). Relative Nephroprotection During Escherichia coli O157:H7 Infections: Association With Intravenous Volume Expansion. Pediatrics 115: e673-e680 [Abstract] [Full Version]  
• Oakes, R. S., Siegler, R. L., McReynolds, M. A., Pysher, T., Pavia, A. T. (2006). Predictors of Fatality in Postdiarrheal Hemolytic Uremic Syndrome. Pediatrics 117: 1656-1662 [Abstract] [Full Version]  
• Brandt, J., Wong, C., Mihm, S., Roberts, J., Smith, J., Brewer, E., Thiagarajan, R., Warady, B. (2002). Invasive Pneumococcal Disease and Hemolytic Uremic Syndrome. Pediatrics 110: 371-376 [Abstract] [Full Version]  
• McCarthy, T. A., Barrett, N. L., Hadler, J. L., Salsbury, B., Howard, R. T., Dingman, D. W., Brinkman, C. D., Bibb, W. F., Cartter, M. L. (2001). Hemolytic-Uremic Syndrome and Escherichia coli O121 at a Lake in Connecticut, 1999. Pediatrics 108: e59-59 [Abstract] [Full Version]  
• Proulx, F., Liet, J. M., David, M., Seidman, E., Tapiero, B., Robitaille, P., Lacroix;, J., Cabrera, G., Butler, J. C., Fortenberry, J. D. (2000). Hemolytic Uremic Syndrome Associated With Invasive Streptococcus pneumoniae Infection. Pediatrics 105: 462-463 [Full Version]  
• Beatty, M. E., Griffin, P. M., Tulu, A. N., Olsen, S. J. (2004). Culturing Practices and Antibiotic Use in Children With Diarrhea. Pediatrics 113: 628-629 [Full Version]  
• Smith-Slatas, C. L., Bourque, M., Salazar, J. C. (2006). Clostridium septicum Infections in Children: A Case Report and Review of the Literature. Pediatrics 117: e796-e805 [Abstract] [Full Version]  
• Del Vecchio, M. T., Sundel;, E. R., Rosefsky;, J. B., Mayoral, C. E., Rosenfeld, W., Marino, R. V., Greensher, J. (2001). Alternating Antipyretics: Is This an Alternative?. Pediatrics 108: 1236-1237 [Full Version]  

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