E. Coli: A-to-Z Guide from Diagnosis to Treatment to Prevention

E. ColiIntroduction to E. coli:

From newborn infections to ground beef recalls, E. coli is an important part of human health and human disease.

What is it?

Escherichia coli bacteria are the major component of normal healthy stool. Some species of E. coli co-exist with us nicely; some species cause serious disease.

Most Escherichia coli bacteria cause no trouble to humans. Problems arise either if Escherichia coli bacteria get somewhere they shouldn’t (such as the urinary tract) or if people are infected by one of the dangerous strains, such as E. coli O157:H7.

E. coli is a major cause of diarrhea (some mild and some severe) and of urinary tract infections.

Who gets it?

Children often get E. coli from food or water that has been contaminated with stool. Undercooked ground beef and unpasteurized milk are common sources, but there have also been outbreaks from other foods such as apple cider, raw vegetables, raw cookie dough, and salami.

Children can get E. coli from swimming or playing in water contaminated with stool.

Children can also get E. coli urinary tract infections (especially if they wipe from back to front).

E. coli is also an important cause of sepsis and meningitis in newborns. They can be infected by E. coli found in the birth canal.

What are the symptoms?

The symptoms of Escherichia coli infection can vary quite widely, depending both on the location of the infection and the strain of E. coli involved.

Diarrhea might be explosive and short-term, or it might be chronic low grade diarrhea that slows a child’s growth. It might be a mild, non-descript diarrheal illness with watery stools, or there may be severe abdominal pain, bloody diarrhea, or a high fever. Those with E. coli O157:H7 might also develop hemolytic uremic syndrome (anemia, low platelets, blood in the stool and urine, and kidney failure).

E. coli in the urinary tract causes typical symptoms of urinary tract infections, which might include burning on urination, increased urination, and perhaps fever.

In newborns, the first signs of E. coli may be subtle. You might see the baby develop some combination of poor feeding, pauses in breathing, a temperature that is too high or too low, irritability, or excessive sleepiness. Some babies vomit, have diarrhea, or have swollen bellies.

Is it contagious?

E. coli can be easily spread from person to person by the fecal-oral route. This is one of the reasons that washing the hands after toileting or diapering is so important. Unwashed hands spread the bacteria widely throughout the environment.

How long does it last?

People tend to develop symptoms between 10 hours and 8 days after being infected. The length of the actual illness can vary greatly.

How is it diagnosed?

Diagnosis of E. coli diarrhea can be difficult. Routine stool cultures usually identify E. coli as a normal stool organism. To find E. coli in the stool, you must be looking specifically for a toxic strain.

Blood tests can offer supportive evidence.

E. coli urinary tract infections are diagnosed with urine cultures. E. coli sepsis is diagnosed with blood cultures. E. coli meningitis is diagnosed with spinal fluid cultures.

How is it treated?

Treatment depends on the location and severity of infection. Fluids are usually important to prevent or treat dehydration.

Antibiotics may be required (as in a urinary tract infection or meningitis), or they may make the situation worse (they can lead to hemolytic uremic syndrome when used in some kinds of E. coli diarrhea).

Work closely with your pediatrician or health care provider when treating E. coli infections.

How can it be prevented?

Real attention to hand washing, especially before eating and after toileting or diapering, can help prevent many E. coli infections. Hand washing is especially important in newborn nurseries and in day care centers.

Fruits and vegetables also need to be washed.

Avoid drinking unpasteurized milk or apple juice.

If children eat ground beef, it should be cooked until there is no pink and the juices run clear.

Children with diarrhea should be kept out of swimming pools and water parks. Don’t let your children swim where there is visible stool in the water, and teach them never to swallow swimming water.

When traveling to undeveloped countries, traveler’s diarrhea precautions should be followed. At home, fecal-oral precautions should be followed at all times.

Related concepts:

Escherichia coli

Alan Greene MD

Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.

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