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Escherichiosis (coli infection)
Last reviewed: 20.11.2021
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Escherichiosis (syn. Escherichioses, coli-infection, coli-enteritis, traveler's diarrhea) is a group of bacterial anthroponous infectious diseases caused by pathogenic (diarrhea) strains of Escherichia coli, with symptoms of general intoxication and gastrointestinal lesions.
ICD-10 codes
- A04.0. Enteropathogenic escherichiosis.
- A04.1. Enterotoxigenic escherichiosis.
- A04.2. Enteroinvasive escherichiosis.
- A04.3. Enterohemorrhagic escherichiosis.
- A04.4. Escherichiosis of other pathogenic serogroups.
Epidemiology of Escherichiosis
The E. Coli normally colonizes the gastrointestinal tract. Its enterotoxigenic and enteropathogenic strains are the main causes of infant diarrhea and traveler's diarrhea in adults. Enterohemorrhagic E. Coli strains, such as type 0157: H7, produce cytotoxins, neurotoxins and enterotoxins, including Shiga toxin, and are therefore capable of causing bloody diarrhea, which in 2-7% of cases may lead to hemolytic-uremic syndrome. These strains are most often received by people when eating insufficiently cooked beef. Other strains of enteroaggregative E. Coli require an early review, as they are potential important causes of persistent diarrhea in patients with AIDS and in children living in tropical regions.
In cases where normal intestinal anatomical barriers are damaged (eg, with ischemia, irritable bowel syndrome, trauma), the E. Coli can spread to underlying structures or enter the bloodstream. The most frequent extraintestinal site of infection is the genito-urinary tract, where the infection usually penetrates the ascending path from the perineum. It is also possible the occurrence of hepatobiliary, peritoneal, cutaneous and pulmonary infections. Bacteremia caused by E. Coli may appear without obvious gate infection. Bacteremia and meningitis due to E. Coli are frequent among newborns, especially in premature babies.
Despite the fact that more than 100 serogonies of Escherichia coli produce Shiga toxin, as well as toxins similar to it, E. Coli 0157: H7 is the most common in North America. In some parts of the US and Canada, the infection caused by E. Coli 0157: H7 may be a more frequent cause of bloody diarrhea than shigellosis and salmonellosis. This infection can occur in people of any age, but acute cases are most common in children and the elderly. The tank for intestinal bacillus 0157: H7 are ruminant animals, so outbreaks and sporadic cases of this infection occur when you eat insufficiently cooked beef (especially goat-baked minced meat) or unpasteurized milk. Food or water contaminated with cow dung or raw ground beef can also become a source of infection. MO can also be transmitted by the fecal-oral route (especially among babies wearing diapers).
After entering the human gastrointestinal tract, E. Coli 0157: H7 and similar strains of Escherichia coli (called Enterohemorrhagic Escherichia coli) produce large amounts of various toxins in the colon lumen. These toxins are similar to the powerful cytotoxins that produce Shigella dysenteriae type 1, cholera vibrio and other enteropathogens. It was found that these toxins are capable of directly damaging mucosal cells and endothelial cells of the vessels of the intestinal wall. When absorbed, they have a toxic effect on the endothelial cells of other vessels, for example, kidney.
[What causes escherichiosis?
Intestinal bacillus is the most numerous species of microorganisms inhabiting the large intestine. Certain strains can produce toxins that cause diarrhea. In addition, all strains can cause an infectious disease in those cases when they get into sterile tissues. Diagnosis of escherichiosis is based on standard techniques of culture research. With diarrhea, it may be useful to study toxins. Treatment with antibiotics is determined by the results of sensitivity tests.
E. Coli 0157: H7 usually causes acute bloody diarrhea, and, sometimes, hemolytic-uremic syndrome. Symptoms of Escherichiosis include cramping abdominal pain and diarrhea, which can be accompanied by a heavy amount of blood. Fever for this infection is insignificant. Diagnosis is based on the culture of feces and on the study of toxins. Treatment that supports the validity of prescribing antibiotics is being discussed.
What are the symptoms of Escherichia?
Escherichiosis caused by E. Coli 0157: H7, usually begins with cramping abdominal pains and watery diarrhea, which can be accompanied by an abundant blood admixture within 24 hours. Some patients describe diarrhea as blood without feces, which formed the basis of the term "hemorrhagic colitis". Fever is usually absent or minor. Sometimes spontaneously body temperature can rise to 39 C. With uncomplicated infection, diarrhea can last 1-8 days.
Approximately 5% of cases (mainly in children less than 5 years old and adults over 60 years old) result in complications such as hemolytic-uremic syndrome, which typically occurs on week 2 of the disease. As with this complication, so without it can be fatal, especially in the elderly.
Where does it hurt?
What's bothering you?
How is Escherichia diagnosed?
Samples of blood, stool or other clinical material are sent for culture. If the enterohaemorrhagic strain is suspected, it is necessary to notify the laboratory about this, since this variant of infection requires a special nutrient medium for detection.
Escherichiosis, caused by E. Coli 0157: H7, must be differentiated with other infectious diarrhea. For this, it is necessary to isolate these MO from the feces cultures. Often, the clinician should ask the laboratory about the search for this particular MO. In view of the fact that bloody diarrhea and acute abdominal pain without fever can have a different non-infectious etiology, the probability of infection due to E. Coli 0157: H7 should be considered for suspicion of ischemic colitis, intestinal invagination and inflammatory bowel syndrome. A rapid study of feces for Shiga toxin can help in the diagnosis of this disease. Patients at risk for non-infectious diarrhea may require an irrigoscopy. During the latter, it is possible to detect erythema and swelling of the sigmoid colon; Barium enema usually proves the presence of edema, with a symptom of a thumbprint.
What do need to examine?
What tests are needed?
How is Escherichia treated?
Escherichiosis is treated empirically, and subsequently the treatment is modified according to the results of the study for susceptibility to antibiotics. Many strains of Escherichia coli are resistant to penicillin and tetracyclines, so other antibiotics, including ticarcillin, piperacillin, cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole and fluoroquinolones, should be used. To drain pus, cleanse necrotic lesions and remove foreign bodies, surgical intervention may be required.
Basically, the treatment for this infection is supportive. Despite the fact that E. Coli is sensitive to the most frequently used antimicrobial drugs, antibiotics do not affect the evolution of symptoms, the elimination of carriage or the prevention of hemolytic-uremic syndrome. In addition, there is a suspicion that fluoroquinolones contribute to the release of enterotoxin.
A week after the infection, high-risk patients developing hemolytic-uremic syndrome (eg children under 5 and elderly) should be examined to identify early signs such as proteinuria, hematuria, the presence of red blood cell debris and elevated serum creatinine levels. Puffiness and hypertension develop later. Patients with complications are likely to require intensive care, including dialysis and other specific therapeutic modalities, in third-order medical centers.
How to prevent escherichiosis?
Escherichiosis can be prevented if it is properly disinfected the stool of infected people, observe hygiene and wash hands thoroughly with soap. Prevention measures that can be effective in a kindergarten include the sharing of infected and uninfected children in different groups or allowing infected children to visit these facilities after 2 negative culture feces. Pasteurization of milk and careful preparation of beef are effective in preventing food transmission of the infection. It is important to report cases of bloody diarrhea to health authorities, since timely intervention by the latter can prevent the occurrence of new infections.