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enterohemorrhagic Escherichia coli (Shiga toxin-producing E coli)

Epidemiology: - first recognized from outbreaks linked to contaminated ground beef in the 1980s & 1990 [5] - outbreak in Germany 2011 [4] - outbreak in 2017 from flour all from a single commercial facility [5] Pathology: - produces hemorrhagic colitis & hemolytic-uremic syndrome - in the US, most Shiga toxin-producing E coli infections are due to E coli O157:H7 Clinical manifestations: - symptoms 2-8 days (average 3-4 days) after ingestion - low-grade fever or no fever - abdominal pain - bloody diarrhea Laboratory: - enterohemorrhagic Escherichia coli identified in isolate - enterohemorrhagic Escherichia coli identified by culture - Escherichia coli DNA - Escherichia coli Shiga-like toxin 1 gene - Escherichia coli Shiga-like toxin 2 gene - Escherichia coli Shiga-like toxin 1+2 gene panel - Escherichia coli Shiga-like toxin 1+2 genes in stool - Escherichia coli shiga-like toxin 1+2 & H7 flagellar genes - Escherichia coli enteropathogenic eae gene - Escherichia coli enterotoxigenic eltA+estB genes Complications: - hemolytic uremic syndrome - risk increased with antibiotics & antimotility agents [1] Management: - generally self-limited & resolves spontaneously with 4 days [1] - hydration & antiemetics [7] - antibiotics may increase risk of hemolytic uremic syndrome [6,8] - empiric antibiotic therapy with fluoroquinolone, azithromycin, or rifaximin recommended in travelers when symptoms restrict activities [1]

Related

enterohemorrhagic bacterial infection shiga toxin

Specific

Escherichia coli O157:H7

General

Escherichia coli

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Orth D, Grif K, Zimmerhackl LB, Warzner R. Prevention and treatment of enterohemorrhagic Escherichia coli infections in humans. Expert Rev Anti Infect Ther. 2008 Feb;6(1):101-8. PMID: 18251667
  3. Page AV, Liles WC. Enterohemorrhagic Escherichia coli Infections and the Hemolytic-Uremic Syndrome. Med Clin North Am. 2013 Jul;97(4):681-95, xi. Review. PMID: 23809720
  4. Frank C, Werber D, Cramer JP et al Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. N Engl J Med. 2011 Nov 10;365(19):1771-80. PMID: 21696328 Free Article
  5. Crowe SJ, Bottichio L, Shade LN et al. Shiga toxin-producing E. coli infections associated with flour. N Engl J Med 2017 Nov 23; 377:2036 PMID: 29166238
  6. Centers for Disease Control & Prevention (CDC) Food Safety Alert. Jan 9, 2019 Outbreak of E. coli Infections Linked to Romaine Lettuce. https://www.cdc.gov/ecoli/2018/o157h7-11-18/index.html
  7. NEJM Knowledge+ Gastroenterology
  8. Smith KE, Wilker PR, Reiter PL et al Antibiotic treatment of Escherichia coli O157 infection and the risk of hemolytic uremic syndrome, Minnesota. Pediatr Infect Dis J. 2012 Jan;31(1):37-41 PMID: 21892124