Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
All of the EEC groups may have complications associated with infection.
However, some groups have far fewer and potentially less serious complications
than other groups. All of the groups, however, have one potentially serious
complication; dehydration. If left untreated, dehydration can lead to multiple
organ damage and death. Severe dehydration happens infrequently in developed
countries, but in third world countries. In general, in developed countries, ETEC, EAEC and EAggEC group
infections have few complications develop.
A relatively frequent complication of EHEC, EPEC and EIEC is
blood in the
stool. Some individuals will have only a small amount of blood but others may
have large amounts and may require a blood transfusion (severe hemorrhagic
diarrhea).
However, about 10% of all persons infected with EHEC (usually E. coli
0157:H7) develop some complication. Occasionally, the complication(s) may lead
to disability or death. EHEC strains (and sometimes, EIEC group organisms) may
produce the serious problems listed below;
Hemorrhagic (bloody) diarrhea: This complication can prolong the
disease by about a week, and cause severe abdominal pain. The individual may
also develop dehydration, anemia and may need a blood transfusion....
Enterovirulent E. coli (EEC) are bacteria that comprise several groups of
E. coli serovars, all of which may cause diarrhea and other problems in the
intestines.
EEC bacteria can cause a wide range of symptoms ranging from mild to bloody
diarrhea, nausea, vomiting, stomach cramping and dehydration. Different groups
often produce less (EAEC group) or more intense symptoms (EHEC group) and
complications.
Although investigators vary on the group structure and names, six groups
are currently presented in the medical literature, listed by their main symptoms
produced or other "unique" group feature:
EHEC (enterohemorrhagic E. coli): Shiga toxins; bloody diarrhea, 10% with
complications
ETEC (enterotoxigenic E. coli): secretory toxins; watery diarrhea
EPEC (enteropathogenic E. coli): toxin similar to Shigella toxin; watery or
bloody diarrhea
EIEC (enteroinvasive E. coli): invade epithelial cells; mucoid, bloody
diarrhea and fever
EAEC (enteroadherent E. coli): adhere to intestinal cells; watery diarrhea
Dehydration may occur in any EEC group infection; if any signs of
dehydration occur, seek medical care. Also seek care if bloody diarrhea
develops.
EEC infections are often presumptively diagnosed by association with a
food, fluid or person that has been definitively diagnosed or associated with
EEC contamination. Definitive diagnosis is made by isolating the EEC organism
from feces of the patient and identifying the EEC group member by its toxin
production, its unique group properties and its serotype.
The majority of EEC group infections are self-limited; however, preventing
dehydration is the major treatment for all EEC groups.
Self-care at home can be done unless signs of dehydration or bloody
diarrhea develop.
The main complication that leads to other serious problems or death is
dehydration. Serious complications are seen with EHEC group (mainly E. coli
0157:H7) occur more frequently than with the other groups; however, a high death
rate (some report 50%) may occur in third-world countries with ETEC group
infections.
About 10% of EHEC infections (mainly E. coli 0157:H7) develop moderate to
severe complications of bloody diarrhea, hemorrhagic colitis, hemolytic-uremic
syndrome (HUS) and Thrombotic thrombocytopenic purpura (TTP).
Prevention of EEC centers on avoiding foods, fluids and touching persons
with EEC. Cooking meats (especially hamburger meat) and other foods above 160F
help kill the organisms. Food handlers should always keep food preparation items
clean and their hands washed.
What are enterovirulent E. coli (EEC)?
Enterovirulent Escherichia coli (E. coli) are comprised of a number of
serotypes (strains of related bacteria identified by their slightly different
antigenic structures) of bacteria that have a strong propensity to cause
infections, initially in the gastrointestinal tract ("entero" in Greek means
intestine; virulent means deadly or disease-causing). Enterovirulent Escherichia
coli (EEC) are members of the bacterial genus Escherichia, named after T.
Escherich, who first isolated the bacteria in 1885. The majority of the genus Escherichia is composed of one species termed "coli" (Latin for colon); however
there are over 700 serotypes of this bacterial species. Many E. coli serotypes
may cause infections other than in the intestine, but the focus of this article
is on the enterovirulent groups (EEC groups).
Escherichia coli (E. coli) are gram-negative bacteria that are rod-shaped,
have the ability to survive in aerobic and anaerobic environments (termed a
facultative anaerobe), and may or may not produce flagella and pili (thin
hair-like projections) depending on environmental needs.
E. coli strains are
found worldwide and live in significant numbers in humans and other animals as
part of the normal bacterial population found in their large intestines. The
organisms have likely co-existed with humans for eons in the normal flora
(bacterial populations usually found in healthy individuals) of human and other
animal colons. However, among the 700 strains of E. coli, there are a few
strains that cause disease. These E. coli strains are some of the most frequent
causes of many common bacterial infections, including
diarrhea, cholecystitis,
bacteremia, cholangitis, urinary tract infection (UTI), traveler's diarrhea, and
other clinical infections such as neonatal meningitis, pneumonia, abdominal
abscesses and hemolytic uremic syndrome (HUS).
A classic example of such an E.
coli strain is E. coli 0157:H7. The name E. coli 0157:H7 seems complex; however
scientists use the numbers and letters to specifically designate small
differences in E. coli strains. The 0157 is the "O" serotype antigen that
identifies one of the over 700 strains and the "H" of H7 represents the antigen
type on the bacterium's flagella. Some E. coli also possess K antigens
(protein/polysaccharide surface components) that have been used to identify
certain strains. These designations (O, H, and K) may be used to identify
strains causing specific diseases and have been utilized to identify outbreaks
of disease.
What are the symptoms caused by
enterovirulent E. coli (EEC)?
The major symptom that all enterovirulent E. coli (EEC) produce in common is
diarrhea. However, the type of diarrhea (for example, bloody, chronic, or
self-limiting) and the complications that may accompany the infections differ
from each other. Similarities of symptoms have caused researchers and clinicians
to arrange E. coli serotypes into groups according to their symptoms and common
pathogenic mechanisms. Depending on which research or clinical physicians
publications are read, there are 4 to 6 groups of E. coli that comprise
all of the enterovirulent E. coli (EEC). Unfortunately, some investigators have more
than one term for some members of the groups. The following is a summary of the
groups that are currently in the literature and the symptoms group members
cause:
EHEC (enterohemorrhagic E. coli): bloody diarrhea,
hemorrhagic colitis,
hemolytic uremic syndrome (HUS), and
thrombotic thrombocytopenic purpura (TTP);
additional terms for EHEC are VTEC and STEC which stand for Vero toxin-producing
E. coli and Shiga toxin-producing E. coli, respectively. One serotype, E. coli
0157:H7, is responsible for the majority of the bloody diarrhea that occurs due
to the production of Shiga toxins.
ETEC (enterotoxigenic E. coli):traveler's diarrhea, a watery diarrhea
with nausea, abdominal cramping, and
fever, caused by several serotypes of E.
coli (0169:H47, 0148:H28 and several others) that produce two toxins that cause
the gastrointestinal tract to secrete fluid (secretory exotoxins)
EPEC (enteropathogenic E. coli): childhood diarrhea, caused by E. coli
bacteria (many different serotypes) that can attach to gastrointestinal tissues,
especially in infants, and produces a watery or bloody diarrhea in infants by
producing a toxin similar to that produced by the bacterium named
Shigella
dysenteriae.
EIEC (enteroinvasive E. coli):Shigella-like dysentery with blood and
mucus, due to E. coli that invade epithelial cells of people of all ages, also
producing vomiting, fever and
chills. These serotypes are closely related to
Shigella spp. (a few children develop HUS)
EAEC (enteroadherent E. coli): childhood watery diarrhea, some cases of traveler's diarrhea in adults, and some urinary tract infections. This group is
composed of E. coli strains (for example, 0119 or 055) that are able to adhere
to human cells (gastrointestinal and other cell types). About one-half of this
group are able to cause mild diarrhea, usually in children, while other E. coli
serotypes that can adhere, do not cause any disease. Like EAggEC, these
enteroadherent E. coli do not produce any Shiga toxins or secretory-causing
exotoxins.
EAggEC (enteroaggregative E. coli): persistent diarrhea in developing
countries especially in children that usually lasts more than 14 days. The
diarrhea is watery, mucus-containing, and in about one-third of individuals, bloody.
Those with EAggEC usually have only a low fever (less than 101 F or 38.3 C) and almost no vomiting.
These E. coli serotypes (for example, 042 and 044) do not produce any Shiga
toxins or secretory exotoxins that cause secretions but cause intestinal
inflammation that is linked to abnormally high intestinal secretion that leads
to watery diarrhea. These strains are unique because they "aggregate" (form
small masses comprised of cultured tissue cells and bacteria) human
gastrointestinal cells by attaching via fimbriae (pili).
As one can surmise, there are unfortunate overlaps in disease syndromes
and that is one reason that authors disagree on the actual number of groups
(EPEC, EAEC, and EAggEC or EACE and EAggEC are often lumped together). It seems
unlikely that the group names will remain stable in the future (see next
section).
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Salmonella bacteria are known to cause salmonellosis, typhoid fever, and paratyphoid fever in humans. Salmonella infection is usually caused by ingesting large amounts of the bacteria in contaminated food or water.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Meningitis is an infection that causes inflammation of the meninges that surround the brain and spinal cord. Symptoms of meningitis include high fever, headache, nausea, vomiting, and stiff neck.
Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include
Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
Recreational Water Illnesses (RWIs) are caused by germs spread by breathing in mists or aerosols, swimming, or having contact with contaminated water in hot tubs, water parks, water play areas, fountains, lakes, rivers, oceans, and swimming pools. Diarrhea is the most commonly reported recreational water illness. Diarrheal illnesses are caused by germs such as Crypto, Shigella, Norovirus, E. coli, and Giardia. Prevention of water born illnesses is key to avoid infection. Avoid swallowing water and practice good hygiene habits are a must.
Pneumonia is a lung infection that can be caused by
different types of microorganisms, including bacteria, viruses, and fungi.
Symptoms of pneumonia include cough with sputum
production, fever, and sharp chest pain on inspiration (breathing in).
Pneumonia is suspected when a doctor hears abnormal
sounds in the chest, and the diagnosis is confirmed by a chest X-ray.
Bacteria causing pneumonia can be identified by sputum
culture.
A pleural effusion is a fluid collection around the
inflamed lung.
Bacterial and fungal (but not viral)
pneumonia can be treated with antibiotics.
What is pneumonia?
Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died fro...
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