Enterovirulent E. coli (EEC)

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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

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.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

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.

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• 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
    
    
  • EAggEC (enteroaggregative E. coli): clump intestinal cells; chronic mucoid 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.