E. Coli

1 What Is E. Coli?

Escherichia coli, or E. coli, is a bacterium commonly found in the lower intestines of healthy humans and animals.

Most strains of E. coli are harmless and considered part of the normal intestinal bacterial flora.

However, disease-causing strains of E. coli result in mild, watery diarrhea, urinary tract infections, and, in more severe cases, serious gastroenteritis and neonatal meningitis.

A particular strain, E. coli O157: H7, is a public health concern, because it causes serious infection and spreads through tainted raw vegetables, fruit, and ground meat. One can be exposed to E. coli through contaminated water or food, such as raw vegetables not cleaned properly and consumed as is. Also, meat not cooked properly or undercooked can also lead to exposure to the bacteria. Individuals who have a strong immunity usually recover from the E. coli 0157:H7 within a week’s time. However, children and elderly adults have a greater risk of developing a life-threatening condition involving kidney failure, called uremic syndrome.

Though most infections only cause diarrhea, it can result in life-threatening bleeding in the digestive tract, which may lead to hemolytic uremic syndrome or kidney failure in young children, the elderly, and pregnant individuals.

2 Symptoms

It can take three days to a week after exposure before the signs and symptoms of an E. coli infection appear.

You may experience diarrhea, which can range from mild and watery to severe and bloody, pain in the abdomen, nausea, and vomiting.

Some individuals fall ill almost immediately, while others go a week before feeling sick.

An intestinal infection due to E. coli starts showing symptoms between one and five days once the individual has been infected with the bacterium. Symptoms include:

  • Abdominal cramping
  • Pain or tenderness in the abdomen
  • Fatigue
  • Gas
  • Nausea
  • Vomiting
  • Fever
  • Loss of appetite
  • Malaise
  • Severe and sudden diarrhea, which can change from watery diarrhea to bloody stools

You should see a doctor or go to the hospital upon having persistent or bloody diarrhea.

3 Causes

Only a few strains of E. coli cause disease.

The strain E. coli O157: H7 is pathogenic, because it produces toxins able to break the lining of the intestines, resulting in bloody diarrhea. E. coli O157: H7 can cause infection even if only small amounts are ingested. Traces of E. coli O157: H7 in contaminated water, bean sprouts, and undercooked ground meat is enough to make you sick.

A person with an E. coli O157: H7 infection can also transmit bacteria to others through contact with feces or urine. Eating contaminated food is a common cause of E. coli infection, because the bacteria are able to survive refrigeration and heat below proper cooking temperatures.

E. coli occurs naturally in the digestive tract of cattle and is introduced into the meat when cow intestines are punctured or damaged during slaughter. E. coli is often present in ground meat, because it combines meat from different animals.

Unpasteurized milk tends to have E. coli due to contamination from a cow’s udders. Vegetables like sprouts also tend to have E. coli due to runoff from cattle lots flowing into farms where produce is grown.

Water presents another significant route for E. coli transmission. Raw sewage and farm runoff introduced into bodies of water can place E. coli in public water supplies. Though the use of ozone, ultraviolet radiation, and chlorine in public water sources kills E. coli, contamination of local water supplies often results in outbreaks. You can also get an E. coli infection by drinking or bathing in water from private wells and swimming in contaminated pools or lakes.

People or animal can also transmit E. coli through touching, especially when hand washing practices are insufficient. Children can get infected after interacting with adults or other children. E. coli outbreaks have been linked to touching animals at petting zoos and animal fairs.

4 Making a Diagnosis

To make an E. Coli diagnosis, a medical professional will assess your symptoms.

E. coli causes diarrhea, but that can be attributed to other causes, so most people do not seek medical care. If you experience severe or bloody diarrhea, you should visit your doctor or available emergency services immediately.

Individuals may develop certain acute symptoms that are mild and thus usually do not require a doctor, as the medical condition will resolve on its own. However, when it comes to the infection spreading to a child or infant, it is better to take them to a pediatrician so they can properly examine the condition and provide the correct medicine, if required. If an individual develops severe signs or symptoms, they will need a team of doctors, such as a nephrologist (a kidney specialist), a critical care specialist, a pulmonologist, a hematologist, and a cardiologist, as well as an infectious disease specialist. If it is related to the kidneys, the patient may be referred to a kidney transplant surgeon. In some cases, hospitalization may also be required to resolve complications.

Here are some things you can do to help your doctor diagnose your symptoms:

  • Write down important the symptoms you are experiencing and the time of their occurrence, even seemingly unrelated ones. Also, include information such as recent diet changes, local or international trips taken, and recently-taken medicines or supplements.
  • During the appointment, it can be helpful if you bring a close family member or friend with you to help recall forgotten information.
  • Make a list of questions you might want to ask the doctor.

In case of an E. coli infection, here are some important questions you may want to ask:

  • What most likely caused my symptoms?
  • What are the necessary tests or procedures?
  • What are the available treatments? Which ones are recommended for my case?
  • What are the long-term effects of this illness?
  • What can I do to prevent this from happening again?
  • Can I have printed materials or brochures or access to websites to increase my understanding?

To help make a diagnosis, your doctor may ask you questions such as:

  • When did the symptoms start?
  • How many times have you had watery stools?
  • How many times have you vomited?
  • Has there been blood, bile, or mucus in the vomit or stool?
  • Have you had a fever?
  • Have you had abdominal pain or cramps?
  • Have you travelled outside the country?
  • Is anyone else besides you experiencing symptoms?

Do not take antidiarrheal medicines to address diarrhea caused by an E. coli infection, as diarrhea can help flush out toxins produced by E. coli. Keep yourself or your child hydrated by taking frequent sips of water or other fluids while waiting for treatment.

When to Visit to the Doctor        

Infection of the intestine caused by E. coli can lead to a number of symptoms, such as dehydration and other serious complications like kidney failure, bloody stool, and, in extreme cases, death. Hence, one should not ignore such signs and should visit the doctor before it is too late. An untreated infection can spread very quickly and infect others around as well. One should visit the doctor if:

  • There is the presence of pus or blood in the stool
  • One has recently travelled abroad and is experiencing symptoms related to intestinal infection
  • One has trouble keeping liquids down
  • Pain in the abdomen that doesn’t get better even after a bowel movement
  • There are symptoms pertaining to diarrhea, such as little or no urine output, dizziness, or feeling extremely thirsty
  • Continuous diarrhea that doesn’t get better even after four to five days, in adults, and two days for infants or children
  • Diarrhea accompanied by sudden fever
  • Vomiting signs that have continued for more than twelve hours. In the case of small children, if they start vomiting, it is better to visit a doctor right away.

5 Treatment

Your body is able to resolve an E. coli infection on its own, so you only have to rest and maintain proper hydration for treatment; there is no need for you to take medications for an E. coli infection.

Antidiarrheal drugs will only slow down the expulsion of toxins from the digestive tract, while antibiotics are not recommended because of the risk of complications.

Also, treatment for this disease depends on its severity. Patients with a healthy immune system often do not require any treatment, since many of the infections are self-limited. More so for an acute diarrheal illness, antibiotic treatments have not proven to be useful. Certain studies have shown the use of antibiotics increases the chance of developing a condition called hemolytic uremic syndrome (HUS), because the medicine tends to damage the bacteria, which in turn releases even more toxins that are harmful to the body. The use of antibiotics is suggested only if the patient is septic or if there is any evidence the bacteria has spread to other parts of the body other than the intestine, which can lead to organ damage. Also, the use of certain medicines, such as atropine or diphenoxylate, which are commonly used to cure diarrhea, can also increase or trigger further complications.

Mild infections can be treated with plenty of rest, increasing one’s intake of fruits, and, in rare cases, using antibiotics. If the infection becomes severe and certain complications arise, the following treatments can be used:

  • Intravenous fluids or electrolytes
  • Red blood cell transfusion
  • Hospitalization in the intensive care unit
  • Plasma exchange
  • Kidney dialysis
  • Kidney transplantation
  • Platelet transfusion
  • Certain medications to control high blood pressure
  • Medications to control seizures

6 Prevention

There is no available vaccine to prevent an E. coli infection. However, there are simple things you can do to prevent having one, including:

  • Cook all meats thoroughly. Take note that grilling may brown the meat well below its cooked temperature, so don’t judge by color alone. Using a meat thermometer, cook meat to at least 160°F (71°C) at the center, especially ground meat and steaks. Cook meats until they are all well done, with no pink color.
  • Avoid unpasteurized milk, fruit juices, and cider. Almost all kinds of boxed or bottled drinks have undergone pasteurization.
  • Always wash fresh vegetables and fruits thoroughly, even if they look and feel clean. Leafy greens and sprouts have crevices that harbor bacteria, including E. coli. Washing them removes dirt and reduces the number of bacteria.
  • Do not wash raw chicken. Washing raw chicken can contaminate your kitchen sink and chopping board with bacteria, including E. coli.
  • Use hot, soapy water when washing utensils used to cut vegetables and raw meat.
  • Make sure to keep raw foods separate from cooked or prepared items. Never put cooked meat on the same plate as raw items.
  • Wash your hands frequently before eating, after preparing food, after changing diapers, and after using the toilet. Make sure to teach children to wash their hands after touching animals or playing with pets, before eating, and after using the toilet.

7 Lifestyle and Coping

There are different ways to adapt your lifestyle to cope with E. Coli.

If you only have mild diarrhea or stomach cramps, you can easily treat an E. coli infection at home.

Prevent dehydration and speed up recovery by drinking lots of fluids. Clear fluids such as juices, water, clear sodas, broths, and gelatin are preferable.

Once you start feeling better, gradually introduce low-fiber foods, such as soda crackers, eggs, toast, or rice.

8 Risks and Complications

E. coli is often present in fresh produce, raw meat, and contaminated water, so everyone is at risk of exposure. However, some individuals are more prone to serious health problems caused by an E. coli infection.

  • Hemorrhagic diarrhea, or hemorrhagic entercolitis: This is defined as an increase in the amount of blood in the stool, or diarrheal stool that does not decrease over time and is often later accompanied by pain in the abdomen, which becomes severe over time. Although this issue can resolve over a week’s time, in some instances, it can lead to anemia, dehydration, and even death. Symptoms usually begin to appear within three to four days, but in some individuals, it can take longer. The symptoms also include pain and tenderness in the abdomen and, in some cases, fever.
  • Hemolytic uremic syndrome (HUS): This condition’s symptoms include anemia, bruising, nose bleeds, fever, irregular breathing, and swelling of parts of the body (mostly the hands or legs). This syndrome is caused by the destruction of blood platelets, which are necessary for the clotting of blood. The symptoms pertaining to HUS usually begin to develop about seven to ten days after the initial start of diarrhea. The syndrome is one of the most common causes of kidney failure in children. Children under the age of ten are most likely to develop this syndrome. The E. coli 0157:H7 strain produces toxins which tend to damage the kidneys and destroy the platelets, leading to kidney failure, excessive bleeding, and, in the worst scenario, death. According to certain studies, about 8%–9% of those infected with this bacterium develop the HUS condition. This syndrome leads to the damaging of red blood cells and can also cause kidney failure, which is life-threatening. Such cases are very severe when the infected person is a child, a pregnant woman, or an elderly adult. The onset of HUS begins five to ten days after the start of diarrhea.
  • Thrombotic thrombocytopenic purpura (TTP): This medical condition is caused by excessive loss of platelets. But the symptoms that occur are not the same, and it mostly occurs in elderly adults. A few of the symptoms pertaining to this medical condition are weakness, fever, kidney failure, mental changes or impairments, and bruising easily. These symptoms tend to rapidly progress and lead to organ failure and, in severe cases, death. In the 80s, TTP was considered fatal, but, due to new techniques such as plasma exchange and infusion techniques, the death rate has been reduced in TTP patients to about 10%.