E. Coli Infection

Symptoms

Enteropathogenic escherichiosis

The incubation time for Class I EPC is several days, and the chief symptoms include vomiting, loose faeces, extreme intoxication, and dehydration. There is a chance that a generalised septic form will manifest. Adults develop class II EPKD, which manifests as salmonellosis-like symptoms.

Enteroinvasive escherichiosis

A course like dysentery or shigellosis is typical for the defeat of EIEC. The abrupt onset, one to three day incubation period, mild intoxication (headache, weakness), subfebrile to high fever levels, and chills are all symptoms. Then comes diarrhoea (occasionally with blood streaks and mucus), followed by abdominal discomfort (mostly in the area around the navel). When the belly is palpated, the colon is in discomfort. This kind of escherichiosis frequently manifests as a mild and erased form, with a modest course. The illness often lasts no more than a few days.

Enterotoxigenic escherichiosis

ETEC involvement may present with clinical symptoms similar to those of salmonellosis, food poisoning , or mild cholera . The incubation period is 1-2 days, intoxication is mild, the temperature usually does not rise, repeated vomiting is noted, profuse enteric diarrhea, dehydration gradually increases, oliguria is noted . There are pains in the epigastric region, which are cramping in nature.
This virus is sometimes referred to as "traveler's disease" since it frequently affects those who have been to tropical areas for work or pleasure. The occurrence of acute fever with chills and intoxication symptoms, as well as severe dehydration, is influenced by climatic circumstances.

Enterohemorrhagic escherichiosis

EHCP develops most often in children. At the same time, intoxication is moderate, the body temperature is subfebrile. There is nausea and vomiting , loose watery stools. In severe cases, by 3-4 days, the disease appears severe pain in the abdomen of a cramping nature, diarrhea intensifies, in stools that lose their fecal character, an admixture of blood and pus may be noted.

Most often, the disease resolves on its own after a week, but in severe cases (especially in young children) on days 7-10, after the disappearance of diarrhea, there is a chance of developing hemolytic- uremic syndrome ( a combination of hemolytic anemia, thrombocytopenia and acute renal failure ). There are frequent violations of brain regulation: cramps of the limbs, muscle rigidity, impaired consciousness up to stupor and coma . The lethality of patients with development of this symptomatology reaches 5%.

Complications

Escherichiosis is usually not prone to complications. In the case of an infection provoked by a pathogen of the EHEC group, there is a possibility of complications from the urinary system, hemolytic anemia, and cerebral disorders.

 

Causes

Escherichia coli (E. coli) is a short, polymorphic, Gram-negative, rod-shaped bacterium whose non-pathogenic strains are present in the normal intestinal flora. Escherichiosis is caused by diarrheagenic serovars of the following groups:

•    Enteropathogenic (EPKP);
•    Enterotoxigenic (ETCP);
•    Enteroinvasive (EICP);
•    Enterohemorrhagic (EHEC);
•    Enteroadhesive (EACP).

Escherichia are able to survive for several months in faeces, water, soil, and other exterior environments. They proliferate and form many colonies in food items, notably milk, and they are easily tolerable of drying. Both boiling and the effects of disinfectants are effective at killing Escherichia coli.

Treatment

Treatment is predominantly outpatient, patients with severe forms and a high risk of complications are subject to hospitalization. Patients are advised diet. For the period of acute clinical manifestations (diarrhea) - table number 4, after termination - table number 13. Moderate dehydration is corrected by taking fluids and rehydration mixtures orally, with an increase and a pronounced degree of dehydration, intravenous infusion of solutions is performed. 
 
As antimicrobial therapy, drugs of the nitrofuran series (furazolidone) or (in severe cases of infection caused by EIEC) fluoroquinolones (ciprofloxacin) are usually prescribed. Drugs are prescribed for 5-7 days. It is advisable to treat escherichiosis of EPKD in children with a combination of sulfamethoxazole and trimethoprim, antibiotic therapy. Generalized forms are treated with second- and third-generation cephalosporins.

To normalise digestion and restore intestinal biocenosis, complicated therapy is used in conjunction with a lengthy course of the disease and includes enzyme preparations and eubiotics. The employment of antitoxic therapeutic methods (serum, extracorporeal adsorption of antibodies) is one of the modern concepts for treating escherichiosis caused by bacteria belonging to the EHEC group.
 

Tests Required for Diagnosis

For the diagnosis of escherichiosis, the pathogen is isolated from feces and vomit, in cases of generalization - from blood, urine, bile or cerebrospinal fluid. After that, a bacteriological examination is performed, sowing on nutrient media. Due to the antigenic similarity of the causative agents of escherichiosis with the bacteria that make up the intestinal normocinosis, serological diagnosis is not very informative.
For laboratory diagnosis of infections caused by EHEC, detection of bacterial toxins in the stools of patients can be used. With this type of escherichiosis, signs of hemolytic anemia , an increase in the concentration of urea and creatinine can be noted in the blood test . Urinalysis usually shows proteinuria, leukocyturia, and hematuria.

Useful info

The prognosis for adults and older children is favorable, with a mild course, there are cases of self-recovery. Young children may suffer from severe escherichiosis, which worsens the prognosis. It is also noticeably more difficult to recover in case of generalization and development of complications. Some particularly severe forms of escherichiosis can end in death without proper medical care.