E. coli enteritis

Answer 1

Definition

E. coli enteritis is inflammation of the small intestine from Escherichia coli (E. coli) bacteria. It is the most common cause of travelers' diarrhea.

Alternative Names

Traveler's diarrhea - E. coli; Food poisoning - E. coli; E. coli diarrhea; Hamburger disease

Causes, incidence, and risk factors

E. coli is a type of bacteria that normally lives in the intestines of humans and animals without causing any problems. However, certain types (or strains) of E. coli can cause food poisoning. One strain (E. coli O157:H7) can cause a severe case of food poisoning.

E. coli germs can get into the food you eat (called contamination) in different ways:

• Meat or poultry can come into contact with the normal bacteria from the intestines of an animal while it is being processed
• Water used during growing or shipping can contain manure or human waste
• Unsafe food handling or preparation in grocery stores, restaurants, or homes

Food poisoning can then occur from eating or drinking:

• Any food prepared by someone who did not use proper hand washing techniques
• Any food prepared using cooking utensils, cutting boards, and other tools that were not fully cleaned
• Dairy products or food containing mayonnaise (such as coleslaw or potato salad) that have sat out of the refrigerator too long. This is most likely to occur in cafeterias, on picnics, and during large social functions.
• Frozen or refrigerated foods that are not stored at the proper temperature or are not reheated properly
• Raw fish or oysters
• Raw fruits or vegetables that have not been washed well
• Raw vegetable or fruit juices and dairy (look for the word "pasteurized")
• Undercooked meats or eggs
• Water from a well or stream, or city or town water that has not been treated

Although not common, E. coli can be spread from one person to another. This may happen when someone does not wash their hands after a bowel movement and then touches other objects or someone else's hands.

Symptoms

Symptoms occur when E. coli bacteria enter the intestine. The time between being infected and developing symptoms is usually 24 - 72 hours.

Diarrhea that is sudden, severe, and often bloody is the most common symptom.

Other symptoms may include:

• Fever
• Gas
• Loss of appetite
• Stomach cramping
• Vomiting(rare)

Symptoms of a rare but severe E. coli infection include:

• Bruises that happen easily
• Pale skin
• Red or bloody urine
• Reduced amount of urine

Signs and tests

The health care provider will perform a physical exam. A stool culture can be done to check for disease-causing E. coli.

Treatment

Cases usually clear up on their own within 1 - 3 days, and no treatment is required.

Antidiarrheal medication may not be recommended, because it can slow the bacteria from leaving the digestive tract.

You may need electrolyte solutions if you are dehydrated. Persons with diarrhea (especially young children) who are unable to drink fluids because of nausea may need medical care and intravenous fluids.

If you take diuretics and develop diarrhea, you may need to stop taking the diuretic during the episode. Do not stop taking any medicine without the advice of your health care provider.

Avoid dairy products. They may make the diarrhea worse due to temporary lactose intolerance.

You can buy medicines at the drugstore that can help stop or slow diarrhea. Do not use these medicines without talking to your health care provider if you have bloody diarrhea or a fever. Do not give these medicines to children.

See also: Diarrhea in children

Expectations (prognosis)

The illness usually runs its course in a few days, without treatment. A small number of patients may need to be admitted to the hospital if they become very dehydrated or they develop hemolytic uremic syndrome.

Complications

Certain types of E. coli can cause severe anemia or even kidney failure.

Calling your health care provider

Call for an appointment with your health care provider if:

• You are unable to keep fluids down
• Diarrhea does not go away in 3 - 4 days
• You see blood in your stool
• You develop symptoms of dehydration
• Your symptoms worsen or do not improve with treatment
• You develop new symptoms

Prevention

Careful hand washing may be helpful. Do not drink untreated or possibly contaminated food or water. Always cook meats well, especially ground meats. Cook meats at high enough temperatures to kill bacteria.

See also: Preventing food poisoning

References

Sodha SV, Griffin PM, Hughes JM. Foodborne disease. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone. 2009;chap 99.

Craig SA, Zich DK. Gastroenteritis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 92.

Answer 2

Definition

E. coli enteritis is inflammation of the small intestine from Escherichia coli (E. coli) bacteria. It is the most common cause of travelers' diarrhea.

Alternative Names

Traveler's diarrhea - E. coli; Food poisoning - E. coli; E. coli diarrhea; Hamburger disease

Causes, incidence, and risk factors

E. coli is a type of bacteria that normally lives in the intestines of humans and animals without causing any problems. However, certain types (or strains) of E. coli can cause food poisoning. One strain (E. coli O157:H7) can cause a severe case of food poisoning.

Bacteria may get into your food in different ways:

• Meat or poultry may come into contact with intestinal bacteria when being processed
• Water that is used during growing or shipping may contain animal or human waste
• Improper food handling or preparation

Food poisoning often occurs from eating or drinking:

• Any food prepared by someone who did not wash their hands properly
• Any food prepared using unclean cooking utensils, cutting boards, or other tools
• Dairy products or food containing mayonnaise (such as coleslaw or potato salad) that have been out of the refrigerator too long
• Frozen or refrigerated foods that are not stored at the proper temperature or are not reheated properly
• Raw fish or oysters
• Raw fruits or vegetables that have not been washed well
• Raw vegetable or fruit juices and dairy products
• Undercooked meats or eggs
• Water from a well or stream, or city or town water that has not been treated

Although not common, E. coli can be spread from one person to another. This may happen when someone does not wash their hands after a bowel movement and then touches other objects or someone else's hands.

Symptoms

Symptoms occur when E. coli bacteria enter the intestine. The time between being infected and developing symptoms is usually 24 - 72 hours.

Diarrhea that is sudden, severe, and often bloody is the most common symptom.

Other symptoms may include:

• Fever
• Gas
• Loss of appetite
• Stomach cramping
• Vomiting(rare)

Symptoms of a rare but severe E. coli infection include:

• Bruises that happen easily
• Pale skin
• Red or bloody urine
• Reduced amount of urine

Signs and tests

Your health care provider will examine you for signs of food poisoning, such as pain in the stomach and signs your body does not have as much water and fluids as it should, called dehydration.

Laboratory tests of your food of your stools may be done to determine if E.coli is causing your symptoms.

Treatment

You will usually recover from the most common types of bacterial gastroenteritis within a couple of days. The goal of treatment is to make you feel better and avoid dehydration.

These things may help you feel better if you have diarrhea:

• Drink 8 to 10 glasses of clear fluids every day. Water is best.
• Drink at least 1 cup of liquid every time you have a loose bowel movement.
• Eat small meals throughout the day, instead of 3 big meals.
• Eat some salty foods, such as pretzels, soup, and sports drinks.
• Eat some high potassium foods, such as bananas, potatoes without the skin, and watered-down fruit juices.

Give your child fluids for the first 4 to 6 hours. At first, try 1 ounce (2 tablespoons) of fluid every 30 to 60 minutes.

Try an over-the-counter drink, such as Pedialyte or Infalyte. Do not water down these drinks. Pedialyte is also available as a popsicle.

Watered-down fruit juice, or broth, may also help.

See also: Diarrhea in children

If you have diarrhea and are unable to drink fluids because of nausea or vomiting, you may need to go to the hospital to receive fluids through a vein (IV). This is especially true for young children.

If you take diuretics, talk to your health care provider. You may need to stop taking the diuretic while you are sick. Never stop or change medications without talking to your health care provider and getting specific instructions.

Antibiotics are usually not prescribed for most common types of bacterial gastroenteritis, unless the diarrhea is extremely severe.

Do not use over-the-counter medicines to treat diarrhea without talking to your doctor first. They should not be given to children.

Expectations (prognosis)

You usually get better in a few days, with proper fluids. Some patients may need to stay in the hospital if they become very dehydrated.

Complications

Certain types of E. coli can cause severe anemia or even kidney failure.

Calling your health care provider

Call for an appointment with your health care provider if you have:

• Blood or pus in your stools
• Black stools
• Stomach pain that does not go away after a bowel movement
• Symptoms of dehydration (thirst, dizziness, light-headedness)
• Diarrhea with a fever above 101°F (100.4°F in children)
• Recently traveled to a foreign country and developed diarrhea

Also call your doctor if:

• The diarrhea gets worse or does not get better in 2 days for an infant or child, or 5 days for adults
• A child over 3 months old has been vomiting for more than 12 hours; in younger babies, call as soon as vomiting or diarrhea begins

Prevention

Careful hand washing may be helpful. Do not drink untreated or possibly contaminated food or water. Always cook meats well, especially ground meats. Cook meats at high enough temperatures to kill bacteria.

See also: Preventing food poisoning

References

Schiller LR, Sellin JH. Diarrhea. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 15.

Reviewed By

Review Date: 01/05/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.