ESCHERITCHIA

Escherichia are non-spore-forming, facultatively anaerobic and rod-shaped

bacteria which are normal inhabitants of the gastrointestinal tract. As long as these
bacteria di not acquire genetic elements encoding foe virulence factors, they remain
benign commensals. Strains that acquire bacteriophage or plasmid DNA encoding
enterotoxins or invasion factors become virulent and can cause either a plain,
watery diarrhea or an inflammatory dysentery.

1. There are three groups of E coli are associated with diarrheal diseases.
a. ETEC (enterotoxigenic)-E coli stains that produce enterotoxins.
i. Rapid onset of watery, non-bloody diarrhea of considerable volume,
accompanied by little or no fever
ii. Abdominal pain, malaise, nausea, and vomiting

iii. Diarrhea and other symptoms cease spontaneously after 24 to 72 hours

b. EIEC (enteroinvasive) - E coli stains have invasion factors and cause tissues
destruction and inflammation resembling the effects of Shigella.

i. Diarrhea caused by the enteroinvasive, cytotoxic an enteropathogenic (EPEC)

stains of E coli ranges from very mild to severe.

ii. Ilneas is usually protracted and accompanied by fever.

a). O157, O26 – bloody diarrhea (hemorrhagic colitis)

b). Other serogroup bacillary dysentery (abdominal pain and scanty stool
containing blood and mucus)

c. EPEC (enteropathogenic) – E coli associated with outbreaks of diarrhea in new

born nurseries , but produce no recognizable toxins or invasion factors.

OTHER NAME

Escherichia coli (E. coli) is a bacterium that is commonly found in the gut of
humans and warm-blooded animals. Most strains of E. coli are harmless. Some
strains however, such as Shiga toxin-producing E. coli (STEC), can cause severe
foodborne disease. It is transmitted to humans primarily through consumption of
contaminated foods, such as raw or undercooked ground meat products, raw milk,
and contaminated raw vegetables and sprouts.

STEC produces toxins, known as Shiga-toxins because of their similarity to the

toxins produced by Shigella dysenteriae. STEC can grow in temperatures ranging
from 7 °C to 50 °C, with an optimum temperature of 37 °C. Some STEC can grow
in acidic foods, down to a pH of 4.4, and in foods with a minimum water activity
(aW) of 0.95.

STEC is destroyed by thorough cooking of foods until all parts reach a temperature
of 70 °C or higher. E. coli O157:H7 is the most important STEC serotype in
relation to public health; however, other serotypes have frequently been involved
in sporadic cases and outbreaks.

THE CAUSES OF ESCHERICHA

People and animals normally have some E. coli in their intestines, but some strains
cause infection. The bacteria that cause infection can enter into your body in a
number of ways.

Improper food handling

Whether food is prepared at home, in a restaurant, or in a grocery store, unsafe

handling and preparation can cause contamination. Common causes of food
poisoning include:

 failing to wash hands completely before preparing or eating food

 using utensils, cutting boards, or serving dishes that aren’t clean, causing
cross-contamination
 consuming dairy products or food containing mayonnaise that have been left
out too long
 consuming foods that haven’t been stored at the right temperature
 consuming foods that aren’t cooked to the right temperature or duration of
time, especially meats and poultry
  consuming raw seafood products
 drinking unpasteurized milk
 consuming raw produce that hasn’t been properly washed

Food processing

During the slaughtering process, poultry and meat products can acquire bacteria
from the animals’ intestines.

Contaminated water

Poor sanitation can cause water to contain bacteria from human or animal waste.
You can get the infection from drinking contaminated water or from swimming in
it.

Person to person

E. coli can spread when an infected person doesn’t wash their hands after having a
bowel movement. The bacteria are then spread when that person touches someone
or something else, like food. Nursing homes, schools, and child care facilities are
particularly vulnerable to person-to-person spreading.

Animals

People who work with animals, especially cows, goats, and sheep, are at increased
risk for infection. Anyone who touches animals or who works in an environment
with animals should wash their hands regularly and thoroughly.

SYMPTOMS

Symptoms of the diseases caused by STEC include abdominal cramps and

diarrhoea that may in some cases progress to bloody diarrhoea (haemorrhagic
colitis). Fever and vomiting may also occur. The incubation period can range from
3 to 8 days, with a median of 3 to 4 days. Most patients recover within 10 days, but
in a small proportion of patients (particularly young children and the elderly), the
infection may lead to a life-threatening disease, such as haemolytic uraemic
syndrome (HUS). HUS is characterized by acute renal failure, haemolytic anaemia
and thrombocytopenia (low blood platelets).

It is estimated that up to 10% of patients with STEC infection may develop HUS,
with a case-fatality rate ranging from 3 to 5%. Overall, HUS is the most common
cause of acute renal failure in young children. It can cause neurological
complications (such as seizure, stroke and coma) in 25% of HUS patients and
chronic renal sequelae, usually mild, in around 50% of survivors.

Persons who experience bloody diarrhoea or severe abdominal cramps should seek
medical care. Antibiotics are not part of the treatment of patients with STEC
disease and may possibly increase the risk of subsequent HUS.

COMPLICATION

About 10% of all persons infected with E. coli 0157:H7 develop some
complication. These complications may lead to disability or death. The major
complications are as follows:

 Hemorrhagic (bloody) diarrhea: This complication can prolong the disease

by about a week, and cause severe abdominal pain. The individual may also
develop dehydration and anemia.
 Hemolytic-uremic syndrome (HUS): This condition also prolongs the
disease, as it usually becomes apparent about seven to 10 days after the onset
of symptoms. Children under 10 years of age are the most likely to get this
complication. HUS is the most common cause of renal failure in children. The
toxin produced by E. coli 0157:H7 enters the blood, causing blood cells to be
damaged and small clots to form. The toxin can lodge in the kidneys and
eventually destroy renal tissue. Sometimes the damage is severe enough to
cause kidney failure.
 Thrombotic thrombocytopenic purpura (TTP): This complication is a
variation of HUS that usually occurs in the elderly. The same mechanisms as
those for HUS are responsible for TTP. However, the elderly develop more
 clotting problems and use up more platelets resulting in easy or "spontaneous"
bruising over the body. The elderly experience more fever and neurologic
changes, in addition to kidney damage. Until the 1980's, TTP was considered
a fatal disease. However, treatment with plasma exchange and infusion
techniques has reduced the mortality rate (deaths) to about 10%.

People with a modified or weakened immune system (for example, women who
are pregnant, infants, elderly) are at risk of other complications
like pneumonia, meningitis, and sepsis (E. coli in the blood).

SOURCES AND TRANSMISSION

Most available information on STEC relates to serotype O157:H7, since it is easily

differentiated biochemically from other E. coli strains. The reservoir of this
pathogen appears to be mainly cattle. In addition, other ruminants such as sheep,
goats, deer are considered significant reservoirs, while other mammals (such as
pigs, horses, rabbits, dogs, and cats) and birds (such as chickens and turkeys) have
been found infected.

E. coli O157:H7 is transmitted to humans primarily through consumption of

contaminated foods, such as raw or undercooked ground meat products and raw
milk. Faecal contamination of water and other foods, as well as cross-
contamination during food preparation (with beef and other meat products,
contaminated surfaces and kitchen utensils), will also lead to infection. Examples
of foods implicated in outbreaks of E. coli O157:H7 include undercooked
hamburgers, dried cured salami, unpasteurized fresh-pressed apple cider, yogurt,
and cheese made from raw milk.

An increasing number of outbreaks are associated with the consumption of fruits

and vegetables (including sprouts, spinach, lettuce, coleslaw, and salad) whereby
contamination may be due to contact with faeces from domestic or wild animals at
some stage during cultivation or handling. STEC has also been isolated from
bodies of water (such as ponds and streams), wells and water troughs, and has been
found to survive for months in manure and water-trough sediments. Waterborne
transmission has been reported, both from contaminated drinking-water and from
recreational waters.

Person-to-person contact is an important mode of transmission through the oral-

faecal route. An asymptomatic carrier state has been reported, where individuals
show no clinical signs of disease but are capable of infecting others. The duration
of excretion of STEC is about 1 week or less in adults, but can be longer in children.
Visiting farms and other venues where the general public might come into direct
contact with farm animals has also been identified as an important risk factor for
STEC infection.

Treatment

For illness caused by E. coli, no current treatments can cure the infection, relieve
symptoms or prevent complications. For most people, treatment includes:

 Rest
 Fluids to help prevent dehydration and fatigue

Avoid taking an anti-diarrheal medication — this slows your digestive system

down, preventing your body from getting rid of the toxins. Antibiotics generally
aren't recommended because they can increase the risk of serious complications.

If you have a serious E. coli infection that has caused hemolytic uremic syndrome,
you'll be hospitalized and given supportive care, including IV fluids, blood
transfusions and kidney dialysis.

PORTAL OF ENTRY

The entry point where the microorganism enters the hosts body eg. Mucous
membranes, cuts in the skin of open wounds, tubes such as urinary catheters,
feeding tubes or vascular access devices.

PREVENTION AND CONTROL

Practicing safe food behaviors can decrease your chances of developing an

intestinal infection due to E. coli. These include:
 washing fruits and vegetables thoroughly

 avoiding cross-contamination by using clean utensils, pans, and serving

platters

 keeping raw meats away from other foods and away from other clean items

 not defrosting meat on the counter

 always defrosting meat in the refrigerator or microwave

 refrigerating leftovers immediately

 drinking only pasteurized milk products (avoiding raw milk)

 not preparing food if you have diarrhea

You should also make sure that all meat is cooked properly. The U.S. Department
of Agricultureprovides guidelines for cooking meat and poultry to proper
temperatures to make sure all bacteria are killed. You can use a meat
thermometer to check that meat is cooked to these temperatures:

 poultry: 165˚F (74˚C)

 ground meat, eggs: 160˚F (71˚C)

 steaks, pork chops, roasts, fish, shellfish: 145˚F (63˚C)

One of the easiest things you can do to prevent an E. coli infection is to regularly
wash your hands. You should wash your hands before handling, serving, or
eating food, and especially after touching animals, working in animal
environments, or using the bathroom. Practicing good hygiene and following
food safety guidelines can go a long way to decreasing your risk of infection.

 PREVENTION FOR EPEC,EIEC/ETEC

a. EPEC:
i.Prevent transmission and stressing the importance of breastfeeding of
infants.
ii. Best treatment is oral fluid and electrolyte replacement (intravenous in
severe cases).
 iii. Antibiotics are not recommended because this practice leads to an
increased burden of antibiotics-resistant pathogenic E coli and of more life
threatening enteropathogens.

b. EIEC/ETEC:
i.Prevention and control are generally the same as for ETEC.
ii.Intervention of the fecal-oral transmission cycle is most effective in
institutional situation.
iii.Broad-spectrum antibiotics are recommended in chronic and /or life
threatening cases.

PATHOGENESIS OF ESCHERICHIA (E COLI)

Over 700 antigenic types (serotypes) of E. coli are recognized based on O, H,

and K antigens. At one time serotyping was important in distinguishing the
small number of strains that actually cause disease. Thus, the serotype
O157:H7 (O refers to somatic antigen; H refers to flagellar antigen) is uniquely
responsible for causing HUS (hemolytic uremic syndrome). Nowadays,
particularly for diarrheagenic strains (those that cause diarrhea) pathogenic E.
coli are classified based on their unique virulence factors and can only be
identified by these traits. Hence, analysis for pathogenic E. coli usually
requires that the isolates first be identified as E. colibefore testing for virulence
markers.

Pathogenic strains of E. coli are responsible for three types of infections in

humans:urinary tract infections (UTI), neonatal meningitis, and intestinal
diseases (gastroenteritis). The diseases caused (or not caused) by a particular
strain of E. coli depend on distribution and expression of an array of virulence
determinants, including adhesins, invasins, toxins, and abilities to withstand
host defenses.

NURSING INTERVENTIONS: ESCHERICHIA COLI

1. Replace fluids and electrolytes as needed.
2. Use proper hand-washing technique.
3. Clean the perianal area and lubricate after each episode of diarrhea.
4. Give nothing by mouth, administer antibiotics as ordered, and maintain body
warmth.
5. Keep accurate intake and output records.
6. Measure stool volume and note the presence of blood and pus.
7. Monitor for decreases serum sodium and chloride levels and signs of gram-
negative septic shock.
8. Watch for signs of dehydration.
9. Monitor vital signs to detect early indications of circulatory prolapse.
10. Explain proper hand-washing technique to patient and family.