• What is E. coli?
• Which kinds of E. coli can cause disease?
• In whom does EIEC cause disease?
• What does it take to be infected?
• What does EIEC do after entering the bowels?
• How long is the incubation period?
• What are the main features of EIEC disease?
• How is the laboratory diagnosis made?
• Is food associated with EIEC?
• How about food handlers?
• How is diarrhea due to EIEC treated?
• How can EIEC disease be prevented?

What is E. coli?

Escherichia coli (E. coli) is a bacteria that normally lives in the intestines of people (and animals). It can also live elsewhere. Most strains of E coli are quite harmless. They are simply part of the normal intestinal flora. However, there are some kinds of E. coli that are capable of causing disease when within the colon.

Which kinds of E. coli can cause disease?

There are five unique classes of E. coli that can cause inflammation of the stomach and bowels (gastroenteritis) and are, therefore, termed enterovirulent. They are virulent (extremely noxious) for the intestine (or, in Greek, the enteron).

Collectively, these five classes of enterovirulent E. coli are referred to as the EEC group (enterovirulent E. coli). Each class of EEC is distinct and different from the others. They are the:

• Enteroinvasive E. coli (EIEC) invades (passes into) the intestinal wall to produce severe diarrhea. 
• Enterohemorrhagic E. coli (EHEC): A type of EHEC, E.coli 0157:H7, can cause bloody diarrhea and the hemolytic uremic syndrome (anemia and kidney failure).
• Enterotoxigenic E. coli (ETEC) produces a toxin that acts on the intestinal lining, and is the most common cause of travelers diarrhea.
• Enteropathogenic E. coli (EPEC) can causes diarrhea outbreaks in newborn nurseries.
• Enteroaggregative E. coli (EAggEC) can cause acute and chronic (long lasting) diarrhea in children.  

In whom does EIEC cause disease?

Although EIEC can cause disease in people of any age around the world, it severely strikes the very young and old and is most common in the developing world.

What does it take to be infected?

Studies indicate that a relatively large dose (100 million to 10 billion bacteria) is probably necessary to establish a colony of these bacteria in an adult. Infants may require fewer numbers of organisms for infection to be established.

What does EIEC do after entering the bowels?

EIEC adheres to the intestinal wall and invades it. By invading the intestinal wall, EIEC kills cells lining the intestines. This triggers an inflammatory response in the colon (colitis) with ulcers there, swelling of the intestinal wall, bleeding from it, etc.

How long is the incubation period?

The disease can appear within 24 hours of infection with EIEC.

What are the main features of EIEC disease?

The most frequent signs and symptoms of EIEC infection are fever, toxicity (feeling very ill, as if one has been poisoned), abdominal cramps, rectal urgency and tenesmus (straining at the stool), and watery or bloody diarrhea.

How is the laboratory diagnosis made?

During the early (acute) phase of infection, large numbers of EIEC are excreted in the feces. Contaminated feces samples can be examined in the laboratory for diagnosis. These EIEC strains of E. coli can be distinguished from the many other E. coli in the feces by a number of special tests (including immunochemical, tissue culture, and gene probe tests). The lab diagnosis of EIEC takes about 3 days.

Is food associated with EIEC?

The answer is "yes." Although EIEC is not usually considered a serious foodborne disease hazard in countries with high sanitary standards and practices, contamination of water with human sewage or careless food handling can contaminate foods.

How about food handlers?

Infected food handlers can contaminate foods.

How is diarrhea due to EIEC treated?

The greatest concern in treating EIEC disease is to replace the fluids and electrolytes (sodium, potassium, etc.) lost in the diarrhea. This can be done by intravenous (IV) therapy or by mouth using for example the rehydrating solutions that are designed to replace electrolytes.

Infants with EIEC should be put back on the breast or given dilute formula as soon as possible after they have been rehydrated.

Antibiotic therapy with agents such as TMP-SMX (trimethoprim-sulfamethoxazole) helps to eradicate susceptible strains of EIEC (that are not resistant) from the intestines.

How can EIEC disease be prevented?

In traveling to developing countries, the best way to avoid EIEC disease is to:

• Be careful about what fluids you drink
• Drink mineral and other processed water
• Drink bottled beverages
• Drink fruit juices
• Be careful about what foods you eat
• Eat breads
• Eat only fruits and vegetables that can be peeled
• Eat foods that are served steaming hot

EIEC is one of the many reasons that restaurants often have a sign reminding employees to wash their hands before leaving the restroom.

The best way to prevent EIEC disease in infants is to keep the child on the breast as long as possible while paying proper attention to personal hygiene and handling of food and water.

POWER POINTS

• Enteroinvasive E.coli (EIEC) are a class of bacteria that can adhere to and invade the intestinal wall, kill intestinal cells, and produce inflammation in the colon (colitis).
• EIEC causes fever, toxicity, cramping abdominal pain, and watery or bloody diarrhea.
• The cornerstone of EIEC therapy is the replacement of fluids and electrolytes (sodium and other ions) lost in the diarrhea.
• Antibiotics are used to treat EIEC infection.
• The ideal approach to EIEC is to avoid exposure to it.

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