Escherichia coli enteritis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D., Yazan Daaboul, M.D.

Overview

Symptoms of E. coli enteritis include diarrhea (either watery or bloody), nausea, vomiting, abdominal pain, and bloating with or without fever (fever is characteristically absent in EHEC enteritis, but may be present in the enteritis caused by other E. coli strains). Less common symptoms may be related to complications of E. coli enteritis, such as hemolytic uremic syndrome, and may include spontaneous bruising, oliguria/anuria, and painless gross hematuria.

History

History-taking for patients with E. coli enteritis should focus on risk factors for the transmission of pathogenic E. coli and development of enteritis:

• Immunocompromised status
• Pregnancy
• Recent ingestion of uncooked or poorly handled vegetables, meat, poultry, raw milk, or poorly stored foods that require refrigeration (e.g. mayonnaise)

• Enterohemorrhagic E. coli O157:H7 is commonly associated with ingestion of ground beef (e.g. in hamburgers) or alfalfa sprouts

• Recent drinking from untreated water (e.g. stream or well)
• Recent travel to developing countries

• Enterotoxigenic E. coli is the most common cause of traveler's diarrhea

• Exposure to daycare
• Exposure to healthcare settings (e.g. nursing homes or hospitals)
• Exposure to contacts with similar symptoms
• Recent history of receptive anal or oral-anal contact

Symptoms

Common Symptoms

Common symptoms of E. coli enteritis include:

• Sudden-onset, mild/severe diarrhea that may either be watery or bloody

• Watery (non-inflammatory): ETEC, EPEC, EAEC, and DAEC. Of note, EIEC may cause watery diarrhea, but it is classically associated with bloody diarrhea.
• Bloody (inflammatory): EHEC, EIEC. Of note, EPEC and EAEC may cause bloody diarrhea, but they are classically associated with watery diarrhea.

• Bloating
• Diffuse, cramping abdominal pain
• Anorexia
• Nausea
• Vomiting (less common in E. coli enteritis than in viral gastroenteritis)
• Tenesmus
• Thirst
• Dizziness
• Fever is characteristically absent in E. coli enteritis caused by EHEC, but may sometimes be present in enteritis caused by other E. coli strains

Less Common Symptoms

Less common symptoms of E. coli enteritis are related to the development of complications, such as hemolytic uremic syndrome. Symptoms include:

• Spontaneous bruising
• Painless gross hematuria
• Oliguria/anuria