Escherichia coli enteritis natural history, complications and prognosis

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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

Following transmission, the incubation period of pathogenic E. coli strains is approximately 1-10 days, during which the infected patient remains asymptomatic. Early manifestations of E. coli enteritis include severe, acute watery diarrhea, diffuse abdominal pain, and vomiting, which may be followed by episodes of bloody diarrhea (in EHEC and EIEC infections). The majority of patients report resolution of symptoms within 5-10 days of symptom-onset. Common complications of '"E. coli enteritis include hemolytic uremic syndrome (in EHEC infection), thrombotic thrombocytopenic purpura (in EHEC infections), and acute kidney injury. Prognosis of E. coli enteritis is generally excellent, and the majority of cases resolve without any long-term sequelae.

Natural History

• Following transmission, the incubation period of pathogenic E. coli strains is approximately 1-10 days, during which the infected patient remains asymptomatic.
• Early manifestations of E. coli enteritis include severe, acute watery diarrhea, diffuse abdominal pain, vomiting, with or without fever.
• When infected with either EHEC or EIEC, diarrhea usually converts from watery to bloody as the infection progresses.
• Patients typically report symptoms of dehydration due to excessive diarrhea and vomiting.
• The majority of patients report resolution of symptoms within 5-10 days of symptom-onset.
• In rare cases of EHEC infection, hemolytic uremic syndrome may develop approximately 7 days following the onset of symptoms.

Complications

Complications of E. coli enteritis include:

• Hemolytic uremic syndrome (typically develops in EHEC enteritis)
• Thrombotic thrombocytopenic purpura]] (TTP)
• Acute kidney injury may be present in severe dehydration

Prognosis

• The prognosis is generally excellent, and the majority of cases resolve without any long-term sequelae.
• In a minority of cases, patients may die to severe dehydration (more common in developing countries) or severe complications.
• Poor prognostic factors include:

• Young age < 5 years of age
• Old age
• Immunocompromised status
• Pregnancy