Escherichia coli Infections

Sejal Makvana; Leonard R. Krilov

doi:10.1542/pir.36-4-167

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Sejal Makvana, MD*
Leonard R. Krilov, MD*,^†

^*Department of Pediatrics, Children’s Medical Center at Winthrop University Hospital, Mineola, NY.
^†State University of New York at Stony Brook School of Medicine, Stony Brook, NY.

AUTHOR DISCLOSURE
Dr Makvana has disclosed no financial relationships relevant to this article. Dr Krilov has disclosed that he has research grants from Pfizer and AstraZeneca (MedImmune). This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

EIEC:: enteroinvasive Escherichia coli
ESBL:: extended-spectrum β-lactamase
ETEC:: enterotoxigenic Escherichia coli
HUS:: hemolytic uremic syndrome
STEC:: Shiga toxin–producing Escherichia coli
UPEC:: uropathogenic Escherichia coli
UTI:: urinary tract infection

Educational Gap

Virulent strains of Escherichia coli are responsible for most diarrheal infections, meningitis, septicemia, and urinary tract infections in children worldwide. Clinicians must learn to recognize, treat, and prevent these infections.

Objectives

After completing this article, readers should be able to:

Describe the epidemiology of E coli infections.
Recognize the clinical features of E coli infections, including the O157:H7 strain.
Appropriately treat children with various types of E coli infections.
Understand ways to prevent E coli infections.

Introduction

Escherichia coli are normal inhabitants of the human large intestine. Most strains are harmless, but some strains acquire bacteriophage or plasmid DNA-encoding enterotoxins or invasion factors and become pathogenic. These virulent strains are responsible for diarrheal infections worldwide, as well as neonatal meningitis, septicemia, and urinary tract infections (UTIs).

Microbiology

E coli are gram-negative bacilli of the family Enterobacteriaceae. They are facultative anaerobes and nonsporulating. E coli strains with the K1 capsular polysaccharide antigen cause approximately 40% of cases of septicemia and 80% of cases of meningitis.

Different strains of E coli are associated with a number of distinctive diarrheal illnesses (Table). Among these are the enterotoxigenic E coli (ETEC), enteroinvasive E coli (EIEC), and Shiga toxin–producing E coli (STEC). Of the STEC, E coli O157:H7 is the prototypic strain. Each class of E coli has distinct somatic (O) and flagellar (H) antigens and specific virulence characteristics. (1)

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Table.

Classification of Escherichia coli Associated With Diarrhea

Epidemiology

Diarrheogenic E coli strains are worldwide in distribution. The route of infection is fecal-oral, predominantly via contaminated water and food. STEC, especially E coli O157:H7, is shed in …