E.

coli
Definition
E. coli in your spinach salad or hamburger can make for a memorable meal — one
that leaves you with severe, bloody diarrhea and abdominal cramps. The Escherichia
coli (E. coli) group of bacteria include numerous strains. Most types of E. coli are
harmless and normally live in the intestines of healthy people and animals. But a few
nasty strains, such as E. coli O157:H7, can cause serious food-borne illness,
commonly referred to as food poisoning.

Healthy adults usually recover from illness caused by E. coli O157:H7 within a week,
but young children and older adults can develop a life-threatening form of kidney
failure called hemolytic uremic syndrome (HUS). Antibiotic medications aren't used
for this E. coli problem, because they can increase your risk of developing HUS.

In the United States, about 75,000 people each year become ill after being infected
with E. coli O157:H7. You may be exposed to the bacteria from contaminated water
or food — especially raw vegetables and undercooked ground beef. The best way to
protect yourself from E. coli is to handle your food safely.

Symptoms
Signs and symptoms of E. coli O157:H7 infection typically begin three or four days
after exposure to the bacteria, though you may become ill as soon as one day
afterward to more than a week later. The main signs and symptoms are:

 Diarrhea, which may range from mild and watery to severe and bloody
 Abdominal cramping, pain or tenderness

You may have a low-grade fever or no fever. Some people experience nausea or
vomiting. If your illness is caused by E. coli O157:H7, you may have 10 or more
bowel movements a day, some consisting almost entirely of blood.

Causes
Among the many strains of E. coli, only a few trigger diarrhea. One group of E. coli
— which includes O157:H7 — produces a powerful toxin that damages the lining of
the small intestine, which can cause bloody diarrhea.

A different type of E. coli called enterotoxigenic E. coli is a leading cause of diarrhea

in children in developing countries and is the culprit in many cases of traveler's
diarrhea. This type has become an increasing source of food-borne illness in the
United States and other developed nations. Enterotoxigenic E. coli bacteria are also
spread in contaminated food — including raw fruits and vegetables, raw seafood and
unpasteurized dairy products — and in contaminated water.
How the bacteria spread
You develop an E. coli infection when you accidentally ingest the bacteria. Potential
sources of exposure to contaminated animal or human fecal matter include:

 Contaminated food. Most cases of E. coli O157:H7 have been linked to

undercooked ground beef. But nearly one-quarter of outbreaks stem from
contaminated produce, including spinach, lettuce, cabbage, sprouts and
tomatoes. Prepackaged vegetables and salad mixes may present a particular
risk. The bacteria can also contaminate raw fruits, such as melons.

Meat can become contaminated when cattle are slaughtered and processed.
Most beef in the United States is produced in industrial feedlots, where large
numbers of cattle are raised in close quarters. Ground beef combines meat
from hundreds or even thousands of different animals, increasing the risk of
contamination.

Industrial farming also generates lagoons of liquid manure, which may spill
into nearby streams. Runoff from feedlots can contaminate vegetable fields
and orchards.

E. coli bacteria also can spread from one surface to another, which means that
bacteria on a cow's udder or on equipment can end up in milk. Pasteurization
kills the bacteria, but raw milk can be a source of infection. Other foods that
may become contaminated with E. coli include dry-cured sausage, salami and
unpasteurized apple juice and apple cider.

 Contaminated water. Runoff from feedlots may pollute ground and surface
water, including streams, rivers, lakes and water used to irrigate crops.
Drinking or inadvertently swallowing untreated water from lakes and streams
can cause infection. Although public water systems use chlorine, ultraviolet
light or ozone to kill E. coli, some outbreaks have been linked to contaminated
municipal water supplies. Private wells are a greater cause for concern. Some
people have been infected after swimming in pools or lakes contaminated with
feces.
 Person-to-person contact. E. coli bacteria can easily travel from person to
person, especially when infected adults and children don't wash their hands
properly. Family members of young children with E. coli infection are
especially likely to become sick themselves. Children can shed the bacteria in
their stools for up to two weeks after symptoms improve.

Outbreaks have also occurred among children visiting petting zoos and in animal
barns at county fairs.

Risk factors
E. coli can affect anyone who is exposed to the bacteria. But children and older adults
face a higher risk of developing complications from infection, including severe illness
or HUS.
When to seek medical advice
If you become ill after eating fresh produce or ground beef, or if you have severe or
persistent diarrhea, contact your doctor promptly. Your doctor may test a stool sample
for E. coli bacteria. Most E. coli infections — even those caused by O157:H7 — clear
up on their own. But if you're at high risk of HUS, see your doctor at the first sign of
profuse or bloody diarrhea.

Tests and diagnosis

To diagnose illness caused by E. coli infection, your doctor will send a sample of your
stool to a laboratory to test for the presence of E. coli bacteria. The bacteria may be
cultured to confirm the diagnosis and identify specific toxins, such as those produced
by E. coli O157:H7. Researchers have also done genetic testing of E. coli bacteria to
help determine if an infected person is at risk of developing HUS.

Complications
Most healthy adults recover from E. coli illness within a week. But some people —
particularly young children and older adults — may develop hemolytic uremic
syndrome (HUS). In this syndrome, bacterial toxins enter the bloodstream and start to
destroy red blood cells. The damaged cells clog the tiny blood vessels in the kidneys,
sometimes leading to kidney failure. HUS is the most common cause of acute kidney
failure in children.

About 3 percent to 15 percent of people infected with E. coli O157:H7 develop HUS.
The syndrome occurs most commonly in young children. Taking anti-diarrheal
medications or antibiotics increases your risk of developing HUS, because toxins
from the bacteria stay in your system longer.

Signs and symptoms of HUS include paleness, irritability, weakness, fatigue, low or
no urine output, red urine and bruising. Most children recover completely from HUS
with no permanent damage. But even with the best of care, including kidney dialysis,
a few children die every year of HUS. Others may have lifelong kidney problems or
other complications.

Treatments and drugs

For illness caused by E. coli O157:H7, no current treatments can cure the infection,
relieve symptoms or prevent complications. For most people, the best option is to rest
and drink plenty of fluids to help with dehydration and fatigue. Avoid taking an anti-
diarrheal medication — this slows your digestive system down, preventing your body
from getting rid of the toxins.

Prevention
No vaccine or medication can protect you from E. coli-based illness, though
researchers are investigating potential vaccines. New federal regulations for food
processing have led to a decline in E. coli contamination of ground beef in the United
States, but less progress has been made in improving the safety of commercially
produced vegetables.

To reduce your chance of being exposed to E. coli, follow these precautions:

 Wash raw produce thoroughly, using running water and a scrub brush.
Although washing produce won't necessarily get rid of E. coli — especially in
leafy greens, which provide many spots for the bacteria to attach themselves to
— careful rinsing can remove dirt and reduce the amount of bacteria that may
be clinging to the produce. Plain water is fine. You don't need to use soap or
commercial cleaners to wash produce. You may want to rinse pre-washed
bagged produce before eating. Drying produce with a clean cloth towel or
paper towel may help, too.
 Wash your hands, utensils and kitchen surfaces with hot, soapy water
before and after handling fresh produce or raw meat.
 Keep raw foods separate from ready-to-eat foods. This includes using
separate cutting boards for raw meat and foods such as vegetables and fruits.
 Thoroughly cook ground beef to at least 160 F. Hamburgers should be well-
done. Meat, especially if grilled, is likely to brown before it's completely
cooked, so use a meat thermometer to ensure that meat is heated to at least 160
F at its thickest point. If you don't have a thermometer, cook ground meat until
no pink shows in the center. Never put cooked hamburgers on the same plate
you used for raw patties.
 Order hamburger cooked medium or well-done when eating out. Be
persistent about getting what you ask for, even if it means sending your food
back.
 Drink pasteurized milk, juice and cider. Any boxed or bottled juice kept at
room temperature is likely to be pasteurized, even if the label doesn't say so.
 Avoid drinking untreated water from lakes and streams and swallowing
water when swimming — even pool water, which can be contaminated with
feces.
 Wash your hands thoroughly after preparing or eating food, using the
bathroom or changing diapers. Make sure that children also wash their hands
before eating and after using the bathroom.

Lifestyle and home remedies

Take these measures to prevent dehydration and reduce symptoms while you recover:

 Drink plenty of clear liquids, including water, clear sodas and broths,
gelatin, and juices. Avoid apple and pear juices, caffeine and alcohol.
 Add semisolid and low-fiber foods gradually as your bowel movements
return to normal. Try soda crackers, toast, eggs, rice or chicken.
 Avoid certain foods such as dairy products, fatty foods, high-fiber foods or
highly seasoned foods for a few days.
 Get plenty of rest.