Epidemiology

• Most cases of acute infectious diarrhea are caused by

viruses

• Bacterial pathogens isolated in 1-6% of cases

- Parasites
 Bacterial Pathogens
- Escherichia coli
- Campylobacter
– Salmonella spp.
– Vibrio
– Yersinia spp
– Clostridium spp
– Bacillus cereus
– Staphylococcus aureus
Escherichia coli
The Enterobacteriaceae
 Large family of Gram negative bacilli.
 32 different genera.
 130 different species.
 All members are similar in morphology and
cultural characters.
 Can be differentiated by biochemical reaction and
antigenic structure.

 General characteristic features:

Discovered in 19th century by Theodor Escherich

Morphology:

GNB (Rod), motile, non sporing, Non capsulated

(capsulated)
Cultural characteristics
 Aerobe/facultative anaerobe.
 Culture media: Ordinary
media.
 MA: LF colonies
 BA: Non hemolytic/
hemolytic
Biochemical reactions:

Ferments sugars
( Acid & gas production)

IMViC Test: ++ - -
Habitat
 GI tract of humans
and mammals.

 Universal inhabitant of
human (mammalian)
colon.
Antigenic structure:

Somatic (O) antigen

Capsular (K) antigen

Flagellar (H) antigen

Virulence factor:
E-coli isn’t usually disease-
causing.

- Surface antigens

- Toxins

 Most of E. coli do not

cause disease in humans
(some are beneficial and
some cause infections)..
 Virulence factors
 Adhesions –colonization factors
 Include both pili or fimbriae.
 Antibodies to these may protect one from colonization.
 Capsule
 Outer membrane proteins - help the organism to
invade by helping in attachment (acting as adhesion) .
 Virulence factors: Toxins:

- Hemolysin

- Enterotoxin: movement of water and ions from the

tissues to the bowel resulting in watery diarrhea.

Heat labile toxin (LT)

Heat stable toxin (ST)

Verotoxin (Shiga like toxin).

E. coli toxins
Both enterotoxins composed of five beta
subunits (binding) and 1 alpha subunit (has
the toxic enzymatic activity).
 1. LT – Similar to cholera toxin/less potent
WOW! 1. Binds to specific Gm1 gangliosides on
the epithelial cells ( small intestine).
Strains of bacteria
similar to E. coli
stimulates adenyl cyclase to increase
have been found in
production of cAMP.
spent printer
cartridges -- but
only in the cyan
2. Increased cAMP, alters the activity of
ones. Scientists have
no explanation.sodium and chloride transporters
producing an ion imbalance that results in
fluid transport into the bowel.
E. coli toxins
2. ST – Heat stable and
binds to specific
receptors to stimulate the
production of cGMP with
the same results as with
LT.
E. coli toxins
 Shiga-type toxin(verotoxin) produced by
enterohemorrhagic strains of E. coli (EHEC)
– cytotoxic, enterotoxic, neurotoxic and may
cause diarrhea and ulceration of the G.I.
tract.

 There are two types shiga-like toxin 1 and

Shiga-like toxin 2.
 Inhibit protein synthesis
Clinical infections:

Urinary tract infection.

Diarrhea

Pyogenic infections

Septicemia

Neonatal Meningitis.
Diarrhea:

Diarrheagenic E coli:

- Enterotoxigenic E. coli (ETEC)

- Enteroinvasive E. coli (EIEC)
- Enteropathogenic E. coli (EPEC)
- Enteroaggregative E. coli (EAEC)
- Enterohemorrhagic E. coli (EHEC)
E. coli gastroenteritis (ETEC)
 Traveler's diarrhea

 Attaches to the intestinal mucosa via

colonization factors and then liberates
enterotoxin.

 Watery diarrhea, nausea, abdominal cramps

and low-grade fever for 1-5 days.

 Transmission: contaminated food or water.

 Disease similar to cholera (less severe)

E. coli gastroenteritis- EIEC
 Capacity to invade intestinal epithelial cells.

 Resemble Shigella.

Attaches to the intestinal mucosa via pili and outer

membrane proteins are involved in direct
penetration, invasion of the intestinal cells, and
destruction of the intestinal mucosa.
Symptoms: fever, severe abdominal cramps,
malaise, and watery diarrhea followed by
scanty stools containing blood, mucous, and
pus.

Lab. Diagnosis:
Sereny test: Mucopurulent conjunctivitis in
guinea pigs.
E. coli gastroenteritis- EAEC

 Attach via pili and liberate cytotoxin ST.

 Persistent diarrhea in children

 Symptoms include watery diarrhea, vomiting,

dehydration and occasional abdominal pain.
E. coli gastroenteritis-EHEC (VTEC)
Attaches via pili to the intestinal mucosa and liberates
the Shiga-like toxin.

 watery diarrhea progresses to bloody diarrhea without

pus and crampy abdominal pain with no fever or a
low-grade fever.

 May progress to hemorrhagic-uremic syndrome :

Low platelet count,

hemolytic anemia
kidney failure.
Most often caused by serotypes O157:H7.
Contract organism by ingesting contaminated food.
Common inhabitant of bovine gut.
Organism may be resistant to stomach acid.

Lab diagnosis:
Sorbitol Mac Conkey agar:
Serotypes O157:H7 does not ferment sorbitol.
 Enteropathogenic E. coli

 Diarrhea in infants and children.

 No LT, ST, other known diarrheal toxin

 possible loss of absorptive capacity of mucosal cells.
 The exact mode of pathogenesis: unclear.

 Diarrhea with large amounts of mucous without

blood or pus occurs along with vomiting, malaise
and low grade fever.

 Mainly in hospitalized infants and in day care

centers.
 Causes potentially fatal infant diarrhea in developing
areas.

 SOI: contaminated water, food or fomites

Additional information:

Super-toxic E. coli:
Outbreak in Europe (2011)

The lab, Beijing Genomics Institutes

conducted “a preliminary analysis that
showed the infection caused by an
entirely new super-toxic E. coli strain.”