E. coli
Escherichia coli (E. coli) bacteria normally live in the intestines of healthy people and animals. Most types of E. coli are harmless or cause relatively brief diarrhea. But a few strains, such as E. coli O157:H7, can cause severe stomach cramps, bloody diarrhea and vomiting.
You may be exposed to E. coli from contaminated water or food — especially raw vegetables and undercooked ground beef. Healthy adults usually recover from infection with E. coli O157:H7 within a week. Young children and older adults have a greater risk of developing a life-threatening form of kidney failure.
Signs and symptoms of E. coli O157:H7 infection usually begin three or four days after exposure to the bacteria. But you may become ill as soon as one day after exposure to more than a week later. Signs and symptoms include:
- Diarrhea, which may range from mild and watery to severe and bloody
- Stomach cramping, pain or tenderness
- Nausea and vomiting, in some people
When to see a doctor
Contact your doctor if your diarrhea is persistent, severe or bloody.
Only a few strains of E. coli trigger diarrhea. The E. coli O157:H7 strain belongs to a group of E. coli that produces a powerful toxin that damages the lining of the small intestine. This can cause bloody diarrhea. You develop an E. coli infection when you ingest this strain of bacteria.
Unlike many other disease-causing bacteria, E. coli can cause an infection even if you ingest only small amounts. Because of this, you can be sickened by E. coli from eating a slightly undercooked hamburger or from swallowing a mouthful of contaminated pool water.
Potential sources of exposure include contaminated food or water and person-to-person contact.
Contaminated food
The most common way to get an E. coli infection is by eating contaminated food, such as:
- Ground beef. When cattle are slaughtered and processed, E. coli bacteria in their intestines can get on the meat. Ground beef combines meat from many different animals, increasing the risk of contamination.
- Unpasteurized milk. E. coli bacteria on a cow’s udder or on milking equipment can get into raw milk.
- Fresh produce. Runoff from cattle farms can contaminate fields where fresh produce is grown. Certain vegetables, such as spinach and lettuce, are particularly vulnerable to this type of contamination.
Contaminated water
Human and animal stool may pollute ground and surface water, including streams, rivers, lakes and water used to irrigate crops. Although public water systems use chlorine, ultraviolet light or ozone to kill E. coli, some E. coli outbreaks have been linked to contaminated municipal water supplies.
Private water wells are a greater cause for concern because many don’t have a way to disinfect water. Rural water supplies are the most likely to be contaminated. Some people also have been infected with E. coli after swimming in pools or lakes contaminated with stool.
Personal 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 get it themselves. Outbreaks have also occurred among children visiting petting zoos and in animal barns at county fairs.
E. coli can affect anyone who is exposed to the bacteria. But some people are more likely to develop problems than are others. Risk factors include:
- Age. Young children and older adults are at higher risk of experiencing illness caused by E. coli and more-serious complications from the infection.
- Weakened immune systems. People who have weakened immune systems — from AIDS or from drugs to treat cancer or prevent the rejection of organ transplants — are more likely to become ill from ingesting E. coli.
- Eating certain types of food. Riskier foods include undercooked hamburger; unpasteurized milk, apple juice or cider; and soft cheeses made from raw milk.
- Time of year. Though it’s not clear why, the majority of E. coli infections in the U.S. occur from June through September.
- Decreased stomach acid levels. Stomach acid offers some protection against E. coli. If you take medications to reduce stomach acid, such as esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid) and omeprazole (Prilosec), you may increase your risk of an E. coli infection.
Most healthy adults recover from E. coli illness within a week. Some people — particularly young children and older adults — may develop a life-threatening form of kidney failure called hemolytic uremic syndrome.
No vaccine or medication can protect you from E. coli-based illness, though researchers are investigating potential vaccines. To reduce your chance of being exposed to E. coli, avoid swallowing water from lakes or pools, wash your hands often, avoid risky foods, and watch out for cross-contamination.
To diagnose illness caused by E. coli infection, your doctor sends 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.
For illness caused by E. coli, no current treatments can cure the infection, relieve symptoms or prevent complications. For most people, treatment includes:
- Rest
- Fluids to help prevent dehydration and fatigue
Avoid taking an anti-diarrheal medication — this slows your digestive system down, preventing your body from getting rid of the toxins. Antibiotics generally aren’t recommended because they can increase the risk of serious complications and they don’t appear to help treat the infection.
If you have a serious E. coli infection that has caused a life-threatening form of kidney failure (hemolytic uremic syndrome), you’ll be hospitalized. Treatment includes IV fluids, blood transfusions and kidney dialysis.
References
- E. coli (Escherichia coli). Centers for Disease Control and Prevention. https://www.cdc.gov/ecoli/index.html. Accessed Aug. 27, 2020.
- E. coli. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/e-coli. Accessed Aug. 27, 2020.
- Holtz LR, et al. Shiga toxin-producing Escherichia coli: Microbiology, pathogenesis, epidemiology, and prevention. https://www.uptodate.com/contents/search. Accessed Aug. 27, 2020.
- Holtz LR, et al. Shiga toxin-producing Escherichia coli: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed Aug. 27, 2020.
- Goldman L, et al., eds. Escherichia coli enteric infections. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Aug. 27, 2020.
- Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed Aug. 27, 2020.
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