Enterotoxigenic E. coli

Enterotoxigenic E. coli cause traveller's and infant diarrhoea via the production of enterotoxins. The heat stable form stimulates guanyl cyclase; the heat labile form closely resembles the cholera toxin and stimulates adenyl cyclase. Primarily they affect the small intestine, causing hyperaemia of the mucosa.

Food and water contaminated by human faeces are chiefly responsible.

Enterotoxigenic serotypes of E. coli include 0115, 0148 and 0153.

Reservoir:

• Gastrointestinal tract of humans and animals

Epidemiology:

• may be associated with travel to developing countries
• may cause cases of gastroenteritis and outbreaks in developed countries

Transmission:

• faecal-oral from person to person (EPEC), foodborne (ETEC, EPEC, EIEC) or waterborne (ETEC, EPEC, EIEC) spread

Incubation period:

• Reported range from 1 hour to 7 days. Most cases within about 10-50 hours (ETEC, EIEC) or about 8-18 hours (EPEC, EAEC)

Common clinical features:

• Diarrhoea (all types), often watery. Abdominal pain common (ETEC, EPEC, EIEC). Nausea, vomiting and fever may occur (all) and/or blood and mucus (EIEC, EAEC)

Infectivity:

• Whilst symptomatic and for 48 hours after diarrhoea has stopped

Notes:

• Excretion often longer than 48 hours after remission, but infectious risk low if normal stools

Reference:

• PHE (2019). Recommendations for the Public Health Management of Gastrointestinal Infections