Enteropathogenic E. coli

Enteropathogenic E. coli cause diarrhoea by an unknown mechanism. It is known that they cause destruction of the microvilli, and that adherence is important, mediated through the production of characteristic fimbrial adhesins. It is a cause of sporadic diarrhoea in infants and outbreaks in nurseries, associated with cross-infection via staff hands.

Enteropathogenic serotypes include 044, 0111, 0114, 0125, etc.

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