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E. coli (Escherichia coli)
E. coli (Escherichia coli)

 

Class
Digestive disorders
Description
Escherichia coli, commonly known as E. coli, is a common bacteria present throughout the environment and common in human and animal intestines, and forms part of the normal gut flora (the bacteria that exist in the bowel). It helps your body break down and digest the food you eat. There are many different types of E. coli and while the majority are harmless and some live in the intestine harmlessly, others can cause serious food poisoning and a variety of diseases, including cystitis, (women are more susceptible to urinary tract infection by E. coli because of the close proximity of the urethra and the anus), meningitis and diarrhoea. It mostly helps people to stay healthy, providing the body with many vitamins, such as vitamin K however, some strains - such as the O157 strain - are potentially fatal.

Some types of E. coli can cause gastrointestinal infections and get from the intestines into the blood. The bacteria is found in faeces and can survive outside of the body. Its levels can provide an indication of general hygiene and faecal contamination of an environment. A common way to catch the infection is by eating food, such as meat which has not been cooked properly, or water, that is contaminated with the bacteria but it can also be found in vegtables and unpasteurised milk..

Some E. coli strains produce toxins (Shiga toxins) that can cause severe illness. One common strain called E. coli 0157 produces such toxins and is usually responsible for the outbreaks that have recently appeared in the news.

What is E. coli O157?
A particularly nasty strain of the bacterium, to which children and older people are especially vulnerable. It is the most common strain of what is known as Vero cytotoxin-producing E. coli (VTEC) and first appeared in Britain in the 1980's.

The E. coli organisms are minute and fewer than 100 can cause illness.

Around 15% of cattle are now thought to carry it in their gut.

The Health Protection Agency recorded 950 cases of illness resulting from E. coli 0157 in England and Wales in 2008.

In the worst recorded outbreak, 20 people died in Scotland in 1996-97 after attending a church lunch in Wishaw, Strathclyde. Following the Scottish outbreak, the British government set up a commission to look into the issue of food safety.

How is VTEC 0157 infection diagnosed?
If infection with VTEC 0157 is suspected then a sample of stool (faeces) is taken. Tests are then made in a lab to establish the presence of VTEC 0157 bacteria and confirm the diagnosis.
Symptoms
Symptoms depend on where the infection is found and which type of E. coli is causing the infection.  The typical symptoms of the E. coli 0157 strain are likely to include severe stomach cramps, vomiting, and diarrhoea or haemorrhagic colitis - a combination of severe abdominal cramps and blood in the stools.

Symptoms can appear within hours or days, depending on a number of factors, including how many organisms are ingested, the person's state of health and their natural resistance to the bug. The incubation period from contracting the bug can range from three to eight days, with symptoms usually becoming apparent three to four days after infection.  Most people shake off the bug within a week.

The symptoms usually last up to seven days if there are no complications and most people shake off the bug within a week, however, some infections can be severe and may be life threatening.

There is a particular life-threatening complication called haemolytic uremic syndrome (HUS) which may develop in up to 7% of people and infects them with a toxin-producing form of E. coli. This is a severe kidney-related complication which kills red blood cells and in some extreme cases, lead to kidney failure, requiring dialysis treatment or a transplant.

Children under five are particularly vulnerable to HUS as they cannot tolerate much fluid or blood loss. About 5%-10% of them progress to this stage.

The elderly and people with damaged immune systems are also more at risk from the infection. .
Causes
You can become infected by eating food or drinking liquid that is contaminated with VTEC 0157. Although it is unusual for the VTEC 0157 bacteria to contaminate food,  when it does, the consequences can be serious. A number of outbreaks of disease caused by VTEC 0157 have been reported in recent years, including the recent outbreaks at animal farms.  Other causes of outbreaks have been reported where the contaminated food has been: mince, milk, cheese, yoghurt, cooked meats, meat pies, salami, raw vegetables, unpasteurised apple juice, and water.

If you have been infected with VTEC 0157, you will pass it out with your faeces, sometimes for several weeks even after symptoms have gone. Therefore, some people pass on the bacteria to others if their hygiene is poor. For example, not washing hands after going to the toilet, and then preparing food for others.

Healthy cattle and sheep can sometimes be carriers of VTEC 0157 and some outbreaks have been linked to handling live cattle. Swimming in contaminated water has also resulted in small outbreaks.
Treatment
Specific treatment depends on the type of infection. Cystitis infections are usually self-limiting (go away by themselves) after two to four days. In some cases a short course of antibiotics may be prescribed.

Intestinal infections by E. coli are not usually treated with antibiotics. Rehydration is important as a lot of fluid may be lost through diarrhoea. This is the mainstay of treatment and important whether the infection is being managed in hospital or at home. Oral rehydration solutions are particularly helpful in children with diarrhoea. In addition to providing fluids they also replace other important minerals and substances lost from the body, including sodium, potassium and glucose.

There is no specific treatment for E. coli 0157 infection.

There is no evidence that antibiotics have any positive impact on the 0157 strain. In fact their use may increased the risk of HUS.

There is also concern that indiscriminate use of antibiotics will increase the chance that the bug will develop resistance, rendering them less effective as treatments.

Anti-diarrhoeal medication should also be avoided.

It is important to drink plenty of fluids, as diarrhoea can quickly lead to dehydration.

Avoid tea, coffee, fizzy drinks and alcohol, and dilute sugary drinks. Over-the-counter painkillers such as paracetamol can be used to ease stomach pain, but non-steroidal anti-inflammatory painkillers such as aspirin should not be used as there is some evidence they make kidney problems worse.
Prevention
E. coli infections can be serious so preventing infections is extremely important. The bacteria are usually spread through faecal matter reaching the mouth, so good hygiene practice is critical in preventing contamination and the spread of the bug. This is particularly important with regards to going to the toilet or handling or preparing food as consumption of contaminated food or water and contact with infected faeces or animals are common sources of infection.

The usual hygiene rules apply, including the need to wash and dry hands thoroughly after going to the toilet and after touching animals (for example, at farms or zoos where children can pet the animlas). Foods should be cooked thoroughly and it is best to avoid unpasteurised dairy products.

Some people have been infected by swallowing water while swimming or playing in lakes or ponds, so it is best to avoid swimming in such places and certainly to avoid  swallowing any water during any activities based around this.

Good hygiene practices in abattoirs reduce contamination of carcasses by faeces but this does not guarantee good health and it is important to employ good hygiene practice whenever dealing with food.

Raw and cooked meat should be kept apart during food preparation, and people should always wash their hands after handling raw meat.

All meat should be properly and thoroughly cooked - cooking kills the bug.

Beefburgers, for example, should be cooked to a minimum internal temperature of 70C for at least two minutes.

Other tips from the Health Protection Agency include:
  • Ensure that refrigerators are working correctly - bacteria grow more quickly at temperatures over 4C
  • Only leave cooked foods, meat and dairy products out at room temperature for a short time
  • Store uncooked meats below cooked meats and salad vegetables to avoid dripping juices onto ready to eat food
  • Thoroughly wash all salad vegetables that will be eaten raw


In general, keeping your hands clean to avoid faecal contamination is also a good idea.

Try to avoid touching your face with your hands, unless they are clean.

And clean hard surfaces with a disinfectant regularly
When to consult your pharmacist
If you have any of the symptoms mentioned above, you should not hesitate to see your GP.  If you notice blood in your stools, or watery diarrhoea in children, you should contact your GP immediately.

Last Reviewed 27.09.09


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