Other Strains of E. coli

E. coli is a very diverse bacterium; most strains are not harmful to humans. Of those types of E. coli that do infect humans, the most dangerous one to humans is the Shiga toxin-producing E. coli (STEC) which is also referred to as verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC). For detailed information on STEC and specifically the strain O157:H7 please click here.

One strain of E. coli that rarely makes the news is enteroaggregative E. coli (EAEC), which is a cause of diarrhea in children more frequently in developing countries. EAEC were first described in 1987 and are named such because they adhere to the mucosal epithelium of the digestive tract with a specific aggregative pattern. EAEC can also form biofilms, protective layers that encapsulate the bacterium in the digestive tract, which help the bacterium to resist the body’s immune system and may contribute to its pathogenicity. EAEC also has cytotoxic effects to the mucosal epithelium, resulting in tissue damage and inflammation.

Symptoms of EAEC largely include watery, mucoid diarrhea with a mean duration in children of 14-17 days, an extremely long duration for diarrhea. The diarrhea can be accompanied by fever and vomiting. There have been several reported outbreaks in developed countries, including 4 in the United Kingdom. All were linked to food consumption, but a specific source was not identified. EAEC has also been tied to malnutrition, even in the absence of diarrhea.(1,2)

Enteropathogenic E. coli (EPEC) is another cause of diarrhea, and like EAEC is more frequent in developing countries. Also like EAEC, EPEC strains can also have cytotoxic effects and a specific adherence pattern. With EPEC are two categories, typical and atypical. Typical type EPEC have a plasmid (circular strand of DNA that can be passed between bacteria, frequently related to antibiotic resistance) that encodes a particular adherence pattern and has more closely related virulence characteristics than atypical EPEC, which do not share a plasmid. Diarrhea from EPEC is most commonly found in infants less than one year old (3). In the developed world, typical EPEC is extremely rare, but the incidences of atypical EPEC have sharply risen. It has been proposed that atypical EPEC may have an origin similar to O157:H7 and other STEC strains of E. coli because of their similar trends of incidences in developed countries. (4,5)

Enteroinvasive E. coli (EIEC) also attach to epithelial cells and cause watery diarrhea. (6) This type of E. coli can also develop into a disease resembling bacillary dysentery which is characterized by blood and mucus in the diarrhea, along with abdominal cramps, vomiting, fever, chills and malaise. Symptoms usually begin to appear 12-72 hours after consumption of the contaminated food. Outbreaks have been attributed to unpasteurized milk, hamburger meat and cheese. (7)

Enterotoxigenic E. coli (ETEC), like most of the other disease causing types of E. coli, is typically found in under-developed countries and is responsible for gastroenteritis or travelers’ diarrhea. Like the other strains of diarrhea, ETEC is characterized by watery diarrhea, abdominal cramps, fever and nausea. ETEC has resulted in 4 outbreaks in the U.S., one resulting from drinking water contaminated with sewage and the other three food-related. (8)

Sources

1. Nataro JP, Steiner Ts, Guerrant RL. 1998. Enteroaggregative Escherichia coli. Emerg Infect Dis. 4:2. Online at http://www.cdc.gov/ncidod/eid/vol4no2/nataro.htm#ref24

2. Steiner TS, Lima AAM, Nataro JP, Guerrant RL. 1998. Enteroaggregative Escherichia coli produce intestinal inflammation and growth impairment and cause interleukin-8 release from intestinal epithelial cells. J Infect Dis. 177: 88-96.

3. Nataro JP, Kaper JB. 1998. Diarrheogenic Escherichia coli. Clin Microbiol Rev. 11: 142-201.

4. Griffin P. 1998. Epidemiology of Shiga toxin-producing Escherichia coli infections in humans in the United States. In: Kaper JB, editor. Escherichia coli O157:H7 and other Shiga toxin-producing E. coli strains. Am Soc Microbiol. p. 15-22.

5. Trablusi LR, Keller R, Tardelli Gomes TA. 2002. Typical and Atypical Eneropathogenic Esherichia coli. Emerg Infect Dis. Online at http://www.cdc.gov/ncidod/EiD/vol8no5/01-0385.htm#31

6. Benenson AS (ed.). 1995. Control of Communicable Diseases Manual, Sixteenth Edition. United Book Press, Baltimore, pp. 140-150.

7. United States Food & Drug Administration. Enteroinvasive Escherichia coli. Online at http://vm.cfsan.fda.gov/~mow/chap16.html

8. United States Food & Drug Administration. Enterotoxigenic Escherichia coli. Online at http://www.cfsan.fda.gov/~mow/chap13.html

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