Enterotoxigenic E. coli - Information for Clinicians
Type of infection
E. coli that carry genes that produce heat-labile or heat-stable toxins similar to cholera toxin and cause watery diarrhea.
Sources of infection
- ETEC is very common in less developed countries and is a leading cause of traveler's diarrhea.
- ETEC infections are caused by exposure to food, ice, or water contaminated with human or animal waste.
- New data show that ETEC causes sporadic illness and foodborne disease in the US.
Usual symptoms
- Illness usually starts 1-3 days after exposure.
- Watery diarrhea, stomach pain, or cramps. Fever, headache, and vomiting can also occur.
Duration of illness
- Typically 3-4 days but may last up to 2-3 weeks.
Treatment
- Prevent and treat dehydration.
- Controlled trials in travelers show benefit with Bismuth subsalycilate (Pepto-Bismol) but it contains salicylate. Do not use if recent varicella or influenza infection or vaccination.
- Several antibiotics have been shown to shorten the duration of diarrhea in travelers with ETEC. Azithromycin is the drug of choice in children. Fluoroquinolones are also effective. Short course (e.g., 3 days) is adequate. Resistance patterns vary by region.
Complications
- Dehydration is the major complication.
Comments
- Travelers should be advised to drink only bottled or canned beverages and boiled or bottled water; avoid ice, raw produce including salads, and fruit that they have not peeled themselves. Cooked foods should be eaten hot.
- Careful hand hygiene should be emphasized.
- Clean contaminated surfaces and disinfect with bleach solution (5-25 tablespoons of household bleach per gallon of water).
- People with diarrhea should not prepare food.