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Updated: Oct 22 2019

Escherichia coli

  • Snapshot
    • A 76-year-old woman presents to the emergency department for altered mental status. She currently lives in a nursing home and was brought to seek treatment by her daughter. She was noted to be more confused over the course of a few days and developed a fever. Her temperature is 101°F (38.3°C), blood pressure is 133/99 mmHg, pulse is 101/min, and respirations are 20/min. Physical examination is notable for being alert and oriented to self but not time or place and suprapubic abdominal pain. A urinalysis is remarkable for being leukocyte-esterase positive. Urine culture grows Escherichia coli.
  • Introduction
    • Classification
      • a gram-negative bacilli
    • Epidemiology
      • incidence
        • the most common cause of UTI in women
    • Microbiology
      • reservoir
        • gastrointestinal tract
      • transmission
        • fecal-oral
        • urethral ascension
        • catheter
        • aspiration
      • properties
        • enterotoxins
          • heat labile
            • increases cAMP
          • heat stable
            • increases cGMP
          • shiga-like toxin
            • inhibits the 60s ribosomal subunit, impairing protein synthesis
        • fimbriae
        • K-antigen (capsule)
        • H-antigen (flagella)
    • Associated conditions
      • enterotoxigenic (ETEC)
      • enterohemorrhagic (EHEC)
        • can result in hemolytic uremic syndrome
      • enteroinvasive (EIEC)
      • neonatal meningitis
      • urinary tract infection (UTI)
  • Presentation
      • E. coli Clinical Presentation
      • Condition
      • Presentation
      • Diagnostic Studies
      • Treatment
      • Enterotoxigenic (ETEC) 
      • Symptoms
        • watery diarrhea that occurs after returning from a resource-limited area
      • Clinical diagnosis and no diagnostic studies are required
      • Supportive treatment
      • Enterohemorrhagic (EHEC)
      • Symptoms
        • bloody diarrhea
        • no fever
      • Physical exam
        • abdominal tenderness
      • Hemolytic uremic syndrome (HUS)
        • associated with the strain O157:H7 
        • triad
          • acute renal failure
          • microangiopathic hemolytic anemia
          • non-immune mediated thrombocytopenia
      • Sorbitol-MacConkey agar
        • O157:H7 does not ferment sorbitol
      • Enzyme-linked immunosorbent assay (ELISA)
      • Polymerase chain reaction (PCR)
      • Supportive care
      • Antibiotics are generally not beneficial and its use has been associated with the development of HUS
      • Enteroinvasive (EIEC)
      • Symptoms
        • begins as watery diarrhea and can lead to bloody diarrhea with pus
          • the organism invades the intestinal cells to multiply intracellularly and then invade adjacent intestinal cells
      • Sereny test
      • Supportive care
      • Neonatal meningitis 
      • Symptoms
        • irritability
        • lethargy
        • poor tone
        • seizures
      • Physical exam
        • temperature instability
          • fever or hypothermia
        • bulging fontanelle
      • Lumbar puncture
      • Ampicillin
      • Cefotaxime or ceftazidime in ampicillin-resistant strains
      • Urinary tract infection (UTI)
      • Symptoms
        • dysuria
        • urinary frequency and urgency
      • Urinalysis and urine culture
      • Trimethoprim-sulfamethoxazole
      • Fosfomycin
      • Nitrofurantoin
    • Clinical diagnosis and no diagnostic studies are required
    • Supportive care
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