Clinical presentation, complications and treatment of infection with verocytotoxin-producingEscherichia coli. Challenges for the clinician

Abstract

SUMMARY Seventeen years after its recognition, outbreaks and sporadic infections attributed to Escherichia coli O157 continue to increase. Acute gastrointestinal, and the systemic complications haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), are frequent and severe. Current challenges that face clinicians are the early recognition of infection, identification of risk factors for poor prognosis, determination of appropriate monitoring for the development of complications, establishment of a therapeutic strategy and, finally, advice for patients about their long‐term prognosis. Clinical features which, in combination, have been shown to distinguish E. coli O157 infection from other enteric pathogens are a history of bloody diarrhoea, visibly bloody stools, absence of fever, a leucocyte count greater than 10 × 109 1−1 and abdominal tenderness on physical examination. The most consistent risk factors for the development of HUS/TTP are the extremes of age and a raised leucocyte count. Bloody diarrhoea and ‘antimotility’ drugs are also likely to be important risk factors. Recent evidence from the central Scotland outbreak suggests that individuals who are taking drugs that reduce gastric acidity or antibiotics at the time of infection with E. coli O157, or who have a short incubation period, may also be at increased risk of progression to HUS/TTP. Clinical management, in particular the role of antibiotics in gastrointestinal infection, remains controversial, and retrospective assessment of the 1996 outbreaks from central Scotland and Japan only adds to this controversy. Therapeutic plasma exchange is a promising treatment for adults who develop HUS/TTP, but its role has yet to be determined definitively, either in a randomized controlled trial or by an international register of cases. Significant chronic sequelae of infection occur, particularly irritable bowel syndrome after uncomplicated gastrointestinal infection, and renal failure after HUS/TTP. Their frequency and severity are likely to become evident over the next decade.

The potential for biocide tolerance in Escherichia coli and its impact on the response to food processing stresses

“…In 2011, Germany reported a major E. coli O104:H4 outbreak linked with fresh sprouted seeds, where 3910 cases of diarrhoeal disease were reported including 782 cases of haemolytic uraemic syndrome (HUS) and 46 deaths (ECDC, 2011). There is concern that such organisms if biocide resistant may have a reduced susceptibility to clinically important antimicrobial compounds such as antibiotics (Russell, 2002) although there is controversy about antibiotic therapy for VTEC infections (Dundas & Todd, 2000;Panos, Betsi, & Falagas, 2006).…”

Persistence of Escherichia coli O157 on farm surfaces under different environmental conditions

“…Escherichia coli O157 is recognized as the most prevalent of all pathogenic E. coli serotypes, with infection often leading to a range of clinical symptoms including haemorrhagic colitis or life‐threatening haemolytic uraemic syndrome (Chart 2000; Dundas and Todd 2000; Rogerie et al. 2001).…”

“…Escherichia coli O157 is recognized as the most prevalent of all pathogenic E. coli serotypes, with infection often leading to a range of clinical symptoms including haemorrhagic colitis or life-threatening haemolytic uraemic syndrome (Chart 2000;Dundas and Todd 2000;Rogerie et al 2001). The occurrence of this bacterium in gastrointestinal illness in humans has been observed worldwide, and worryingly, the UK incidence rate shows no obvious signs of decreasing (Jones 1999;Parry and Palmer 2000).…”

Induction of a Humoral Immune Response following anEscherichia coliO157:H7 Infection with an Immunomodulatory Peptidic Fraction Derived fromLactobacillus helveticus-Fermented Milk

“…Pathogenesis of E. coli O157:H7 is linked to numerous virulent factors (24), leading to pathological conditions such as hemorrhagic colitis, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, acute renal failure, and even death (6). E. coli O157:H7 is considered a worldwide threat not only because of its increasing incidence and low infectious dose, but also due to the severity of clinical presentation and complications during treatment, particularly with the controversial role of antibiotics (12). Recent studies have explored alternative therapeutic strategies, such as the use of probiotic lactic acid bacteria (LAB).…”