MEDICAL LABORATORY TECHNOLOGY
CSI251 : MICROBIOLOGY III
ESCHERICHIA COLI
(E. COLI)
PREPARED BY: ZAKARIA ISMAIL
SESSION DISEMBER –MAC 2012/2013
INTRODUCTION
☼ Discovered by Theodore von Escherich in 1885
☼ 2 microns in length and 1 micron in wide
☼ Rod shaped
☼ Covered with small pili
☼ Family : Enterobacteriaceae
☼ Genus : Escherichia
☼ Species : E. coli (main)
PATHOGENICITY
☼ Urinary Tract Infection
Patient with cystitis (bladder infection) and pyeloneophritis
(kidney infection)
Common in women
☼ Infections are wounds, peritonitis, sepsis and endotoxin induced
shock.
☼ Meningitis and bacteremia in neonates (E. coli capsular type K1)
☼ Diarrhoeal disease
Infantile gastroenteritis
Travellers’ diarrhoea
Dysentery
Haemorrhagic diarrhoea which may progress to HUS
HABITAT
☼ Gastrointestinal tract (GIT) of human
☼ Abundant in soil, water and vegetation
☼ Used as indicator of human health risk from harmful organism
present in water
☼ The median number of E. coli present in water samples should
< than 126/100 mL if it is to use for recreation
INFECTIONS
☼ 4 major types of E. coli strains
Enteropathogenic (EPEC)
Enterotoxigenic (ETEC)
Enteroinvasive (EIEC)
Enterohemorrhagic (EHEC) / E. coli 0157
☼ Enteropathogenic (EPEC)
Infantile diarrea
Due to bacteria adhering to epithelial cell, multiply and
causing lesion
Common in children, adults are rare
Low-grade fever, malaise, vomiting and diarrhea
Stool contains great amount of mucus, but blood is not usually
present
Outbreaks in hospital nurseries
Can be life threatening to babies
Rehydration
☼ Enterotoxigenic (ETEC)
Infants and adults in developing countries
Travelers diarrhea (faecal-oral route)
• The organism are likely to be new in their immune systems
Colonisation of SI causes release of
• Heat labile (LT)
• Heat stable toxin (ST)
Acquired by ingesting contaminated food or water
Poor sources of clean drinking water
Poor hygiene
Infections
• 1-5 days
• Non-bloody and watery diarrhea
• Nausea
• Abdominal cramps
• Low-grade fever
Dehydration in infants and young children
Low incidence in adults
Breast fed infants suggest protective immunity
ETEC virulence factor
• Able to secrete 2 types of exotoxins that can act enteric
tract
i. Heat labile (similar to cholera toxin)
ii. Heat stable
• Causes stomach upset resulting to large amount of fluid
secretion
☼ Enteroinvasive (EIEC)
Non motile (resembling Shigella)
Causes dysentery (resembling Shigella)
Direct penetration, invasion and destruction of intestinal
mucosa
Child and adult transmitted via fecal-oral route
Fever, severe abdominal cramps, malaise, watery diarrhea,
toxemia accompanied by stools containing mucus, pus and
blood
☼ Enterohemorrhagic (EHEC)
Widely known for its lethal capability, E. coli 0157:H7 is the
most common and dangerous strain of E. coli
Found in faeces and meat
When milk, water, and even the air come in contact with cow
feces they may become contaminated with E. coli
Meat is the primary source of infection in humans especially
ground meat
Low infective dose (10 organism)
Contaminations is caused by direct exposure to fecal matter of
cattle
To eradicate E. coli 0157:H7, the contaminate material must be
cooked at >160°F
Associated with hemorrhagic diarrhea and HUS (Hemolytic
Uremic Syndrome)
E. coli 0157 VF : Shiga like toxin,
2 cytotoxins,
verotoxins I and II
Adherence and colonization
Identified by stool culture on sorbitol MacConkey medium
(E. coli 0157 does not ferment sorbitol in 48 hours),
biochemical test and finding the erotoxin in stool filtrates
The infection can be fatal especially in young and elderly
Processed meat, undercooked hamburger, unpasteurized milk,
mayonnaise have been implicated in the spread of organism
☼ Enteroaggregative (EAEC)
Causes chronic watery diarrhoea and vomitting, mainly
children
Due to bacteria adhering to tissue cells often in stacks
(aggregates)
EPIDEMIOLOGY
☼ Recognised in 1980
☼ Jan 93
3 children died after eating undercooked hamburger at fastfood
restaurant in Washington
☼ In US, approximately 73000 people afflicted with E. coli
0157:H7 and 50-60 people die each year
☼ Jan 93-Sept 95
63 reported outbreaks in 23 states
☼ In Japan
School lunch outbreaks
SIGN & SYMPTOMS
☼ Vomiting
☼ High fever
☼ Prolonged diarrhea (infants)
☼ Feces with blood, mucus and pus
☼ Severe stomach cramps and stomach tenderness
☼ Diarrhea
☼ Nausea
LAB DIAGNOSIS
☼ Specimen
Pus
Urine
Blood
☼ Microscopic morphology
Gram negative bacilli
Motile rod
☼ Cultural morphology on selective and differential media
Blood : Mucoid
β-hemolytic colonies
MacConkey : LF (Pink)
Some EPEC are NLF
(Colorless)
EMB : Green sheen
Sorbitol MacConkey : EHEC 0157:H7 (No color)
Most strain do not grow on XLD, DCA, SS or other selective
media used to isolate Shigella/Salmonella
BIOCHEMICAL TEST
Indole Positive
Methyl Red (MR) Positive
Voges-Proskauer (VP) Negative
Citrate Negative
Motility Positive (most strain)
Triple Sugar Iron (TSI) A/A, gas present, no H2S
Urease Negative
Phenylalanine Deaminase Negative
(PD)
☼ Some EIAC gives similar biochemical reaction as Shigella spp.
AST
☼ Antimicrobials that are used against Gram negative organisms
Sulphonamides
Trimethophrim
Cotrimoxazole
Nalidixic acid
Tetracycline
Ampicilin
Aminoglycosides
☼ Plasmid-mediated antibiotic resistance, however, is common
☼ In treatment of E. coli diarrhea, the use of antibiotics is in general
only for minor importance
THANK
YOU
