Diarrhoeagenic

E.coli
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LEARNING OBJECTIVES:
>Introduction
>EPEC ( Enteropathogenic E.coli )
>ETEC(Enterotoxigenic E.coli)
>EIEC (Enteroinvasive E.coli)
>EHEC (Enterohemorrhagic E.coli)
>EAEC(Enteroaggregative E.coli)
>DAEC(Diff usely-adherent E.coli)
INTRODUCTION:
→1885-German pediatrician Theodore Escherich describes it as
Bacterium coli commune.
1919-Castellani& Chalmers defined genus and species-Escheria & e.coli
1945-Bray established causative role during outbreak of childhood
diarrhea in london.
→Genus= gram-negative bacilliVi,oxidase –ve,nonfastidious,motile with
peritrichous flagella
→Virulenec factors of E.coli =1)surface anitigens like somatic/O ag,
flagellar/H ag,capsular/K ag, fimbrial ag.
2)Toxins like enterotoxin and CNF1 and SAT
→Clinical manifestations= UTI, diarrhea ,other –pneumonia(VAP),
osteomyelitis etc.
→Lab Diagnosis= Sample collection –depends on the site of infection
(urine,stool,pus,wound sawb,blood,CSF)
Direct smear-gram –ve bacilli & pus cells
Culture- blood agar ( gray,moist colonies )
MacConkey agar( flat, pink LF colonies)
Culture smear& motitlity- Motile gam –ve bacilli
Identication- Catalase +ve, Oxidase –ve
ICUT Test ( indole+ve, Citrate –ve, Urease-ve, TSI: A/A,
gas+ve ,H2S –ve).

MacConkey Agar
DIARRHEAGENIC E.COLI
These are antigenically diff from comensal E.coli in
intestine. WHO estimated nearly 20,000 deaths are caused
due to diarrheagenic E.coli.
There are total 6 pathogens of diarrheagenic E.coli:

1.EPEC 4.EHEC
2.ETEC 5.EAEC
3.EIEC 6.DAEC
1.EPEC (Enteropathogenic E.coli)
Freq causes infantile diarrhea & occasionally spoardic
diarrhea in adults.
Person to person spread.
its nontoxigenic and noninvasive
mechanism= • Adhesion- to intest mucosa mediated
by plasmid coded bundle forming pill→ cup like
projections called Pedestals.
•A/E lesions(attaching & effacing lesions)- typical
lesions produced on intest epi → increased
secretion& watery diarrhea.
2.ETEC(Enterotoxigenic E.coli)
Most common cause of travelers disease
Causes acute watery diarrhea in infants&adults
Its toxigenic but not invasive
Pathogenesis= •Attachment to intest mucosa mediated
by fimbrial protein called CFA (colonization factor ag)
•toxin production-1)heat labile toxin(increases cAMP)
2)heat stable (increases cGMP )
Diagnonis=detetcion of toxins is the mainstay of
diagnosis ( by latex agglutination test,ELISA,PCR
methods)
Treat= in severe condn-azithromycin indicated
3.EIEC( Enteroinvasive E.coli)
 Its biochemically,pathogenically and closely related to shigella.
 Pathogenesis= EIEC is not toxigenic but invasive . Epi cell
invasion is mediated by plasmid coded ag called VMA
(virulence marker ag).
 Manifestations= includes ulceration of
bowel,dysentry(diarrhea with mucuc & blood called bacillary
dysentry resembling shigellosis)
 Diaganosis=detection of VMA by ELISA
HeLa cell invasion assay
Compared to other E.coli strains its biochemically atypical
(nonmotile & lactose nonfermenters).
•treat= although its self limited azithromycin recommended.
4.EHEC (Enterohemorrhagic E.coli)
 Prevalent in industrialized countries.
 Serotypes=O15:H7 most common
 EHEC usually transmitted via contaminated food ie.
Undercooked ground beef,lettuce,spinach etc.
 Low infective dose = <10₂bacilli required to initiate
infection.
 Pathogenesis= EHEC secretes toxin called verocytotoxin/
shiga toxin hence its also called STEC(shiga toxin
producing E.coli).two types ST1 & ST2. It resembles with
shiga toxin produced by shigella dusentriae & acts by
inhibiting protein synthesis by 60s ribosome.
 Manifestations= shiga toxin is predilection for endo cells causing
capillary microangiopathy leads to Heamorrhagic colitis – gross
bloody diarrhea,abd fever ,fecal leukocytosis w/o fever
HUS (hemorrhagic uremic syndrome)- injury to small vessels of
kidney & brain. More common in children.
 Diagnosis= special culture media – sorbital macconkey agar &
rainbow agar
Toxin detection- demo of vero call lines & fecal toxin detetc by ELISA
or rapid test .
DNA PCR probes- detects gene coding for Stx1 & Stx2.
Rainbow
agar
5.EAEC(Enteroaggregative E.coli)
 Its named so because it adheres to Hep-2cells , layering of
bacteria in aggregated in stacked brick fashion. Most stains are O
untypeable but H typeable.
 Pathogenesis=intest colonization mediated by aggregative
adhesion fimbriae1 1(reg by aggR gene). Also produces EAST 1
toxin(enteroaggregative heat stabile enterotoxin 1).
 Manifestations= persistent and acute diarrhea .
 Diagnosis=1) detection of aggR & aatA gene by PCR 2)HEp2
adherence test (golld standard).
 Treat= only immunocompromised patients – ciprofloxacinfor 3-7
days recommended.
•E.coliO104:H4-strain that caused major outbreak in germany
(feature- produces shiga toxin&HUS)
6.DAEC(Diffusely-adherent E.coli)
Charecterized by:1)ability to adhere to Hep-2 cells in
diffuse pattern.
2)expresses diffuse adherence fimbriae which
contributes to pathogenesis
3)DAEC is capable of causing diarrheal disease,
primarily in children aged 2-6 yrs old
SUMMARY:
 Diarrheagenic E.coli antigenically diff from commensal
E.coli
 6 pathotypes: EPEC,ETEC,EIEC,EHEC,EATEC,DAEC)
 EPEC- infantile diarrhea.
 ETEC most common cause of travellers disaese.
 EIEC- VMA can be useed for diagnosis.
 EHEC- special culture medias like rainbow agar & sorbitol
macconkey agar is used.
 EAEC-produces EAST1 toxin
 Mostly antibiotcs(like azithromycin , ciprofloxacin etc) are
recommended .
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