Escherichia coli infection

Infectious diseases

Clinicals - History

Fact Explanation
Symptoms of neonatal meningitis Newborns present with fever, jaundice, decreased feeding, listlessness and failure to thrive. Irritability, lethargy, vomiting, lack of appetite, and seizures are seen in neonates. Older children presents with headache, neck pain, photophobia, vomiting, seizures and fever. Symptoms of neonatal meningitis
Newborns present with fever, jaundice, decreased feeding, listlessness and failure to thrive. Irritability, lethargy, vomiting, lack of appetite, and seizures are seen in neonates. Older children presents with headache, neck pain, photophobia, vomiting, seizures and fever.
Symptoms of pneumonia Patients with pneumonia presents with fever, shortness of breath, cough and chest pain. Symptoms of pneumonia
Patients with pneumonia presents with fever, shortness of breath, cough and chest pain.
Symptoms of biliary tract infection Acute onset fever with chills, right upper quadrant abdominal pain, jaundice, dark urine and pale stools are characteristic of cholangitis. Charcot triad (fever, pain, and jaundice) is seen in majority. Symptoms of biliary tract infection
Acute onset fever with chills, right upper quadrant abdominal pain, jaundice, dark urine and pale stools are characteristic of cholangitis. Charcot triad (fever, pain, and jaundice) is seen in majority.
Symptoms of intra-abdominal abscess Low grade fever and abdominal pain are presenting complains. Some patients can develop prostatic abscesses. Symptoms of intra-abdominal abscess
Low grade fever and abdominal pain are presenting complains. Some patients can develop prostatic abscesses.
Watery diarrhea Enterotoxigenic E coli (ETEC), enteropathogenic E coli (EPPEC) and enteroaggregative E coli (EAEC) can cause watery diarrhea. ETEC release enterotoxins which affect the small intestinal cells and stimulates excessive chloride ion secretion in to the bowel lumen. This increases the osmotic pressure in the lumen causing osmotic diarrhea. Toxins produced by EPEC cause destruction of absorptive microvilli in the small intestine. EAEC causes mucous hypersecretion by the goblet cells.
Diarrhea can be accompanied by fever, tenesmus and symptoms of dehydration like increased thirst and reduced urine output.
Watery diarrhea
Enterotoxigenic E coli (ETEC), enteropathogenic E coli (EPPEC) and enteroaggregative E coli (EAEC) can cause watery diarrhea. ETEC release enterotoxins which affect the small intestinal cells and stimulates excessive chloride ion secretion in to the bowel lumen. This increases the osmotic pressure in the lumen causing osmotic diarrhea. Toxins produced by EPEC cause destruction of absorptive microvilli in the small intestine. EAEC causes mucous hypersecretion by the goblet cells.
Diarrhea can be accompanied by fever, tenesmus and symptoms of dehydration like increased thirst and reduced urine output.
Blood and mucous diarrhea Enteroinvasive E coli (EIEC) and enterohemorrhagic E coli (EHEC) can cause blood and mucous diarrhea. Both EHEC and EIEC initially cause watery diarrhea which later become bloody diarrhea. Abdominal cramps and absence of fever are characteristic of infection with EHEC. EHEC have cytotoxic action and cause hemorrhage and edema of the lamina propria in the ascending and transverse colon. EIEC produces enterotoxin and affects the colonic epithelial cells. Blood and mucous diarrhea
Enteroinvasive E coli (EIEC) and enterohemorrhagic E coli (EHEC) can cause blood and mucous diarrhea. Both EHEC and EIEC initially cause watery diarrhea which later become bloody diarrhea. Abdominal cramps and absence of fever are characteristic of infection with EHEC. EHEC have cytotoxic action and cause hemorrhage and edema of the lamina propria in the ascending and transverse colon. EIEC produces enterotoxin and affects the colonic epithelial cells.
Symptoms of urinary tract infection (UTI) Low-grade fever, dysuria, increased frequency of micturition and urgency are common. Some complain of suprapubic pain. Patients with complicated UTI present with high fever with chills and rigors, and flank pain. Symptoms of urinary tract infection (UTI)
Low-grade fever, dysuria, increased frequency of micturition and urgency are common. Some complain of suprapubic pain. Patients with complicated UTI present with high fever with chills and rigors, and flank pain.

Clinicals - Examination

Fact Explanation
Signs of meningitis Patients are febrile. Presence of neck stiffness is indicated by positive Kernig's Sign and Brudzinski's Sign. Bulging and tense fontanels are seen in young children with open fontanels. Signs of meningitis
Patients are febrile. Presence of neck stiffness is indicated by positive Kernig's Sign and Brudzinski's Sign. Bulging and tense fontanels are seen in young children with open fontanels.
Signs of pneumonia Localized area of reduced chest expansion, dull percussion note, reduced air entry and bronchial breathing are suggestive of pneumonia. Signs of pneumonia
Localized area of reduced chest expansion, dull percussion note, reduced air entry and bronchial breathing are suggestive of pneumonia.
Hypotension Seen in severe cases of cholangitis, cholecystitis and sepsis. Hypotension
Seen in severe cases of cholangitis, cholecystitis and sepsis.
Jaundice Newborns present with jaundice with infection and sepsis. Older patients can have jaundice in cholangitis. Jaundice
Newborns present with jaundice with infection and sepsis. Older patients can have jaundice in cholangitis.
Signs of dehydration Diarrhea can result in dehydration. Patients have reduced skin turgor, sunken fontanels and eyes, dried mucus membranes, low blood pressure, small volume pulses and altered consciousness. Signs of dehydration
Diarrhea can result in dehydration. Patients have reduced skin turgor, sunken fontanels and eyes, dried mucus membranes, low blood pressure, small volume pulses and altered consciousness.
Signs of UTI Renal angle tenderness is present in pyelonephritis. Signs of UTI
Renal angle tenderness is present in pyelonephritis.
Per-rectal examination Tender, hot prostate is palpated in prostatic abscess. Per-rectal examination
Tender, hot prostate is palpated in prostatic abscess.

Investigations - Diagnosis

Fact Explanation
Full blood count Leukocytosis or a left shift is seen due to infection. Hemoglobin and platelets are low if hemolytic uremic syndrome occurs. Full blood count
Leukocytosis or a left shift is seen due to infection. Hemoglobin and platelets are low if hemolytic uremic syndrome occurs.
Blood picture Hemolysis and thrombocytopenia are seen in hemolytic uremic syndrome. Blood picture
Hemolysis and thrombocytopenia are seen in hemolytic uremic syndrome.
Microscopic examination E coli are seen as a gram-negative bacillus under the microscope. Microscopic examination
E coli are seen as a gram-negative bacillus under the microscope.
Culture Blood, cerebrospinal fluid, urine, sputum, stool or abscess fluid can be cultured. Presence of more than 105 organisms is diagnostic of UTI. Culture
Blood, cerebrospinal fluid, urine, sputum, stool or abscess fluid can be cultured. Presence of more than 105 organisms is diagnostic of UTI.
Urine full report Pyuria and hematuria are present. Urine full report
Pyuria and hematuria are present.
Urine dipstick test Presence of blood, leucocyte esterase, nitrite, and protein can be detected. Urine dipstick test
Presence of blood, leucocyte esterase, nitrite, and protein can be detected.
Chest X-ray Chest X ray is important in diagnosing pneumonia. Chest X-ray
Chest X ray is important in diagnosing pneumonia.
CT scan Aids in diagnosing pyelonephritis and pneumonia. CT scan
Aids in diagnosing pyelonephritis and pneumonia.
Ultrasounds scan kidney-ureter-bladder Detects pyelonephritis. Ultrasounds scan kidney-ureter-bladder
Detects pyelonephritis.
Polymerase chain reaction Allows rapid and accurate diagnosis. Polymerase chain reaction
Allows rapid and accurate diagnosis.
Cerebro-spinal fluid full report Aids in differentiating viral meningitis and bacterial meningitis. Cerebro-spinal fluid full report
Aids in differentiating viral meningitis and bacterial meningitis.

Investigations - Management

Fact Explanation
Serum electrolytes Dehydration and hemolytic uremic syndrome can cause acute renal failure. Serum electrolytes
Dehydration and hemolytic uremic syndrome can cause acute renal failure.
Serum creatinine Elevated in acute renal failure. Serum creatinine
Elevated in acute renal failure.

Management - Supportive

Fact Explanation
Health education Feco-oral transmission of the organism causes diarrhea. Hand hygiene and food hygiene are important preventive measures. Raw milk and under cooked meats should be avoided.
In order to minimize the incidence of neonatal meningitis, labor should be carried out as a sterile procedure by health care professionals.
Health education
Feco-oral transmission of the organism causes diarrhea. Hand hygiene and food hygiene are important preventive measures. Raw milk and under cooked meats should be avoided.
In order to minimize the incidence of neonatal meningitis, labor should be carried out as a sterile procedure by health care professionals.
Hemodialysis Indicated in acute renal failure. Renal transplant may be needed in end-stage renal disease. Hemodialysis
Indicated in acute renal failure. Renal transplant may be needed in end-stage renal disease.
Drainage of abscesses Since most of the antibiotics do not act in the presence of an acidic medium, drainage fasten the recovery. Trans urethral resection of prostate (TURP) is done for prostatic abscesses. Drainage of abscesses
Since most of the antibiotics do not act in the presence of an acidic medium, drainage fasten the recovery. Trans urethral resection of prostate (TURP) is done for prostatic abscesses.
Hydration Hydration is important in management of diarrhea. Antibiotics and antidiarrheal agents should not be used in diarrhea. Hydration
Hydration is important in management of diarrhea. Antibiotics and antidiarrheal agents should not be used in diarrhea.

Management - Specific

Fact Explanation
Antibiotics Third-generation cephalosporins and fluoroquinolones are frequently used to treat e coli infections. Fluoroquinolone, trimethoprim/sulfamethoxazole, or nitrofurantoin are used to treat uncomplicated UTIs. However definitive treatment may depend on the antibiotic susceptibility of the organism. Antibiotics
Third-generation cephalosporins and fluoroquinolones are frequently used to treat e coli infections. Fluoroquinolone, trimethoprim/sulfamethoxazole, or nitrofurantoin are used to treat uncomplicated UTIs. However definitive treatment may depend on the antibiotic susceptibility of the organism.

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