Escherichia coli

Gram-negative rod
Facultative anaerobe

Named for Theodor Escherich

German physician (ca. 1885)
Demonstrated that particular strains were
responsible for infant diarrhea and
gastroenteritis

Normal flora of the mouth and intestine

Protects the intestinal tract from bacterial
infection
Assists in digestion
Produces small amounts of vitamins B12 and K

Colonizes newborns GI tract within hours

after birth

There are more than 700 different serotypes

of E. coli
Distinguished by different surface proteins
and polysaccharides 1
Escherichia
Bergey’s Manual of Systematic Bacteriology

• Escherichia coli
– coli- large intestine, colon
– Mammalian large intestine
• Escherichia blattae
– blattae. L. n. blatta cockroach
– Hindgut of cockroach Blatta orientalis

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 Serotypes
Many strains Antibody – antigen rxn

• O antigen
– Somatic (on LPS)
– 171 antigens
• H antigen
– Flagella
– 56 antigens
• K antigen
– Capsule and or
fimbrial antigen
– 80 antigens O18ac:H7:K1

18th O antigen 1st K antigen

7th H antigen 3
Pathogenic Agent
• Urinary Tract Infections
• Sepsis / neonatal meningitis
• Enteric / diarrheal diseases

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Uropathogenic E. coli UPEC
• Most common form of extraintestinal
E. coli infection
• Acute symptomatic UTI
– 12% of all men
– 10-20% of women
– 100,000 patients hospitalized for renal
infections

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Neonatal Meningitis E. coli NMEC
• Meningitis in an infection of the fluid and membranes that cover the brain and
spinal cord
– Bacteria
– Viruses
– Fungi
• E. coli incites between 1/4 and 1/3 of meningitis cases in newborns
– Less than 2% of cases of meningitis at all other ages
• Approximately 1 out of 5 newborns with E. coli meningitis dies
– Survivors frequently sustain permanent brain damage
• The majority of cases occur in premature babies
• K-1
– 80% of NMEC E. coli strains produce K-1 capsular antigens
– K1 capsular polysaccharide
– O18ac:H7:K1
– Inhibits phagocytosis
• Siderophore production
– Sequesters Fe
• Endotoxin

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Enteric / diarrheal diseases

E. coli can adhere to the mucosa of the

large intestine

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TYPES OF E. COLI

• Six major types of Escherichia coli

cause diarrhea:
Enterotoxigenic E. coli (ETEC)
Enteroinvasive E. coli (EIEC)
Enteropathogenic E. coli (EPEC)
Enterohemorrhagic E. coli (E. coli
O157:H7)
Enteroaggregative E. coli (EAggEC)
Diffuse adherent E. coli (DAEC)
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Enterotoxigenic E. coli ETEC
• Adhere to intestinal mucosa by fimbriae
• Produce enterotoxins
– Plasmids contain genes for enterotoxins
– Cause leakage of intestinal epithelial cells
• Loss of electrolytes & water
• Attach by fimbriae
• Cause diarrhea in children & adults
• Toxins increase intracellular levels of cAMP
• Causes cell leakage
• Traveler’s diarrhea
• Weanling diarrhea

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Enteropathogenic E. coli EPEC
• Attaching & effacing
– Effacement of
microvilli
– Adherence between
bacterium and
epithelial cells
– Unique histopathology
– Locus of enterocyte
effacement

Clinical Microbiology Reviews 1998 11:142-201

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Clinical Microbiology Reviews 1998 11:142-201

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Enteroaggregative E. coli EAEC
• Adhere to HEp-2
cells
– Human laryngeal
carcinoma cells
• Bacterial cells
autoagglutinate
– Stick to one
another
• Do not secrete
enterotoxins
Clinical Microbiology Reviews 1998 11:142-201

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Clinical Microbiology Reviews 1998 11:142-201

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Enteroinvasive E. coli EIEC
• Biochemically, genetically, and pathogenetically
closely related to Shigella spp.
• Cause watery diarrhea
– Not bloody
• EIEC cells invade intestinal epithelial cells, lyse
the phagosomal vacuole, spread through the
cytoplasm and infect adjacent cell
– Shigella does the same thing
• Plasmid encoding a gene for a K surface antigen
– Attach and invade mucosal cells

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Clinical Microbiology Reviews 1998 11:142-201

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Enterohemorrhagic E. coli EHEC
• Severe gastrointestinal distress
• Hemorrhagic colitis
– Crampy abdominal pain
– Watery diarrhea
– Little or no fever
– Bloody diarrhea
• New serotype O157:H7
– 1983
– Undercooked hamburgers

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Reservoir
• Healthy cattle are the major reservoir
for human infection
– Deer, sheep, goats, horses, dogs, birds and
flies
• Bacterial cells can survive in manure and
water troughs
• Infection is more common during the
summer in both the northern and
southern hemisphere

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• Transmitted via food
– Ground beef
– Raw milk
– Lamb meat
– Venison jerky
– Salami and other fermented dried meat products
– Lettuce, spinach, alfalfa sprouts
– Unpasteurized apple cider
• Transmitted via water
– Drinking and swimming in unchlorinated water
• Direct person to person contact
– Diaper changing
– Improper sanitation
– Day care & chronic adult care facilities

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Clinical Features
• Average interval
between exposure &
illness is 3 days
• Most patients recover
with 7 days
• 70% of patients report
bloody stools
• 30-60% of patients The Lancet 1998 352:1207-1212
report vomiting
Sequelae
• Approx 5% of patients A condition following as a
develop HUS consequence of a disease.
Proteinuria
Excess protein in the urine.

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Identification
• MacConkey agar (SMAC)
– Does not ferment sorbitol rapidly
– Forms colorless colonies on sorbitol
containing MacConkey agar
• Serology
– Colorless colonies on SMAC are screened
for the 0157 antigen

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Shiga Toxins
• Exotoxin
• Very similar to toxin produced by Shigella
dysenteriae
– Inhibits protein synthesis in host cell
– A subunit inactivates the 60S ribosomal subunit
• Shiga toxin producing E. coli (STEC)
– Verotoxins
• Most OH157 strains produce Shiga toxin 2
– 25% produce Shiga toxin 1
• Identical to Shigella toxin
• A B exotoxin
– A subunit exists on a temperate bacteriophage

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• Cells leak Na+, Cl-, K+, HCO3- and water
• Watery diarrhea
• Cramps
• Nausea
• Vomiting
• Bloody stool

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Virulence Factors
• Virulence plasmid (pO157)
– Encodes a hemolysin
– O157 strains can use iron from blood
released into the intestine
• Locus of enterocyte effacement
– Adhesion proteins

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