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E coli
What is E. Coli?
E. coli (Escherichia coli), is a type of bacteria that normally lives in your intestines. It’s also found in the gut of some animals.
Most types of E. coli are harmless and even help keep your digestive tract healthy. However, some types of E. coli, particularly E. coli O157:H7, can cause intestinal infection. E. coli O157:H7 and other strains that cause intestinal sickness are called Shiga toxin–producing E. coli (STEC) after the toxin that they produce.

While many of us associate E. coli with food poisoning, you can also get pneumonia, breathing problems, and urinary tract infections from different types of the bacteria. In fact, 75% to 95% of urinary tract infections are caused by E. coli.

Some versions of E. coli make you sick by making a toxin called Shiga. This toxin damages the lining of your intestine. The strains of E. coli that make the toxin are sometimes called STEC, which is short for “Shiga toxin-producing E. coli.”
One especially bad strain, O157:H7, can make you very sick. It causes abdominal cramps, vomiting, and bloody diarrhea. It is the leading cause of acute kidney failure in children. It can also cause life-threatening symptoms such as:
Adult kidney failure
Fever
Bleeding
Confusion
Seizures
You should get emergency help if you have any of these symptoms.

People with weakened immune systems, pregnant women, young children, and older adults are at increased risk for developing these complications.
Most intestinal infections are caused by contaminated food or water. Proper food preparation and good hygiene can greatly decrease your chances of developing an intestinal infection.

Most cases of intestinal E. coli infection can be treated at home. Symptoms generally resolve within a few days to a week.

 

Causes

People and animals normally have some E. coli in their intestines, but some strains cause infection. The bacteria that cause infection can enter into your body in a number of ways.

Among the many strains of E. coli, only a few trigger diarrhea. One group of E. coli — which includes O157:H7 — produces a powerful toxin that damages the lining of the small intestine, which can cause bloody diarrhea. You develop an E. coli infection when you ingest this strain of bacteria
Unlike many other disease-causing bacteria, E. coli can cause an infection even if you ingest only small amounts. Because of this, you can be sickened by E. coli from eating a slightly undercooked hamburger or from swallowing a mouthful of contaminated pool water.

You can become infected when you swallow even a small amount of E. coli bacteria. Among the ways this can happen:
Ground meat: You eat ground meat that carries E. coli, and the meat wasn’t cooked enough to kill the bacteria. When meat is processed, sometimes bacteria from the animals’ intestines make their way into the meat. This happens more with ground meat (Beef) because it comes from more than one animal.
Untreated milk: You drink unpasteurized milk, which hasn’t been heated to kill bacteria. E. coli can get into the milk from the cow’s udder or from milking equipment.

Vegetables and fruit: You might eat fresh vegetables or fruit that’s been tainted by water that has the bacteria. This happens most often when manure from nearby animals mixes with the water supply.
Other foods and beverages: You might also get E. coli from unpasteurized fruit juices and yogurt and cheese made from raw milk.

Water: You swallow water that contains E. coli, perhaps while swimming in a pool, lake, or pond. Human and animal feces may pollute ground and surface water, including streams, rivers, lakes and water used to irrigate crops. Although public water systems use chlorine, ultraviolet light or ozone to kill E. coli, some outbreaks have been linked to contaminated municipal water supplies. Private wells are a greater cause for concern because they don't often have any disinfecting system. Rural water supplies are the most likely to be contaminated. Some people also have been infected after swimming in pools or lakes contaminated with feces.

Other people: You might get E. coli from another person who has it, such as a child. The bacteria can be passed to you if you clean up after an infected person and then don’t wash your hands really well before you touch your mouth. Family members of young children with E. coli infection are especially likely to acquire it themselves. Outbreaks have also occurred among children visiting petting zoos and in animal barns at county fairs. E. coli can spread when an infected person doesn’t wash their hands after having a bowel movement. The bacteria are then spread when that person touches someone or something else, like food. Nursing homes, schools, and child care facilities are particularly vulnerable to person-to-person spreading

Animals: It can be found at petting zoos or animal exhibits at fairs. People who work with animals, especially cows, goats, and sheep, are at increased risk for infection. Anyone who touches animals or who works in an environment with animals should wash their hands regularly and thoroughly.

You can also contaminate food in your own kitchen if you allow a knife or cutting board that has touched uncooked meat (like chicken) to come into contact with food that will be eaten raw (like a salad).

Improper food handling
Whether food is prepared at home, in a restaurant, or in a grocery store, unsafe handling and preparation can cause contamination. Common causes of food poisoning include:
failing to wash hands completely before preparing or eating food
using utensils, cutting boards, or serving dishes that aren’t clean, causing cross-contamination
consuming dairy products or food containing mayonnaise that have been left out too long

consuming foods that haven’t been stored at the right temperature
consuming foods that aren’t cooked to the right temperature or duration of time, especially meats and poultry
consuming raw seafood products
drinking unpasteurized milk
consuming raw produce that hasn’t been properly washed

Symptoms
You’ll probably start to feel ill 2 to 10 days, after you’ve taken in the E. coli bacteria. The Average is 4 days. The most common symptoms are:
Abdominal cramps
Sudden, severe watery Diarrhea, which may be bloody or change to bloody stools
Nausea
Loss of appetite
vomiting (uncommon)
Constant fatigue
You may not have a fever. If you do, it may be slight less than 101.

Healthy people infected with E. coli usually feel better within a week (5 to 10 days). But some people have a serious complication called hemolytic uremic syndrome, which affects the kidneys.
This is more likely to happen to older people and children.

Symptoms can last anywhere from a few days to more than a week.

Symptoms of a severe E. coli infection may include:
bloody urine
decreased urine output
pale skin
bruising
dehydration

Call your doctor if you experience any of these severe symptoms.
According to the Centers for Disease Control and Prevention, about 5 to 10 percent of those who are infected develop hemolytic uremic syndrome (HUS), a condition in which the red blood cells are damaged. This can lead to kidney failure, which can be life-threatening, especially for children and the elderly. HUS generally begins about 5 to 10 days after the onset of diarrhea.

Risk Factors
While anyone can experience an E. coli infection, some people are more at risk than others. Some risk factors include:
Age: Older adults and young children are more likely to experience serious complications from E. coli.
A weakened immune system: People with weakened immune systems are more susceptible to E. coli infections.
Season: E. coli infections are more likely to occur during the summer months, June to September, for unknown reasons.
While anyone can experience an E. coli infection, some people are more at risk than others. Some risk factors include:
Low stomach acid levels: Stomach acid offers some protection against E. coli. If you take medications to reduce your levels of stomach acid, such as esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid) and omeprazole (Prilosec), you may increase your risk of an E. coli infection.
Certain foods: Riskier foods include undercooked hamburger; unpasteurized milk, apple juice or cider; and soft cheeses made from raw milk.

When to seek Medical Advice.
Intestinal infection can lead to dehydration and serious complications, such as kidney failure and sometimes death, if it’s not treated.

You should see your doctor if:
You have diarrhea that isn’t getting better after four days, or two days for an infant or child.
You have a fever with diarrhea.
Abdominal pain doesn’t get better after a bowel movement.
There is pus or blood in your stool.
You have trouble keeping liquids down.
Vomiting has continued for more than 12 hours. For a baby under 3 months old, contact your pediatrician as soon as symptoms begin.
You have symptoms of intestinal infection and have recently traveled to a foreign country.
You have symptoms of dehydration, such as a lack of urine, extreme thirst, or dizziness.

A doctor can confirm an E. coli infection with a simple stool sample.

Preparing for your appointment
Most people don't seek medical attention for E. coli infections.
If your symptoms are particularly severe, you may want to visit your primary care doctor or seek immediate care.

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any recent life changes or international travel.
Make a list of all medications, vitamins or supplements that you're taking.
Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor
Here's some information to help you get ready for your appointment and know what to expect from your doctor.

For E. coli, some basic questions to ask your doctor include:
What's the most likely cause of my symptoms?
What kinds of tests do I need?
What treatments are available, and which do you recommend?
Will there be any lasting effects from this illness?
How can I prevent this from happening again?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting

Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What to expect from your doctor. Your doctor may ask:
When did your symptoms begin?
How often are you having diarrhea?
Are you vomiting? If so, how often?
Does your vomit or diarrhea contain bile, mucus or blood?
Have you had a fever? If so, how high?
Are you also having abdominal cramps?
Have you recently traveled outside the country?
Does anyone else in your household have the same symptoms?

What you can do in the meantime
If you or your child has an E. coli infection, it may be tempting to use an anti-diarrheal medication, but don't. Diarrhea is one way the body rids itself of toxins. Preventing diarrhea slows that process down.
Take small sips of fluid as tolerated to try to stay hydrated.

Diagnosis
To diagnose illness caused by E. coli infection, your doctor will send a sample of your stool to a laboratory to test for the presence of E. coli bacteria. The bacteria may be cultured to confirm the diagnosis and identify specific toxins, such as those produced by E. coli O157:H7.

Treatments
For illness caused by E. coli, no current treatments can cure the infection, relieve symptoms or prevent complications. For most people, treatment includes:
Rest
Fluids to help prevent dehydration and fatigue
Avoid taking an anti-diarrheal medication — this slows your digestive system down, preventing your body from getting rid of the toxins. Antibiotics generally aren't recommended because they can increase the risk of serious complications.
If you have a serious E. coli infection that has caused hemolytic uremic syndrome, you'll be hospitalized and given supportive care, including IV fluids, blood transfusions and kidney dialysis.

In most cases, home care is all that’s required to treat an E. coli infection. Drink plenty of water, get lots of rest, and keep an eye out for more severe symptoms that require a call to your doctor.
You should always check with your pediatrician before giving medications to infants or children.
If dehydration is a concern, your doctor may order hospitalization and intravenous fluids.
The only way your doctor can know for sure if you have an E. coli infection is to send a sample of your stool to a lab to be analyzed.
Fortunately, the infection usually goes away on its own.

For some types of E.coli associated with diarrhea, such as the watery travelers’ diarrhea, antibiotics can shorten the length of time you have symptoms and might be used in moderately severe cases.
But if you have fever or bloody diarrhea or if your doctor suspects Shiga toxin-producing E. coli, antibiotics should not be taken. They can actually increase the production of Shiga toxin and worsen your symptoms.
It’s important to rest and get plenty of fluids to replace what your body is losing through vomiting or diarrhea.

Don’t take over-the counter medications that fight diarrhea. You don’t want to slow down your digestive system, because that will delay your body’s shedding of the infection.
Most people show improvement within five to seven days after the onset of an infection, and make a full recovery.

Home remedies
Follow these tips to prevent dehydration and reduce symptoms while you recover:
Clear liquids. Drink plenty of clear liquids, including water, clear sodas and broths, gelatin, and juices. Avoid apple and pear juices, caffeine, and alcohol.
Add foods gradually. When you start feeling better, stick to low-fiber foods at first. Try soda crackers, toast, eggs or rice.
Avoid certain foods. Dairy products, fatty foods, high-fiber foods or highly seasoned foods can make symptoms worse.

Prevention
One of the most important things you can do to protect yourself and your family against E. coli is wash your hands, particularly in these situations:
Before you prepare food
Before preparing bottles or food for infants or toddlers
Before touching anything, such as a pacifier, that goes into a small child’s mouth.
After you’ve used the bathroom or changed a diaper
After you’ve had contact with animals, even your own pets
After handling raw meat
No vaccine or medication can protect you from E. coli-based illness, though researchers are investigating potential vaccines. To reduce your chance of being exposed to E. coli, avoid risky foods and watch out for cross-contamination.

You can also prevent E. coli infections by being careful about the foods that carry the greatest chance of contamination:
Cook hamburgers until they’re 160 F inside. Hamburgers should be well-done, with no pink showing anywhere in the meat. But color isn't a reliable indicator of whether or not meat is done cooking. Meat — especially if grilled — can brown before it's completely cooked. That's why it's important to use a meat thermometer to ensure that meat is heated to at least 160 F (71 C) at its thickest point.
Drink only pasteurized milk, juice, and cider. Any boxed or bottled juice kept at room temperature is likely to be pasteurized, even if the label doesn't say so.
Wash all of your produce before you eat it. Be especially careful to get dirt off leafy greens such as lettuce and spinach. Washing produce won't necessarily get rid of all E. coli — especially in leafy greens, which provide many spots for the bacteria to attach themselves to. Careful rinsing can remove dirt and reduce the amount of bacteria that may be clinging to the produce.

In your kitchen, a couple of simple rules will help keep you safe:
Wash: Clean knives, counters, and cutting boards with hot, soapy water after raw meat has touched them.
Wash your hands. Wash your hands after preparing or eating food, using the toilet, or changing diapers. Make sure that children also wash their hands before eating, after using the bathroom and after contact with animals.
Keep raw and cooked separate: Use different cutting boards for food that you eat raw, such as vegetables and fruit. Don’t put cooked meat back on the same plate you used for raw meat without washing the plate first.
Do not defrosting meat on the counter
always defrosting meat in the refrigerator or microwave
refrigerating leftovers immediately
drinking only pasteurized milk products (avoiding raw milk)
not preparing food if you have diarrhea
You should also make sure that all meat is cooked properly. The U.S. Department of Agriculture provides guidelines for cooking meat and poultry to proper temperatures to make sure all bacteria are killed. You can use a meat thermometer to check that meat is cooked to these temperatures:
poultry: 165˚F (74˚C)
ground meat, eggs: 160˚F (71˚C)
steaks, pork chops, roasts, fish, shellfish: 145˚F (63˚C)
One of the easiest things you can do to prevent an E. coli infection is to regularly wash your hands. You should wash your hands before handling, serving, or eating food, and especially after touching animals, working in animal environments, or using the bathroom. Practicing good hygiene and following food safety guidelines can go a long way to decreasing your risk of infection.
When you're swimming, try not to swallow the water, whether it's a pool, a lake, or the ocean. It may be tainted.