E.<unk>  enteritis is an infectious bacterial gastroenteritis caused by a pathogenic strain of the Gram-negative rod,<unk> <unk> . It is one of the most common causes of diarrhea worldwide and is responsible for 20% to 50% of all infectious diarrhea, with an incidence in the USA of approximately 20-30 cases per 100,000 individuals. E.<unk>  enteritis may be classified according to the causative E.<unk>  strain into Enterotoxigenic E.<unk>   (ETEC), Enteropathogenic E.<unk>  (EPEC), Enterohemorrhagic E.<unk>  (EHEC), Enteroinvasive E.<unk>  (EIEC), and Enteroaggressive E.<unk>  (EAEC). Transmission of pathogenic E.<unk>  strains is usually by the fecal-oral route in contaminated foods and water. The pathogenesis by which each E.<unk>  strain causes clinical manifestations is unique: ETEC, EHEC, and EAEC secrete toxins, EIEC invades the host colonocytes and migrates within cells, whereas EPEC uses EPEC-elongation factor (EAF) to cause "attachment and effacing". Risk factors in the development of E.<unk>  enteritis include young and old age, immunocompromised status, pregnancy, recent ingestion of uncooked or poorly handled vegetables, meat (e.g. hamburgers), poultry, raw milk, or poorly stored foods that require refrigeration (e.g. mayonnaise), drinking from untreated water, recent travel to developing countries, exposure to infected individuals, daycare, and healthcare settings, and recent sexual history of receptive anal or oral-anal contact. Following transmission, the incubation period of pathogenic E.<unk>  strains is approximately 1-10 days, during which the infected patient remains asymptomatic. Early manifestations of E.<unk>  enteritis include diffuse abdominal pain, vomiting, and severe acute watery diarrhea, which may be followed by episodes of bloody diarrhea (in EHEC and EIEC infections). The majority of patients report resolution of symptoms within 5-10 days of symptom-onset. Common complications of E.<unk>  enteritis include hemolytic uremic syndrome (in EHEC infection), thrombotic thrombocytopenic purpura (in EHEC infection), and acute kidney injury. Prognosis of E.<unk>  enteritis is generally excellent, and the majority of cases resolve without any long-term sequelae. Identification of the causative strain is usually not necessary for diagnosis and treatment. Diagnostic laboratory tests may include either stool culture, ELISA, or polymerase chain reaction (PCR). Rehydration is the mainstay of therapy of E.<unk>  enteritis. Oral rehydration fluids (e.g. oral rehydration solutions) are indicated among patients who can tolerate oral intake, otherwise IV rehydration is indicated. Since the majority of cases of E.<unk>  enteritis are self-limited and the exact infective strain is often not identified, empiric antimicrobial therapy is generally not recommended. Antimicrobial therapy, using either fluoroquinolone or TMP-SMX may be administered (but is not required) in ETEC infection, EPEC infection, and EIEC infection, but not in EHEC infection. Effective preventive measures include hand washing using soap and water and proper food handling.
Escherichia coli enteritis
Clostridial necrotizing enteritis
Shigellosis
Campylobacteriosis
Traveler's diarrhea
Dysentery
Pseudomembranous colitis
Eosinophilic gastroenteritis