What is Enteropathogenic Escherichia coli (E. coli)?

From the Guidelines

Enteropathogenic E. coli (EPEC) is a type of bacteria that causes watery diarrhea, primarily affecting infants and young children in developing countries, and treatment typically involves oral rehydration therapy with solutions containing appropriate electrolytes to prevent dehydration. In severe cases, antibiotics such as trimethoprim-sulfamethoxazole (8-10 mg/kg/day divided twice daily for 3-5 days) or ciprofloxacin (500 mg twice daily for adults or 20-30 mg/kg/day for children, for 3-5 days) may be prescribed, though antibiotic resistance is increasingly common 1. Prevention is crucial and includes proper handwashing, safe food preparation, clean drinking water, and proper sanitation. EPEC causes illness by attaching to intestinal cells and creating characteristic "attaching and effacing" lesions, disrupting normal gut function. The bacteria use a type III secretion system to inject effector proteins into host cells, altering cellular processes and causing diarrhea through disruption of tight junctions, inflammation, and impaired absorption. Unlike some other E. coli strains, EPEC does not produce Shiga toxins but still causes significant morbidity, especially in children under five years old. Some key points to consider in the management of EPEC infections include:

• The use of oral rehydration therapy as the primary treatment for dehydration 1
• The potential for antibiotic resistance, particularly to fluoroquinolones and trimethoprim-sulfamethoxazole 1
• The importance of proper handwashing, safe food preparation, and clean drinking water in preventing the spread of EPEC 1
• The need for continued surveillance and monitoring of antibiotic resistance patterns to inform treatment decisions 1.

From the Research

Characteristics of Enteropathogenic E. coli

• Enteropathogenic E. coli (EPEC) is a leading cause of infantile diarrhea worldwide 2
• EPEC infection can induce diarrhea, intestinal damage, metabolic alterations, and increased intestinal permeability in a murine model 2
• Atypical EPEC infection is associated with mild, nondehydrating, and noninflammatory diarrhea, but with a longer duration than other species 3

Oral Rehydration Therapy for EPEC Infection

• Oral rehydration therapy (ORT) has been used to prevent or reverse dehydration in children with acute gastroenteritis, including those caused by EPEC 4
• However, ORT may not be effective in all cases of EPEC infection, as seen in a study where a patient with EPEC O125:B15-induced diarrhea had continued high stool fluid output and required intravenous therapy 5

EPEC Infection in Vulnerable Populations

• EPEC infection can cause diarrhea in cancer and immunosuppressed patients, with a higher bacterial burden and antimicrobial resistance seen in these populations 6
• Immunosuppressed cancer patients with EPEC-associated diarrhea may experience delayed cancer care due to their infection 6

Pathogenesis and Virulence Factors

• The type 3 secretion system (T3SS) is important for EPEC virulence, as seen in a study where an escN mutant (lacking T3SS) did not cause weight loss or increased inflammatory biomarkers in mice 2
• EPEC strains can exhibit distinct patterns of adherence and variable cytotoxicity when studied in human intestinal enteroids (HIEs) 6