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E. Coli Infections: Diarrhea

What Are E. Coli Infections?

E. coli is a type of bacteria that normally lives in the intestines, where it helps the body break down and digest food.

Some types (or strains) of E. coli, though, are infectious (causing infections that can spread to others). They spread through contaminated food or water, or from other infected people or animals.

Infections due to E. coli (Escherichia coli) bacteria can cause severe, bloody diarrhea. Sometimes they also cause urinary tract infections, pneumonia, meningitis, bacteremia (a bacterial infection in the blood), or sepsis (a dangerous full-body response to bacteremia). Some infections can lead to serious health problems, especially in very young or very old people, or people with weak immune systems.

But most healthy people who get an infection don't develop serious problems and recover on their own without treatment.

How Do E. Coli Infections Happen?

Most often, E. coli spreads when someone eats food that contains the bacteria. At-risk foods include:

  • undercooked ground beef (such as in hamburgers)
  • produce grown in animal manure (of cows, sheep, goat, or deer) or washed in contaminated water
  • unpasteurized dairy or juice products

The bacteria also can spread from person to person on unwashed hands and surfaces, by swimming in contaminated water, and from touching animals at farms or petting zoos.

Sometimes outbreaks happen. An outbreak is when a disease happens in greater numbers than expected in a particular area. E. coli outbreaks usually happen because many people ate the same contaminated food.

What Are the Signs & Symptoms of an E. Coli Infection?

Some types of E. coli bacteria make a toxin (a poisonous substance) that can damage the lining of the small intestine. This can lead to bad stomach cramps, vomiting, and diarrhea (often with blood in it). When that happens, people can get dehydrated.

Symptoms usually start 3–4 days after a person had contact with the bacteria and end within about a week.

Are E. Coli Infections Contagious?

Yes, an E. coli infection is contagious for at least as long as the person has diarrhea, and sometimes longer.

What Problems Can Happen?

Most people recover completely from an E. coli infection. But some can develop a serious kidney and blood problem called hemolytic uremic syndrome (HUS).

Signs of HUS include:

  • peeing less than usual
  • looking pale or swollen
  • unexplained bruises
  • bleeding from the nose or gums
  • extreme tiredness
  • seizures

HUS can be life-threatening and needs to be treated in a hospital.

How Are E. Coli Infections Diagnosed?

Doctors might do a stool test to look for E. coli bacteria. They also can order blood tests to check for possible problems.

How Are E. Coli Infections Treated?

Antibiotics can't help and, in fact, can be harmful. And anti-diarrheal medicines can increase the risk of problems and should not be used.

Kids with an E. coli infection should rest as much as possible and drink plenty of fluids to avoid dehydration. Those who get dehydrated might need to get care in a hospital and be given IV fluids. Kids with HUS may need dialysis for kidney failure and/or blood transfusions.

As kids recover from an infection, they usually can return to:

  • normal activities after two stool tests show no bacteria
  • swimming after 2 weeks have passed with no symptoms

These recommendations may vary in different areas, so it’s a good idea to ask your doctor or check with your health department.

Can E. Coli Infections Be Prevented?

E. coli outbreaks have been tied to a wide variety of foods, such as fresh spinach, hamburgers, ground beef, bologna, hazelnuts, packaged cheeses, shredded lettuce, and prepackaged cookie dough.

Safe food preparation can go a long way toward protecting your family from E. coli infections:

  • Cook meat well until it reaches a temperature of at least 160°F/70°C at its thickest point.
  • Thoroughly clean anything that comes into contact with raw meat.
  • Choose pasteurized juices and dairy products.
  • Clean raw produce well before eating.

Teach your kids to wash their hands well and often, especially after going to the bathroom, touching animals, or playing outside, and before eating or preparing food. They should avoid swallowing water while swimming.

When Should I Call the Doctor?

Call your doctor if your child has any symptoms of an E. coli infection, especially stomach pain or lasting, severe, or bloody diarrhea.

Call right away if your child shows signs of dehydration (such as peeing less than normal) or of hemolytic uremic syndrome, especially if your child had a recent gastrointestinal illness.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date Reviewed: Sep 1, 2022

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