E. Coli Infections

E. coli (Escherichia coli) is a type of bacteria that often lives in the intestines of people and animals. There are different strains of E. coli and most are harmless and a normal part of a healthy digestive system. But some strains are infectious and may cause serious health problems.

Causes and risk factors of E. coli infections

E. coli infections typically spread when bacteria from stool (poop) gets into your mouth and digestive system (fecal-oral transmission). This can happen due to:

• Contaminated food: Eating undercooked meat, especially ground beef, unpasteurized dairy products, or unwashed fruits and vegetables that were contaminated from poor handling or irrigation.
• Contaminated water: Drinking water that has been contaminated with animal or human waste. 
• Cross-contamination: Spreading bacteria from raw meat or other foods to ready-to-eat or prepared foods or surfaces because of poor hand washing or kitchen and utensil cleaning.
• Person-to-person contact: Direct contact with an infected person, especially if hygiene is poor.

You may be more likely to get an E. coli infection or to have complications based on your:

• Age: Babies, young children and people over age 65 are at higher risk for complications.
• Immune system: If you have a chronic disease, are undergoing chemotherapy or taking medications that suppress your immune system, you are more likely to catch a severe infection.
• Travel: Traveling to areas that have poor sanitation or hygiene makes it more likely that you will get an E. coli infection. Travelers’ diarrhea, which is caused by E. coli infection, is common in people visiting these areas.
• Health conditions: If you have diabetes, chronic kidney disease, ulcerative colitis or other health conditions, you may be at higher risk of complications from an E. coli infection.
• Medications: Taking medications that lower your stomach acid, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) or pantoprazole (Protonix) may increase your risk.

Infections are more common in the summer, though experts don’t know why.

Symptoms of E. coli infection

Most of the time, symptoms may include:

• Diarrhea: Frequent loose or watery stools, sometimes with mucus.
• Abdominal pain: Mild to severe cramping or pain in the belly.
• Nausea: Queasiness and lack of appetite.
• Vomiting: Vomiting may occur with an E. coli infection but is less common than other symptoms.
• Fever: Some people have a low-grade fever.
• Fatigue: Feeling tired or weak.

Symptoms usually start in three to five days. Some strains of E. coli make you sick in hours and others take up to 10 days.

E. coli can also cause urinary tract infections, pneumonia and other illnesses that have different symptoms. 

With a more serious digestive system infection, you may notice:

• Bloody diarrhea: This can be a sign of intestinal damage.
• Kidney failure: Hemolytic uremic syndrome (HUS) is a serious condition that can cause reduced urine output, swelling, fatigue, pale skin and bruising. It needs immediate medical attention.
• Sepsis: A serious infection of the bloodstream.
• Malnutrition: Children with frequent diarrhea may not get the nutrients they need.

When to seek medical attention for E. coli

You may be able to manage a mild E. coli infection at home. Rest and drink plenty of fluids such as water, oral rehydration solutions or clear broths. Don’t take medication to prevent diarrhea, since diarrhea helps your body get rid of the toxins.

Choose foods that are easy to digest and gentle on your stomach, like bananas, rice, applesauce, toast, crackers and eggs. Avoid dairy products, fatty or spicy foods, caffeine and alcohol, since they can make diarrhea worse.

Wash your hands often, especially after you use the bathroom and before you eat. This helps keep the infection from spreading to other people.

You should reach out to a health care provider if:

• You have severe symptoms, like bloody diarrhea, intense abdominal pain or signs of dehydration like a dry mouth, feeling very thirsty, not urinating much or dizziness.
• You’re vomiting a lot, which could cause dehydration.
• You have a fever over 102°F.
• You’re seeking care for a baby under 3 months old.
• Your symptoms do not improve within four days (two days for a child) or they get worse.
• You have recently travelled internationally.
• You are at high risk. This includes young children, older adults, pregnant women and people with weakened immune systems.
• You have symptoms of severe complications such as reduced urine output, swelling, fatigue, pale skin or bruising.

Getting care quickly can help you manage symptoms, prevent complications and reduce the odds of spreading the infection to others.

Diagnosing E. coli infection 

To diagnose an E. coli infection, your health care provider may use:

• Stool tests: Stool tests can identify the strain of E. coli that’s causing the infection. 
• Blood tests: Blood tests can check for signs of infection or complications, such as high white blood cell counts or kidney function markers. 
• Urine tests: Urine tests can evaluate kidney function if there are signs of severe illness.

Your provider will make sure you don’t have another infection that can cause similar symptoms, such as salmonella, campylobacteriosis, giardiasis or norovirus. Stool tests can show if an infection is caused by E. coli or these other conditions. PCR testing may also detect norovirus.

Irritable bowel syndrome (IBS) can also cause symptoms that are similar to E. coli. Your provider can diagnose IBS based on your symptoms and by ruling out other causes with stool cultures and blood tests.

Treating and managing E. coli infection

Treating E. coli infections is usually focused on relieving symptoms, which may last two days to two weeks. It can help to rest, drink plenty of fluids and eat foods that are bland and easy to digest.

Most of the time, you won’t need antibiotics for an E. coli infection. They may not be effective and could even make your symptoms worse. But antibiotics may work against certain strains. If your health care provider finds that you need antibiotics, they may prescribe trimethoprim/sulfamethoxazole, ciprofloxacin, rifaximin or nitrofurantoin.

Preventing E. coli Infections

These strategies can help you reduce your risk:

• Cook ground beef and other meats to an internal temperature of at least 160°F to kill bacteria. Check the temperature with a food thermometer.
• Don’t eat or drink unpasteurized milk, cheese, ice cream or other dairy products or unpasteurized cider or juice.
• Rinse fresh fruits and vegetables under running water and scrub them with a brush to remove contaminants. It’s especially important to clean lettuce and spinach well.
• Use separate cutting boards, utensils and plates for raw meats and ready-to-eat foods. Plastic, silicone and ceramic cutting boards are better than wood. 
• Keep frozen meat contained when it’s thawing. Don’t leave it out directly on the counter.
• Don’t rinse meat before you cook it.
• Refrigerate leftovers right away.
• Wash your hands thoroughly with soap and water, especially before eating, after using the bathroom or changing diapers, after handling raw meat and after touching animals in a petting zoo, barn or farm.
• Regularly clean and disinfect kitchen surfaces, including countertops, cutting boards and utensils. 
• If you are traveling to an area with questionable water quality, use bottled or treated water.
• Try not to swallow water when you’re swimming in lakes, streams, rivers or pools.
• Be mindful of consuming raw or undercooked foods, such as sushi or raw eggs.
• Avoid close contact with people who are sick and do not share utensils or food with someone who has infection symptoms.

Getting care

E. coli infections are often caused by contaminated food or water, but you can reduce your risk with good hygiene and food preparation and cooking. If you get sick you may be able to recover at home with rest, fluids and a bland diet.

If you are at high risk of complications or have serious symptoms such as bloody diarrhea, severe pain or signs of dehydration, talk with a Banner health care provider. 

The highly trained experts at Banner Health are prepared to diagnose and treat E. coli infections and similar health conditions. Reach out to get the comprehensive care you need.