E.coli GI Infection

Escherichia coli, most commonly called E.coli, refers to rod-shaped bacteria commonly found in the large intestines of humans and animals. Although most strains of E.coli do not cause serious illness, some strains can make people sick, causing severe stomach cramps, diarrhea, and vomiting.

In Canada, about 440 cases of intestinal E.coli infection are reported per year, costing Canadians $440 million in lost productivity and health care.

How can I prevent Escherichia coli (E.coli)?

• Hand washing is one of the best ways to prevent the spread of foodborne infections
• Use warm soapy water to clean knives, cutting boards, utensils, hands and any surfaces that may have come in contact with food – especially raw meats and fish
• Store raw meats in sealable containers on the lower shelf of the refrigerator to help prevent raw juices from contaminating other foods
• Keep raw meats away from other food when shopping
• Wash fresh fruits and vegetables with a dish brush before eating, but do not use soap or detergents
• Read labels for proper cooking and storage instructions
• Always check “best before” dates and discard any foods that have expired
• Refrigerate or freeze perishable food within two hours of cooking
• Freeze or eat leftovers within four days of cooking and be sure to reheat leftovers until steaming hot
• Keep your refrigerator clean and at a temperature below 4 °C
• Keep cold foods at or below 4 °C
• Keep hot foods hot; at or above 60 °C

How do I prevent Traveler’s Diarrhea?

• Discuss prevention and treatment options of traveler’s diarrhea with your healthcare provider 6 weeks before your departure
• Consider medication or an oral vaccine to protect yourself against travelers’ diarrhea prior to departure
• Wash your hands with soap under warm running water for at least 20 seconds before eating, after using the bathroom or interacting with animals
• Use alcohol-based hand sanitizer if soap and water are not available
• Avoid high-risk foods and beverages like undercooked meat or fish, fresh salads, raw vegetables, unpeeled fruits, cold sauces, unpasteurized dairy products and untreated water and ice cubes
• Avoid brushing your teeth with tap water – pour bottled water on your toothbrush

Some individuals infected with E.coli do not have symptoms and may inadvertently spread the bacteria to others.

E.coli infections typically begin three or four days after exposure.

Typical symptoms of an E.coli infection are:

• Severe stomach cramps;
• Diarrhea (often bloody);
• Vomiting; and fever Diagnosing an E.coli infection can be complicated because there are many other infections that share the same symptoms. Doctors can confirm E.coli by taking a stool sample to identify toxins produced by the bacteria.

Risks Associated with Escherichia coli (E.coli)

Dehydration is a potentially serious risk factor – especially in children, the elderly and those with suppressed immune systems. Symptoms of dehydration include decreased urination, dry mouth, dry throat, pallor and dizziness when standing. Children suffering from dehydration may cry with little to no tears, be lethargic or irritable.

Severe dehydration can be serious and may require re-hydration in a hospital. If you think you or someone under your care is dehydrated, contact your healthcare provider.

About 5 to 10 per cent of those who contract E.coli develop a condition called hemolytic uremic syndrome (HUS). HUS is a rare kidney and blood disorder which can be fatal. Symptoms of HUS can include confusion, abnormal bleeding or bruising and seizures. HUS can also result in need for blood transfusion and kidney dialysis. Kidney damage from HUS can be permanent, so timely diagnosis and treatment is extremely important.

Testing for E.coli

Diagnosing traveler’s diarrhea can be complicated because there are many infections that cause similar symptoms.

To confirm a case traveler’s diarrhea, physicians will order a stool sample that will be tested for toxins produced by the bacteria.

Treating E.coli

There is currently no treatment to cure an E.coli infection, but the infections generally settle on their own within a week or less. For most people, rest and intake of fluids to help prevent fatigue and dehydration are recommended.

Those who are infected are advised to avoid taking anti-diarrheal medication as diarrhea is the body’s mechanism of clearing the infection and associated toxins.

Antibiotics are not recommended because they can increase the risk of HUS by increasing the amount of toxin released from bacteria.

Prevention is your best medicine, especially when considering going on vacation in an area where access to clean water may be an issue.

Traveler’s diarrhea, which can be caused by E.coli, is the most common illness to affect those who travel abroad. Travelers are at higher risk when going to destinations with poor standards of hygiene and sanitation and/or eating at places with poor food handling practices. 

Managing E.coli

Working collaboratively with your health care professional will help you protect your body from digestive diseases and maximize your digestive health. When you report your health status completely, concisely and accurately, your physician can provide you with the best care and treatment plan. Be sure to stay informed on ways to maintain your health and well-being, track and record your symptoms, and write down questions and concerns to discuss at your next appointment.

• There are hundreds of identified E. coli strains, resulting in a spectrum of disease from mild, self-limited gastroenteritis to renal failure and septic shock.¹
• Diarrheal illness may come into effect as a result of E. coli, either watery or bloody. ¹
• E. coli that causes diarrhea ​​can be transmitted through contaminated food or water. ²
• In most cases, the illness can be resolved without treatment, but it can lead to life-threatening diseases including haemolytic uraemic syndrome (HUS), especially among the elderly and young children. ³

Citations

1. https://www.ncbi.nlm.nih.gov/books/NBK564298/
2. https://www.cdc.gov/ecoli/general/index.html
3. https://www.who.int/news-room/fact-sheets/detail/e-coli
4. https://about-ecoli.com/ecoli_diagnosis

Can I die from traveler’s diarrhea?

Traveler’s diarrhea is generally neither life threatening nor severe. Most bouts of the illness begin within the first week of travel and resolve on its their own within 3-5 days. When treating traveler’s diarrhea, the goal is to prevent dehydration, which can be of special concern for children, pregnant women, those with compromised immune systems, and the elderly.

If you are at increased risk for any of the reasons above, you should consult your family physician to discuss whether you should take a course of antibiotics with you to take if you have a bout of traveler’s diarrhea.

Can I take an antimotility drug?

Antimotility drugs, like Imodium or Lomotil, can reduce the amount of diarrhea you experience. If you decide to use this over-the-counter treatment, you should speak with your physician or pharmacist first. Diarrhea is one way the body rids itself of pathogens (microorganisms that cause disease) from the gastrointestinal tract. Taking these antimotility drugs may mean it takes the body longer to clear the pathogen.

Bismuth-containing medicines, such as Pepto-Bismol, may help with the diarrhea as bismuth has antibacterial properties.

Can I use tap water from the hotel to brush my teeth?

Using tap water to brush your teeth is best avoided as the water may be contaminated. To avoid getting sick, use bottled water when brushing your teeth; this is the best way to protect yourself.

How can I avoid Traveler’s Diarrhea when traveling abroad?

Three common ways to contract traveler’s diarrhea are through contaminated water, contaminated food and poor hygiene.

Water safety can be questionable, so it is important to avoid tap water as much as possible. Only drink boiled or bottled water and avoid ice cubes.

The food you eat can be contaminated. When traveling, try to select foods that are served hot and are completely cooked, avoid raw meats, eat fruits you can peel, and avoid raw leafy vegetables.

To avoid infecting yourself, try to clean your hands often, especially before eating. Use soap and water or a hand sanitizer and avoid touching your face and mouth.

I am travelling to a developing country and am afraid of developing traveller’s diarrhea. What can I do to protect myself?

People who visit foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Although there are antibiotic prophylaxis available, they are not recommended in most cases. While you are travelling, wash your hands with warm, soapy water, drink bottled water and eat food that are served warm and cooked thoroughly. Try to avoid tap water (including ice), dairy products, raw vegetables, uncooked meats, and seafood. Foods that are usually safe to drink include hot coffee and tea, beer, wine and carbonated beverages. Fruits and vegetables that can be peeled are generally safe to eat.

If I get traveler’s diarrhea, how long will it last?

Most cases of traveler’s diarrhea are mild and typically last 3-5 days. However, some cases can become severe and may result in dehydration, fatigue and a high-grade fever that may require hospitalization.

When travelling, can I shower in the local water?

Yes you can, just make sure you don’t swallow any water. (And don’t swallow water when swimming).

Where am I most likely to get traveler’s diarrhea?

You can contract traveler’s diarrhea from anywhere in the world, but you are at greater risk of contracting the condition when visiting, Central and South America, Mexico, Africa, the Middle East, Asia, Eastern Europe, South Africa and some parts of the Caribbean. The risk of traveler’s diarrhea increases in areas with lower hygiene and sanitation standards and poor food-handling practices.