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U.S. Department of Health and Human Services

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BBB - Enteropathogenic Escherichia coli (EPEC)

Bad Bug Book:
Foodborne Pathogenic Microorganisms and Natural Toxins Handbook
Enteropathogenic Escherichia coli

A new version of the Bad Bug Book was released in 2012, below is a previous version.


1. Name of the Organism:

Enteropathogenic Escherichia coli (EPEC)

Currently, there are four recognized classes of enterovirulent E. coli (collectively referred to as the EEC group) that cause gastroenteritis in humans. Among these are the enteropathogenic (EPEC) strains. EPEC are defined as E. coli belonging to serogroups epidemiologically implicated as pathogens but whose virulence mechanism is unrelated to the excretion of typical E. coli enterotoxins. E. coli are Gram-negative, rod-shaped bacteria belonging the family Enterobacteriaceae. Source(s) and prevalence of EPEC are controversial because foodborne outbreaks are sporadic. Humans, bovines, and swine can be infected, and the latter often serve as common experimental animal models. E. coli are present in the normal gut flora of these mammals. The proportion of pathogenic to nonpathogenic strains, although the subject of intense research, is unknown.

2. Nature of Acute Disease:

Infantile diarrhea is the name of the disease usually associated with EPEC.

3. Nature of Disease:

EPEC cause either a watery or bloody diarrhea, the former associated with the attachment to, and physical alteration of, the integrity of the intestine. Bloody diarrhea is associated with attachment and an acute tissue-destructive process, perhaps caused by a toxin similar to that of Shigella dysenteriae, also called verotoxin. In most of these strains the shiga-like toxin is cell-associated rather than excreted.

Infective dose -- EPEC are highly infectious for infants and the dose is presumably very low. In the few documented cases of adult diseases, the dose is presumably similar to other colonizers (greater than 10^6 total dose).

4. Diagnosis of Human Illness:

The distinction of EPEC from other groups of pathogenic E. coli isolated from patients' stools involves serological and cell culture assays. Serotyping, although useful, is not strict for EPEC.

5. Associated Foods:

Common foods implicated in EPEC outbreaks are raw beef and chicken, although any food exposed to fecal contamination is strongly suspect.

6. Relative Frequency of Disease:

Outbreaks of EPEC are sporadic. Incidence varies on a worldwide basis; countries with poor sanitation practices have the most frequent outbreaks.

7. Course of Disease and Complications:

Occasionally, diarrhea in infants is prolonged, leading to dehydration, electrolyte imbalance and death (50% mortality rates have been reported in third world countries).

8. Target Populations:

EPEC outbreaks most often affect infants, especially those that are bottle fed, suggesting that contaminated water is often used to rehydrate infant formulae in underdeveloped countries.

9. Food Analysis:

The isolation and identification of E. coli in foods follows standard enrichment and biochemical procedures. Serotyping of isolates to distinguish EPEC is laborious and requires high quality, specific antisera, and technical expertise. The total analysis may require from 7 to 14 days.

10. Selected Outbreaks:

For more information on recent outbreaks see the Morbidity and Mortality Weekly Reports from CDC.