Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Diarrhea by several different mechanisms due to E coli Hemorrhagic colitis and hemolytic-uremic syndrome Neonatal sepsis or meningitis Urinary tract infection Opportunistic infections Diagnosis confirmed by culture +++ General Considerations ++ Enterobacteriaceae Family of gram-negative bacilli that are normal flora in the gastrointestinal tract and are also found in water and soil Cause gastroenteritis, urinary tract infections, neonatal sepsis and meningitis, and opportunistic infections E coli is the organism in this family that most commonly causes infection in children Klebsiella, Morganella, Enterobacter, Serratia, Proteus, and other genera are also important, particularly in the immunocompromised person Klebsiella, Enterobacter, Serratia, and Morganella are normally found in the gastrointestinal tract and in soil and water Klebsiella may cause a bronchopneumonia with cavity formation Klebsiella, Enterobacter, and Serratia Often hospital-acquired opportunists associated with antibiotic usage, debilitated states, and chronic respiratory conditions Frequently cause urinary tract infection or sepsis +++ Clinical Findings +++ Symptoms and Signs ++ E coli gastroenteritis May cause diarrhea of varying types and severity Enterotoxigenic E coli (ETEC) Usually produce mild, self-limiting illness without significant fever or systemic toxicity, often known as traveler's diarrhea May be severe in newborns and infants, and occasionally an older child will have a cholera-like syndrome Enteroinvasive E coli (EIEC) Cause a shigellosis-like illness, characterized by fever, systemic symptoms, blood and mucus in the stool, and leukocytosis Uncommon in the United States Shiga toxin-producing E coli (STEC) Cause hemorrhagic colitis Diarrhea initially is watery; progresses to blood streaking or grossly bloody stools Fever usually is absent Abdominal pain and cramping occur Hemolytic-uremic syndrome occurs within a few days of diarrhea in 2–5%; characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure Neonatal sepsis Jaundice, hepatosplenomegaly, fever, temperature lability, apneic spells, irritability, and poor feeding Respiratory distress develops when pneumonia occurs; it may appear indistinguishable from respiratory distress syndrome in preterm infants Meningitis is associated with sepsis in 25–40% of cases Other metastatic foci of infection may be present, including pneumonia and pyelonephritis Sepsis may lead to severe metabolic acidosis, shock, disseminated intravascular coagulation, and death Neonatal meningitis High fever Full fontanelles Vomiting Coma Convulsions Pareses or paralyses Poor or absent Moro reflex Opisthotonos Hypertonia or hypotonia Sepsis coexists or precedes meningitis in most cases Acute urinary tract infection Dysuria, increased urinary frequency, and fever in the older child. Nonspecific symptoms such as anorexia, vomiting, irritability, failure to thrive, and unexplained fever are seen in children younger than age 2 years Young infants may have jaundice +++ Differential Diagnosis ++ Enteropathogenic E coli (EPEC) infection may resemble salmonellosis, shigellosis, or viral gastroenteritis +++ Diagnosis ++ Serotyping, biochemical and nucleic acid tests for enterotoxin production or invasiveness, and tests for P-fimbriae are performed in research laboratories STEC MacConkey agar with sorbitol substituted ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth