Anatomy-Lexicon

Escherichia coli - E. coli

introduction

Escherichia coli is a type of bacteria that is found in the human large intestine, the "Colon", Is also permanently present in the healthy. E. coli only makes up less than 0.1 percent of the intestinal flora in a healthy body.

In most cases, these bacteria do not cause disease. However, there are individual subtypes of Escherichia coli that can trigger a variety of diseases inside and outside the intestine. These are called "pathogenic strains".

A frequent infection with pathogenic Escherichia coli strains occurs through drinking water contaminated with faeces. The different strains of bacteria attack the intestines in different ways and cause in the most common cases Diarrhea, but can also Urinary tract infections, Wound infections, Pneumonia, Meningitis and life threatening Blood poisoning cause.

Especially Patients with weak immune systems and children in infancy are a risk group for serious disease courses.

Escherichia coli in the urine

If there are Escherichia coli bacteria in the urine, this indicates a Urinary tract infection down. As a rule, the mucous membrane of the bladder or the urethra (urethra). They are less affected ureter (Ureter) and the Renal pelviswhat one as Pelvic inflammation (Pyelonephritis) would denote.
Three-quarters of all urinary tract infections are caused by Escherichia coli Bacteria are triggered and women and girls in particular are often affected due to the significantly shorter urethra.

root cause

Coli bacteria have many possible origins and ways of colonizing the urinary tract.
Poor hygiene in the genital area, traffic or contact with faecal water (for example in public swimming pools) can cause inflammation.

Women are particularly often affected because their urethra is particularly short in contrast to the male, making it much easier to get into the urinary bladder.

Symptoms

The Symptoms are first of all one similar to normal infection with a fever and a general feeling of illness.
There are also flank pain (usually Kidney pain), Pain above the pubic bone and most importantly Burning sensation when urinating.
In rare cases it can Blood in the urine come.

therapy

It is advisable to drink a lot in order to flush out the pathogens and to warm the affected area with a hot water bottle. If the symptoms do not improve on their own after a few days, a doctor must be consulted.

Some bacterial infections require antibiotic treatment.
The doctor will prescribe a broad-spectrum antibiotic if he suspects a persistent urinary tract infection caused by Escherichia Coli.

At the same time, he will have a urine test done. Since the bacteria are also in the urine in the case of a urinary tract infection, the doctor can use a urine sample to create a bacterial culture by allowing the existing bacteria to grow in the otherwise very sterile urine.

Through the targeted addition of various antibiotics, the laboratory doctor can determine which antibiotic the bacteria are particularly sensitive to. This examination is known as an "antibiogram".
Since this process takes several days, the doctor may prescribe another, more effective antibiotic after a few days.

prophylaxis

As a precaution, it is advisable to adhere to particular hygiene when using the toilet, to urinate after the sexual act if possible and to use hygienic and fresh panty liners. If possible, the abdomen should not be hypothermic, as this weakens the immune system and allows infections.

Escherichia coli in the blood

If bacteria such as E. coli get into the blood, this can be a very dangerous condition. With the bloodstream, bacteria can be washed out throughout the body and affect different organs. In addition, the immune system is very strongly activated by the large number of pathogens. If this happens, one speaks of sepsis (Blood poisoning). The strong activation of the immune system leads to the release of different messenger substances. Some of these messenger substances have an effect on the circulatory system.

Since a large number of these messenger substances appear at once, the circulation can become overloaded. The blood pressure drops sharply. In this case it is called septic shock. But bacteria such as E. Coli in the blood do not always have to lead to sepsis. Especially in lower concentrations, there is no dangerous overreaction of the immune system. If bacteria such as E. Coli can be detected in the blood without sepsis, it is called bacteremia. Bacteremia can also be threatening, as E. coli bacteria can get into the entire body in the bloodstream.

Read more on the topic: Bacteria in the blood - how dangerous is it?

E. coli enteritis

In most cases, the body will recover from a disease of the Escherichia coli bacteria on its own. The most common disease caused by E.Coli is triggered, is the intestinal inflammation, the so-called "Enteritis“.

Enteritis is an inflammation of the small intestine. If the stomach is involved, it is called gastroenteritis, if the colon is involved, it is called enterocolitis. Different Escherichia Coli bacterial strains can cause intestinal inflammation. The best-known representatives are abbreviated to EHEC, EPEC, EIEC and ETEC. They attack the cells of the intestinal mucosa in different ways and trigger the inflammation. However, the main symptom of all Coli bacterial infections is diarrhea.

The different E. Coli strains occur in all age groups and in different regions of the world. For example, EPEC occurs particularly in young children, with ETEC particularly occurring in regions with very warm climates.

Almost all forms of enteritis causing Coli bacteria subside after a few days and do not require any antibiotic therapy.

Therapy of enteritis by E. coli

Since it is associated with diarrhea, in some cases severe, the body must be treated symptomatically as soon as possible in order to counteract the loss of fluid caused by the diarrhea. In most cases it is enough to drink a lot. Sometimes you have to add a little salt to the drinking water, as these are also eliminated by the diarrhea.

In severe cases, the body must be given intravenous water with electrolytes, if the patient is too weak and the diarrhea is too severe to be made up by drinking alone. In these cases, treatment must be carried out as an inpatient in the hospital.

If the course of the disease hardly improves over a few days, the doctor may have to start antibiotic therapy after further examinations.

In the case of pain and other accompanying symptoms, painkillers may be taken to relieve pain under the direction of a doctor

Blood poisoning from E. coli

As Blood poisoning or sepsis one describes the state in which one Bacteria in the blood Has.
Normally, the bacterial infections caused by Escherichia Coli are limited on mucous membranes, for example of the intestines.
Get into the Bloodstream, the inflammation is referred to as generalized and it can be life-threatening at times.

A risk for a septic course, for example Wound infections represent.
Once the skin is damaged, the path into the bloodstream is open. Bacteria can build up in the wound and cause inflammation in the affected area and even release bacteria into the bloodstream.

An incipient blood poisoning can be recognized by suddenly fluctuating Temperature> 38 ° C or <36 ° C, at a Heart rate> 90 / min, at a Respiratory rate> 20 / min or very high levels of inflammation in the blood test.

With existing and worsening sepsis it comes to Limitations in organ functions, in the worst case to the failure of individual organs, in particularly weak patients or in a severe course. In the most severe case, it becomes septic shock With Multiple organ failurewhich in many cases is fatal. Blood poisoning requires immediate emergency treatment in the hospital.

E. coli sepsis

With sepsis, bacteria spread through the bloodstream. This leads to a strong activation of the immune system. This very strong immune reaction can be very dangerous as it can impair the circulation or damage organs. The whole body is affected by the infection. Sepsis is therefore a life-threatening condition. E. coli bacteria cause about 11-24% of all sepsis. E. coli is a widespread bacterium that colonizes the intestines in a harmless form, even in healthy people. It is very adaptable and can metabolize a wide range of nutrients. Plus, it divides very quickly. An E. coli bacterium can double in size every twenty minutes.

Forms of E. coli that are resistant to common antibiotics are often found in hospitals in particular. All of this enables the bacterium to cause dangerous sepsis if it can get into the bloodstream. At the beginning of a sepsis there is usually a localized inflammation. The urinary tract is relatively close to the anus. Therefore, this original inflammation in E. coli can affect the urinary system, for example. If larger quantities of bacteria suddenly enter the blood from this local inflammation, this can trigger sepsis. Young children and people with a not fully functional immune system, such as patients suffering from AIDS, are particularly at risk (see also: Blood poisoning in children). About 0.3% of all patients in hospitals suffer from sepsis. Blood poisoning is treated with antibiotics and intensive medical treatment to ensure the patient's survival.

Read more on the topic: Blood poisoning

E. coli meningitis

Meningitis is inflammation of the meninges. This can be triggered by an infestation with E. coli. Meningitis is a dangerous infection. The reason for this is the direct proximity of the meninges to the underlying brain tissue. Newborns under 3 months of age are particularly at risk. E. coli is estimated to be responsible for 20% of all newborn meningitis. The infection can occur during childbirth or in the first few weeks of life. If one considers the total population, only about 2% of all meningitis cases are caused by a bacterium of the genus E. coli.

E. coli meningitis almost never occurs in healthy adults. People whose immune system is severely weakened are particularly at risk. These include AIDS patients or people who have had organ transplants due to immunosuppression. Patients who have suffered severe head injuries are also at risk due to the possible port of infection. E. coli usually causes a purulent inflammation of the meninges. This is where it differs from other bacteria such as Borrelia or Treponema. These bacteria usually lead to non-purulent meningitis. Treatment of meningitis caused by E. coli is carried out in an inpatient setting. Potent antibiotics are used.

Read more on the topic: Meningitis

E. coli prostatitis

Prostatitis is inflammation of the prostate. It can be triggered, for example, by E. coli. Often, however, no pathogens can be detected. If E. coli bacteria are the cause, the prostate tissue is infected and the bacteria multiply. The body reacts with an immune response. A distinction is made between acute and chronic prostatitis. In the acute form, there is a fever with chills and burning pain when urinating. Nevertheless, there is often a strong urge to urinate.

The chronic form is more protracted. The pain is less severe but remains for a long time. It can lead to a loss of libido or erectile dysfunction. A wave-like course of the complaints is typical. Both acute and chronic prostatitis are treated with antibiotics. Treatment for up to six weeks is common, especially for chronic bacterial prostatitis. Nevertheless, more than half of the men treated were symptom-free again within six months.

Read more on the subject: Prostatitis

Transmission of E. coli

Since Escherichia Coli bacteria are mainly found in the intestines, the most common route of transmission is via stool or food.

Urinary tract infection by Coli bacteria is a common issue, especially among women. One of the most common ways of transmission is incorrect toilet hygiene, for example by wiping in the wrong direction. Good hand hygiene after contact with faeces is also particularly important.

Women very often get a urinary tract infection with E. coli through sexual intercourse. These are either bacteria from your own intestinal flora that get into the urethra through sexual intercourse, or the partner's intestinal bacteria that are on the limb due to poor hygiene.

in the hospital mainly ensures the spread of bacteria inadequate hand hygiene poses a problem. There it is advisable to use the hand disinfectants provided.
At home it is particularly important to wash your hands thoroughly after using the toilet, before preparing and consuming food, after contact with sick people, but also after contact with animals.

There is also a possibility of infection through contaminated food. Potentially burdened Food must therefore be sufficient cooked to kill the pathogens. Raw meat always poses a risk of bacterial infections. The general one should not be underestimated Kitchen hygiene. Cutting boards, knives and everything that has come into contact with raw meat must be rinsed with hot water before further use.

Faecal contaminated water is also a risk factor. In Germany, according to the Drinking Water Ordinance, not a single coli bacterium may be present in 100ml of water. In phases of E. coli outbreaks, especially, make it too public swimming pools a risk. Avoid swallowing too much water. You should definitely take a hot shower after visiting the swimming pool.

Which antibiotic works best against E. coli?

Normally, E. coli bacteria can be killed by a variety of different antibiotics. These include cephalosporins or broad spectrum penicillins (see also: Ampicillin). They prevent the synthesis of the bacterial cell wall. Since human cells do not synthesize cell walls, side effects are rare. So-called fluoroquinolones (see also: Ciprobay®). These inhibit an enzyme found only in bacteria, which is required to unwind the DNA. Since this is necessary for DNA replication, among other things, the E. coli bacteria can no longer multiply.

DNA synthesis is also the point of attack for various antibiotics. The combination preparation cotrimoxazole (Cotrim®) contains two active ingredients that work together to prevent DNA synthesis in E. coli. In addition to these commonly used antibiotics, there are a number of less frequently used antibiotics with different effects. However, some strains of E. coli bacteria now have a number of resistance mechanisms. These prevent the bacteria from being killed by certain antibiotics. In order to find out which is the most effective antibiotic, a resistance test is often carried out first.

Read more on this: Treatment with antibiotics

Toxin producing E. coli

A number of different strains of E. coli exist. Some of these strains produce toxins. These are toxins that can be harmful to humans. Toxin-producing E. coli strains therefore belong to the so-called pathogenic, i.e. disease-causing E. coli. Enterohaemorrhagic E. coli (EHEC) due to an epidemic in 2011. This strain produces the so-called verotoxins. Verotoxins damage human cells. Although the EHEC bacteria remain in the intestine, toxins they produce get into the bloodstream. Bloody diarrhea develops. In severe cases, kidney damage or anemia can also be the result.

In addition to EHEC, there are a number of other toxin-producing strains. These also include enterotoxic E. coli (ETEC). They produce two different toxins, one of which is only deactivated by temperatures above 100 ° C. Both toxins cause massive watery diarrhea. Many of the toxins produced by E. coli are very similar in structure and mode of action to other bacterial toxins. For example, one of the toxins produced by ETEC is about 80% similar in structure to the cholera toxin. This also triggers watery diarrhea. E. coli-type bacteria are able to exchange parts of their DNA with one another. This also includes DNA sections in which different toxins are coded. This allows the ability to produce toxins to spread across populations or jump between strains.