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Enterohaemorrhagic Escherichia coli (EHEC)

Key facts

• Enterohaemorrhagic E. coli (EHEC) is a bacterium that can cause severe foodborne disease.
• Primary sources of EHEC outbreaks are raw or undercooked ground meat products, raw milk and faecal contamination of vegetables.
• In most cases, the illness is self-limiting, but it may lead to a life-threatening disease including haemolytic uraemic syndrome (HUS), especially in young children and the elderly.
• EHEC is heat-sensitive. In preparing food at home, be sure to follow basic food hygiene practices such as "cook thoroughly".
• Following the WHO Five keys to safer food is a key measure to prevent infections with foodborne pathogens such as EHEC.

Overview

Escherichia coli (E. coli) is a bacterium that is commonly found in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless. Some strains however, such as enterohaemorrhagic E. coli (EHEC), can cause severe foodborne disease. It is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products, raw milk and contaminated raw vegetables and sprouts. Its significance as a public health problem was recognized in 1982, following an outbreak in the United States of America.

EHEC produces toxins, known as verotoxins or Shiga-like toxins because of their similarity to the toxins produced by Shigella dysenteriae. EHEC can grow in temperatures ranging from 7°C to 50°C, with an optimum temperature of 37°C. Some EHEC can grow in acidic foods, down to a pH of 4.4, and in foods with a minimum water activity (Aw) of 0.95. It is destroyed by thorough cooking of foods until all parts reach a temperature of 70°C or higher. E. coli O157:H7 is the most important EHEC serotype in relation to public health; however, other serotypes have frequently been involved in sporadic cases and outbreaks.

Symptoms

Symptoms of the diseases caused by EHEC include abdominal cramps and diarrhoea that may in some cases progress to bloody diarrhoea (haemorrhagic colitis). Fever and vomiting may also occur. The incubation period can range from three to eight days, with a median of three to four days. Most patients recover within 10 days, but in a small proportion of patients (particularly young children and the elderly), the infection may lead to a life-threatening disease, such as haemolytic uraemic syndrome (HUS). HUS is characterized by acute renal failure, haemolytic anaemia and thrombocytopenia. It is estimated that up to 10% of patients with EHEC infection may develop HUS, with a case-fatality rate ranging from 3 to 5%. Overall, HUS is the most common cause of acute renal failure in young children. It can cause neurological complications (such as seizure, stroke and coma) in 25% of HUS patients and chronic renal sequelae, usually mild, in around 50% of survivors.

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