Escherichia coli gastroenteritis

Introduction to Escherichia coli gastroenteritis Enterobacteriaceae includes a large group of Gram-negative bacilli with similar biological traits, most of which are found in the intestines of humans and animals. Some of them have obvious pathogenic effects on humans. When the state of the host changes or bacteria enter the intestines. Outside the tract, the normal flora of the intestine can also cause various diseases as a conditional pathogen. basic knowledge The proportion of illness: 30% Susceptible people: no specific people Mode of infection: digestive tract spread Complications: diarrhea, dehydration

Causes of Escherichia coli gastroenteritis

(1) Causes of the disease

This strain is a Gram-negative bacillus, the size is (1.1 ~ 1.5) m × (2.0 ~ 6.0) m (live bacteria) or (0.4 ~ 0.7) m × (1.0 ~ 3.0) m (staining bacteria), most strains have a whole body Flagella, can move, there are pili on the whole body, no spores, some strains have envelopes, pili are located on the surface of the bacteria, fibrous attachments, are hydrophobic protein components, have good antigenicity, can stimulate the body to produce corresponding The antibody is a facultative anaerobic bacterium, which can develop at 15 to 45 ° C. The optimum growth temperature is 37 ° C, and the optimum pH is 7.4 to 7.6. On the intestinal bacteria selection medium, it can ferment lactose to produce sugar. The indicator discolors to form colored colonies, while most of the pathogenic bacteria in the Enterobacteriaceae do not decompose lactose, and the colonies are colorless. This point has a selective effect on the isolation of Enterobacteriaceae pathogenic bacteria, fermenting glucose, lactose, maltose, mannitol. A variety of sugar alcohols produce acid to produce gas; for sucrose, dulcitol, raffinose, rhamnose, etc. vary depending on the strain, IMVC test is -, urease, phenylalanine, malonate and other negative, antigen The structure is more complicated, mainly consisting of three kinds of antigens: O, H and K. The O antigen is a heat-resistant polysaccharide phospholipid complex. There are 171 species before, which is the basis of serotyping; H antigen is a heat-labile protein, and 56 antigens have been established so far; K antigen is an envelope antigen, and 100 species are known to date. Survival for weeks to months, survival in the lower temperature feces, prone to drug resistance, the emergence of drug resistance, mainly obtained by the delivery of plasmids with drug resistance factor (R factor).

(two) pathogenesis

1. Invasiveness: Escherichia coli has K antigen and pili, K antigen has anti-phagocytosis, and has the effect of resisting complement and antibody; pili can help bacterial adhesion, producing cilia of toxic Escherichia coli The bacterium is called colonization factor or colonization factor, including CFAI, CFAII. They are controlled by bacterial plasmids and can be transmitted to other strains through plasmids. They are highly antigenic and can stimulate the host to produce specific antibodies and have invasiveness. The strain can invade the surface of the intestinal mucosa causing inflammation.

2. Enterotoxin: Etoxin released during the growth and reproduction process is called Escherichia coli enterotoxin, according to its stability to heat: heat-stable enterotoxin (ST), heat-resistant sausage Toxin (heat-labile enterotoxir, LT), both ST and LT are encoded by extrachromosomal genetic material plasmids, which control synthesis, and certain strains of EFEC produce cytotoxic substances.

(1) Heat-labile enterotoxin (LT): Enterotoxin similar to Vibrio cholerae, can stimulate adenosine cyclase in intestinal epithelial cells, convert ATP into cAMP, promote excessive secretion of intestinal fluid, and exceed intestinal resorption capacity. As a result of diarrhea, heat-resistant enterotoxin (ST) causes the amount of intracellular cGMP to increase by activating guanylate cyclase on the cells, resulting in dysfunction of fluid balance and diarrhea.

(2) Endotoxin: Escherichia coli cell wall has endotoxin activity, and its toxic site is lipid A; O-specific polysaccharide contributes to the defense function of bacteria against host.

3. Adhesin: Adhesin (BFP), formerly known as the pathogenic Escherichia coli adhesion factor (EAF), is a pili encoded by a large plasmid of the bacterium, which is closely related to adhesion. BFP-mediated adhesion is local adhesion. The bacteria are not evenly distributed on the cell surface, but clusters or micro-colonies are present on the cells. At the same time, the adhesion is long-term adhesion, and the bacterial cells are not directly related to the cells. Contact, the two are connected by pili.

4. Ginseng: Ginseng, formerly known as EAE protein, is a minor outer membrane protein of enteropathogenic Escherichia coli with a molecular weight of 94 kD and a height of N-terminal region of the invasin of Yersinia. The homology is that the coding gene eae A is located on the chromosome of the cell, and a similar structure of eae A has recently been found in hemorrhagic Escherichia coli.

Compactin is the main material basis for the close adhesion and invasion of Escherichia coli to host cells. When it binds to the corresponding receptors on the host cell membrane, it causes the increase of intracellular Ca2 concentration and phosphorylation of proteins. The scaffold is rearranged to form a dense fibrillar actin pad at the bacterial adhesion, thereby allowing the bacteria to invade the cells. At this time, the infected cells appear as brush-like edges and lose microvilli.

5.eae A gene family: Tnpho A was inserted into plasmid-containing EPEC-induced mutations. As a result, 22 strains were found to be non-invasive in 329 strains, and 5 strains of Tnpho A were inserted into the eae A gene of the chromosome, demonstrating invasiveness and tightness. Attached, closely related to the production of compaction, another 2 strains of Tnpho A inserted under the eaeA, lost the ability to adhere to the epithelial cells, but still produce compaction, which indicates that there is an eae gene cluster in EPEC, The gene under eae A is called eae B.

Through genetic studies, combined with the above-mentioned pathogenic factors, Donnenberg proposed that the pathogenesis of EPEC is divided into three phases. The first phase is mediated by BFP encoded by bfp A on the EAF plasmid, allowing bacteria to adhere to each other and adhere to the microvilli. Plasmids and chromosomal loci lead to initial local adhesion, phase 2 chromosomal gene initiation signal conversion, resulting in protein tyrosine phosphorylation, increased intracellular calcium concentration, early cell scaffold destruction, microvilli changes and fluid secretion, third With the progress of the infection, the eae gene cluster is activated, and the produced tight hormone makes the bacteria adhere to the epithelial cell membrane, which causes the destruction of the cell scaffold, and the bacterial adhesion to the lower actin, myosin, etc., and a part of the bacteria invade the epithelium. cell.

Escherichia coli gastroenteritis prevention

1. Manage the source of infection

(1) Early detection: through self-reporting, mutual reporting, outpatient, round-the-clock, etc., early detection of patients, places where the epidemic has occurred, special emphasis on medical observation for the management personnel, water supply personnel, food processing sales personnel and conservation personnel Frequently understand the stool situation, if necessary, do stool examination, timely discovery of patients and pathogen carriers, regular follow-up of patients discharged from the hospital, understand the stool, with or without symptoms and signs, timely detection of recurrent and chronic patients.

(2) Isolation and treatment: diarrhea caused by the patient or carrier as the source of infection, the patient should immediately be sent to the hospital for intestinal isolation, treatment, treatment should be timely, thorough, and must be cured before discharge, during the isolation period Patients should strengthen health education and management. Patients should abide by various regulations, consciously pay attention to not contact with healthy people, and do not dump excrement casually to prevent environmental pollution.

2. Cut off the route of transmission

(1) Do a good job in water supply sanitation: the health department should regularly check the water quality and disinfection effect, and the decentralized water supply should select the water source. Drinking water (including water for the house, water for washing) must be disinfected. When using chlorine disinfectant, Pay attention to the effective chlorine content and the residual chlorine should be maintained at 0.2 ~ 0.3mg / L.

(2) Manage good food hygiene:

1 Frequent inquiries and physical examinations of the perpetrators, found that suspicious patients immediately sent to the hospital for examination and treatment, the management of the staff before and before meals (including before cooking) should insist on washing hands, wear work clothes at work, keep clean, fistula Personnel, catering service personnel and childcare workers should leave their jobs immediately after they become ill and wait until they are fully restored before returning to work.

2 Implement the meal-sharing system, wash the dishes in water, keep the dishes in chopsticks, and sterilize the common tableware. The leftover food should be fully heated before eating. Do not eat cold vegetables and raw or half-life foods. Do not buy, do not, do not Eat moldy food, raw knives, plates and containers should be separated.

(3) Grasp the manure management: manure, garbage, sewage should be treated in a harmless manner, toilets, livestock pens, garbage dumps, etc., should be managed by a special person, cleaned and washed every day, keep clean, no flies.

(4) Do a good job in environmental sanitation: Always clean and remove rubbish. Doors and windows (including toilet doors and windows) should have good anti-fly equipment. During the flies, you should spray drugs regularly to eliminate flies.

(5) Pay attention to personal hygiene: Through health education, develop good hygiene habits, do not drink raw water, do not eat unclean fruits and cold food, and insist on washing hands with water before and after meals.

(6) Do a good job in medical protection: Wear gloves when handling patient excretions and vomits, apply soap after contact with patients and before meals, wash hands thoroughly with running water, and take prompt preventive measures for close contacts.

3. Protect susceptible populations

Strengthen physical exercise, pay attention to work and rest, pay attention to diet, drinking water hygiene and personal hygiene. According to the epidemic situation at the time, choose appropriate vaccines, vaccine prevention for key populations, wartime, rescue and disaster relief, and consider taking appropriate drug prevention for emergencies. .

4. Do a good health epidemiological survey

(1) Epidemiological investigation of epidemic areas: Do a good case investigation, find out the source of infection and possible transmission conditions, take preventive measures to prevent the spread of the disease, and organize personnel to conduct epidemiological investigations when diarrhoea is prevalent. Popular causes and epidemic factors, take effective measures to control the epidemic.

(2) Contact management: Those who are in close contact with life should be quarantined to understand the health situation, especially to prevent pollution of water sources.

(3) Expedition and preventive medication: All personnel at the epidemic point will be examined once a day from the date of commencement of treatment. For the second consecutive day, the first harvest should be taken before taking the medicine. The following drugs can be taken for prevention:

A. Compound sulfamethoxazole: 2 times / d per person, 2 tablets each time, and even served for 3 days.

B. Doxycycline: The first dose of adult is 0.2g, and each time 0.1g, once / d, and even served for 3 days.

C. Tetracycline: Adult 0.5g, once every 6 hours, and even served for 3 days.

D. Furazolidone: 2 times / d, once 0.2 g, and even served for 3 days.

The daily amount of children is calculated by weight: compound sulfamethoxazole 25 mg, furazolidone 10 mg, and doxycycline 6 mg.

Escherichia coli gastroenteritis complications Complications, diarrhea, dehydration

Nausea and vomiting, frequency of diarrhea is more frequent, more watery stools, due to a large number of vomiting and diarrhea showing obvious symptoms of dehydration and acidosis, acute renal failure can occur, if the treatment is not timely, infants and young children can die within a few days.

Escherichia coli gastrointestinal symptoms common symptoms diarrhea is watery with sticky ... bloating hypokalemia convulsions hypothermia coma nausea irregular fever hypokalemia

Due to the virulence between the different types of Escherichia coli, the different invasive conditions and the difference in body resistance, the clinical manifestations are also inconsistent.

One type is that bacteria only attach to the intestinal mucosa to grow and produce enterotoxin. By activating the adenylyl cyclase of intestinal wall cells, when the level of intracellular cyclic adenosine monophosphate (cAMP) is elevated, it can promote intestinal secretion. (LT), and the secretion of intestinal fluid caused by ST toxin is mediated by cyclized guanosine (cGMP), and enterotoxin can also damage the epithelium of peripheral blood vessels, cause diarrhea, and discharge a large amount of watery stool (clinically similar to cholera-like disease). Another type is that bacteria can invade intestinal mucosal epithelial cells, multiply and produce toxic substances, causing a network of liquid to overflow into the intestinal lumen, and finally the epithelial cells rupture, leading to intestinal mucosal necrosis and ulceration, and stool with pus (Clinical similar to dysentery-like disease), the main lesions are mainly ileum.

Examination of Escherichia coli gastroenteritis

1. Collect specimens

Use a sterile cotton swab to take the feces of patients with diarrhea. If there is no feces, insert a rectal swab soaked with phosphate buffer into the anus 4-6 cm (infants 2 to 3 cm), and rotate the rectum surface in the rectum. After the mucus is taken out, it is contained in the transport or preservation solution. If it cannot be sent in time, the sample should be stored at 4 ° C, but not more than 8 h.

2. Enrichment and isolation culture

For the isolation of Escherichia coli, weak selective medium should be used in the initial separation, such as eosin methylene blue, Chinese blue rose sorbitol maikankai plate, streak separation, cultured at 35-37 ° C for 18-24 hours. Observe the morphological characteristics of the colony, select purple or dark red, the size is 1 ~ 3mm, the edges are neat and shiny, and the single colony of the central bulge is identified.

3. Identification

(1) Preliminary identification: According to the characteristics of colony, the smear-stained bacterial shape and staining reaction, the pure culture bacteria were taken for biochemical reaction, and the corresponding results were initially identified as Escherichia coli.

(2) Final identification: The general routine test can be used to make the above preliminary identification. If necessary, the final identification can be made according to the biochemical reaction listed in the Berger System Bacteriology Handbook.

(3) Identification test: Certain Escherichia coli, especially unpowered non-fermented milk extracts, should be distinguished from Shigella. The main identification tests of the two can be tested with sodium acetate and ammonium gluconate and the use of mucic acid. In the three tests of salt acid production, Escherichia coli was positive, while Shigella was negative.

1 pathogenic Escherichia coli:

A. Hypothetical test: pick the culture on the identification plate where the colony grows densely, and use the three kinds of polyvalent O serum of EPEC for the slide agglutination test, such as agglutination with a certain multivalent O serum, and then with the multivalent serum. The contained O monovalent serum is tested, for example, agglutinated with a certain O monovalent serum, and then 3 to 5 individual colonies are picked, and the serum is subjected to an agglutination test.

B. Biochemical test: select the colony with strong agglutination of O monovalent serum to inoculate trisaccharide iron agar, suspend the sputum matrix test paper, and culture at 36 ° C for 18-20 h, all lactose, sucrose acid, glucose acid production and most gas production, H2S negative The sputum-positive strain can be confirmed as Escherichia coli. If the sputum matrix is negative, the VP test must be negative, and it cannot grow on the citrate agar to confirm Escherichia coli.

C. Serological confirmation test: scrape the culture on the trisaccharide iron agar, make a bacterial suspension with physiological saline, and dilute to a concentration equivalent to the MacFarland No. 3 turbidity tube. If the original titer is at 1: (160 ~ 320), can be diluted 1:40 (with 0.5% saline), in a 10mm × 75mm test tube, the diluted antiserum and the bacterial suspension are mixed in equal amounts, after observation at 50.6 ° C water temperature for 16h, if Aggregation occurs and can be confirmed as the O factor.

2 Hemorrhagic Escherichia coli: known as the stool of patients with hemorrhagic enteritis, can be streaked with sorbitol instead of lactose on the MacConkey agar plate, after culture, select 3 to 5 sorbitol non-fermented colonies, O157 serum (preferably with H7 serum at the same time) was used for the slide agglutination test and the single tube agglutination test to determine the diagnosis.

The isolated strain should be inoculated with trisaccharide iron agar, suspended sputum matrix test paper, cultured at 36 ° C for 18 ~ 20h, the typical biochemical characteristics are lactose, sucrose acid production, glucose acid production gas, H2S negative, sputum matrix positive, and inoculation The sorbitol fermentation tube is a slow fermentation.

3 toxic Escherichia coli:

A. Biochemical test: pick 5 coagulable colonies on the identification plate, generally pick the typical colonies of lactose fermentation, inoculate trisaccharide iron agar, suspend the sputum matrix test paper, and culture at 36 ° C for 18-20 h, all lactose, Sucrose produces acid, glucose produces acid and produces more gas. H2S-negative, sputum-positive strains can be confirmed as Escherichia coli. If the sputum matrix is negative, the VP test must be negative and cannot be in the citrate. Growth on agar can be confirmed as Escherichia coli.

B. Enterotoxin test: Toxigenic Escherichia coli is mainly confirmed by enterotoxin test. There are many methods for enterotoxin test. At present, LT is measured by dual-phase agar diffusion test, and ST is measured by sucking test in suckling mice. Rabbits were ligated to the ileum section to determine LT and ST.

The two enterotoxins have been determined by genetic diagnosis.

a. Two-way agar diffusion test: The test strains were inoculated on Elek medium in a circular loop at 5 points, and two parts were prepared in the same manner, and cultured at 36 ° C for 48 hours, and a polymyxa was placed on the lawn of each strain. B-paper, at 6 ° C for 5 ~ 6h, intestine toxin into the agar, in the center of 5mm from the lawn, dig a hole of 4mm diameter, and use a drop of agar bottom, add LT antitoxin in the hole 30 l, and the known LT and non-toxigenic strains were used as controls. The culture was observed at 36 ° C for 15-20 h. The white precipitate was positive between the plaque and the antitoxin well, otherwise it was negative.

b. Inoculation test of suckling mice: The tested strains were inoculated into Honda toxigenic broth, cultured at 36 ° C for 24 h, centrifuged at 3000 r / min for 30 min, and the supernatant was filtered through a membrane filter, heated at 60 ° C for 30 min, and filtrate per ml. Add 0.02ml of 2% Evans blue solution, inject 0.1ml of the 1st to 4th day old suckling rat stomach with plastic tubing, inoculate 3~4 at the same time, fasten for 3~4h, then anesthetize with chloroform, take out all Intestinal tube, weighing the weight of the intestine (including effusion) and remaining body weight, the ratio of intestinal weight to residual weight is greater than 0.09 is positive, 0.07 ~ 0.09 is suspicious.

c. Rabbit ligation and ileum test: The tested strain was inoculated into Honda toxigenic broth, cultured at 36 ° C for 24 h, centrifuged at 3000 r / min for 30 min, and the supernatant was filtered through a membrane filter. The filtrate was divided into two portions, one not Heating, for testing LT; another 60 ° C heating for 30 min, for ST test, take 2kg rabbits, fasting for 1 day, laparotomy after anesthesia, remove the ileum segment, according to 10 ~ 15cm for a segment, segmental ligation, Take 2 ml of one injection broth as a negative control, and another 2 ml of the filtrate of the known toxin-producing broth culture as a positive control, and inject the other 2 ml of the filtrate of the broth culture of the test strain into the other sections, and suture the abdominal wall. At ST, laparotomy was performed 6 to 8 hours after injection; when LT was measured, laparotomy was performed 18 hours after injection, and the filtrate in each intestinal segment was taken, the volume was measured, and the length of the intestinal segment, the amount of fluid (ml) and the intestine were measured. The ratio of the length of the segment (cm) is greater than 1 to be positive.

d. Serological test: The enterotoxin test positive strain can be used to determine the O antigen by ETEC-related multivalent O serum and monovalent serum for slide agglutination test.

4 invasive Escherichia coli:

A. Biochemical test: 3 to 5 colonies should be picked on the identification plate. Generally, more colonies of non-fermented lactose similar to Shigella should be picked, but the dominant colonies of fermented lactose can also be picked properly and will be picked. The colonies are inoculated with semi-solid tubes and cultured at 36 ° C for 18-24 hours. The motility strains can generally be discarded unless the serological identification is 0124, leaving the unpowered strain, inoculated with trisaccharide iron agar, hanging sputum matrix test paper, 36 Cultured at °C for 18-20 hours, and tested for lysine decarboxylase. The typical biochemical characteristics of EIEC are: lactose, sucrose does not produce acid or acid, glucose produces acid, produces gas or does not produce gas, H2S is negative, and sputum matrix is positive. The lysine decarboxylase is negative, and there is no motility except O124. The lysine decarboxylation test can also be performed after the serological test.

B. Serological test: A trisaccharide iron agar culture was picked and two multivalent O serums of EIEC were used for a slide agglutination test to determine the composition of the O antigen.

C. Guinea pig corneal test: The bacteria were instilled into the eyes of guinea pigs for 2 to 5 days to see if there were redness, tearing, and congestion.

D. ELISA test: rabbits were immunized with toxic strains of known EIEC or Shigella, and the obtained immune sera were absorbed by a homologous avirulent strain, and determined by ELISA, EIEC toxic strains and Shigella The type of toxic strains are all positive. This method is used to detect the invasive polypeptide of the tested bacteria, and can also be detected by gene probe method.

5 Concentrated Escherichia coli: An important feature of the concentrated Escherichia coli (EAEC) is the formation of characteristic aggregate adhesion around Hap-2 cells, and Yamamoto found this aggregation adhesion of EAEC at 37 °C. It can occur on the growth surface of some liquid media to form a thick adherent agglomerated mass. This phenomenon does not occur at 25 ° C or 42 ° C. The liquid medium is best in L or MH medium, which can be used as EAEC. Preliminary identification method, the formation of bacteria in the liquid medium test: Escherichia coli inoculated in MH liquid medium (Difco), incubated at 35 ~ 37 ° C for 18 ~ 24h, where the surface (partial sinking tube bottom) formed a mass It was positive, and it was negative for evenly turbid sterile block. In 1996, Wang Mei et al. performed a simple screening test on intestinal cohesive-adhesive Escherichia coli, and tested the formation of bacteria on MH medium with Hep-2. Comparison of the cell adhesion test showed that the agreement rate of the two was 77%, and 88.5% including diffuse and localized, indicating that the clot formation test is a reliable method for preliminary screening of EAggEC.

There is currently no relevant information.

Diagnosis and identification of Escherichia coli gastroenteritis

Diagnostic criteria

Incubation period

Short-term only a few hours, Escherichia coli food poisoning, vomiting, diarrhea within 2h, the general incubation period is 1 to 3 days.

2. Clinical manifestations

(1) Light type: generally no fever, loss of appetite, diarrhea as the main performance, daily stool 3 to 6 times, often yellow or green indigestion-like loose stools, mostly mixed with a small amount of foam soup, And accompanied by abdominal distension, abdominal pain and nausea.

(2) medium-sized: may have low fever, in addition to mild symptoms and nausea and vomiting, frequent diarrhea, more watery stools, may have mild dehydration and acidosis symptoms.

(3) Heavy: The body temperature is irregularly hot, 38~40°C lasts for several days, diarrhea is 10~20 times a day, often yellow-green watery stool, mixed with a small amount of mucus, can have odor, also see milk color Or rice soup-like, similar to cholera, mostly nausea and vomiting, infants often have convulsions, due to a large number of vomiting and diarrhea showing obvious symptoms of dehydration and acidosis, acute renal failure can occur, about 30% of ETEG diarrhea in Bangladesh Moderate or severe dehydration, severe dehydration in adult cases, often can not be distinguished from cholera, if the treatment is not timely, infants and young children can die within a few days, EIEC diarrhea is similar to acute dysentery, the main symptoms of EHEC infection is Bloody stools and severe abdominal pain, EAEC caused by persistent diarrhea (> 14 days), bloody stools, fever (38 ° C) and vomiting.

3. Dehydration and electrolyte imbalance

(1) Dehydration: According to the degree of water loss in the body, it can be divided into light, medium and heavy 3 degrees. The mild dehydration of the eye socket is slightly depressed, and the pulse is still normal; moderate dehydration except the eye socket, the front depression is accompanied by lack of elasticity of the skin. Easy to grab, skin recovery time is 2 ~ 5s, fingerprint wrinkles, pulse breakdown; severe dehydration, cyanosis, skin grasping is not easy to recover, blood pressure drops, often microcirculation disorders, muscle spasm, weak pulse, less urine or Urine closed.

(2) Acidosis: The breathing is obviously deepened, the CO2 binding force is below 18mmol/L, the lips are cherry red, and the ketone is often seen in the breath. The severe cases have irritability, lethargy, coma, convulsions, and even shock. The CO2 binding capacity is 11.25mmol. /L below.

(3) hypokalemia: after rehydration treatment, the blood concentration phenomenon is corrected, the urine volume is increased, and the excretion of blood potassium is accelerated. At the same time, when the glucose is synthesized, the potassium is transferred into the cells, and the serum potassium is lowered. The symptoms of potassium deficiency, obvious hypokalemia symptoms appear more than 1 week after diarrhea, severe cases of soft palate and even respiratory muscle paralysis, arrhythmia, coma, can be life-threatening.

(4) Hypocalcemia: often occurs after blood transfusion or correction of acidosis, the child is crying and restless, muscles of the limbs are tense, convulsions of the hands and feet, convulsions and hyperreflexia.

During the epidemic period, infants and young children with diarrhea should first consider Escherichia coli gastroenteritis, first isolation treatment, waiting for pathogen examination to confirm the diagnosis. In non-epidemic period, especially sporadic cases, it is often difficult to diagnose by clinical only. Must be combined with pathogens, serological examination confirmed.

Differential diagnosis

The causes of diarrhea are more complicated, such as bacteria, viruses, parasites, etc. Some chemicals can also cause diarrhea. Escherichia coli enteritis should be distinguished from the following diseases.

Bacterial dysentery

Caused by Shigella, diarrhea with pus or mucus is more common, less, and often urgency and heavy, more cold and heat, stool microscopic examination can find a large number of pus cells, red blood cells and phagocytic cells, infant poisoning bacteria Or atypical bacillary dysentery should be identified by pathogenic diagnosis.

2. Vibrio cholerae

After causing infection, severe diarrhea occurs first and then vomiting, rarely nausea, vomit and diarrhea stools are rice-like watery, the amount is large, no urgency and heavy, a small number of patients have a small amount of bloody stools, dehydration often cause muscle pain, skin wrinkles, the body surface temperature is lower than normal, microscopic examination can find extremely active Vibrio, should be further identified by bacterial culture.

3. Vibrio parahaemolytic food poisoning

Caused by Vibrio parahaemolyticus, mainly due to eating food contaminated by the bacteria (more related to seafood), the onset of rapid, first with chills, paroxysmal abdominal pain (upper abdominal cramps), vomiting diarrhea, Most of them are watery stools or bloody watery stools, mostly for the same meal, and should be identified by bacterial culture.

4. Salmonella food poisoning

Eating by Salmonella typhimurium contaminated food, acute onset, often accompanied by cold, abdominal pain, bloating, nausea, vomiting, diarrhea, watery stool and stench, early bacteremia, more common people Onset, relying on pathogens, serological diagnosis and identification.

5. Viral diarrhea

Diarrhea caused by enterovirus infection, characterized by highly contagious, rotavirus, small round virus and other infections have vomiting in the early stage, successive diarrhea, more watery stools and mucus, mostly in autumn and winter, other viral Diarrhea is more common in summer and autumn, nausea and vomiting, in addition to gastrointestinal symptoms, often have respiratory symptoms, pharyngitis, and convulsions, often involving the neck muscles, back muscles, children in the age of more common green watery or egg-like water Antibiotic treatment is generally ineffective, and the course of disease is self-healing in 5 to 7 days. It is further identified by serology and virus isolation.

6. Campylobacter enteritis

Campylobacter jejuni causes mild and viral enteritis, and is similar to ulcerative colitis or Crohn's disease. It has fever, diarrhea or mucus-like stool, stench, bile color, severe pus and bloody stools. More than one week of recovery, children often have abdominal cramps, convulsions can occur when high fever, the incidence is more related to contact with poultry, livestock or drinking unsterilized milk, raw water, dark field microscopic examination can find the bending of the archery-like active power Bacteria, bacterial culture for further diagnosis.

7. Yersinia enteritis

More common in children, related to food, water pollution, abdominal pain, diarrhea, hypothermia, watery stool, may have sepsis, can be complicated by nodular erythema, pseudo appendicitis, arthritis, bacterial culture can be further identified.

8. Other

Attention should be paid to the identification of diarrhea caused by Giardia, Amoebic dysentery, and amoeba or Giardia can be found in stool microscopy.

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