Gastroenteritis due to enteropathogenic, enterotoxigenic, and invasive Escherichia coli: A review

Escherichia coli that produce diarrhea can be divided into three groups: 1) enteropathogenic, 2) enterotoxigenic, and 3) enteroinvasive. The mechanism of disease production by enteropathogenic E. coli is unknown, but these strains are not presently known to be inherently pathogenic, although they may be important as a cause of gastroenteritis in infants. The two known mechanisms of disease production are elaboration of enterotoxin and mucosal invasion. Heat-labile toxin-producing E. coli are the main cause of diarrhea in travelers while heat-stable toxin-producing E. coli are a cause of scours among new-born swine and cattle. Enteroinvasive E. coli have not been shown to be an important cause of diarrhea in the United States. Enteropathogenic, enterotoxigenic, and enteroinvasive E. coli that currently are associated with diarrhea worldwide may each consist of relatively few serotypes different from those associated with out-breaks of diarrhea in the past. This implies a possible new role for sero-typing of E. coli.