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Diseases & Topics

Escherichia coli (E. coli) Infection

Escherichia coli are bacteria found in the feces of animals such as cattle, sheep and goats. Some types of E. coli bacteria such as E. coli O157:H7 can cause illness in people who consume water or food that has come in contact with the bacteria or who come in contact with infected animals. If people touch contaminated material, they can transfer the bacteria from their hands to their mouths, or to others.

Most outbreaks in the United States have been associated with raw or undercooked ground beef, unpasteurized milk, unpasteurized juice and leafy greens (spinach, lettuce, etc.).

Each year in the United States, E. coli infections cause approximately 265,000 illnesses and about 100 deaths. Approximately 40 percent of these infections are caused by the strain E. coli O157:H7, a strain that is part of the shiga toxin-producing group of E. coli bacteria (STEC). The other 60 percent of E. coli cases are caused by non-0157:H7 shiga toxin-producing E. coli (STEC).

Symptoms of STEC infection include diarrhea or bloody diarrhea, which may be accompanied by abdominal cramps, nausea and vomiting. Low-grade fever may be present. Some people sickened by E. coli O157:H7 (5-10%) may develop severe complications, including kidney failure or hemolytic uremic syndrome (HUS). Young children, the elderly and people with other medical conditions are particularly at risk. Untreated, HUS can lead to death, so it is essential that people with E. coli receive prompt medical treatment to minimize their chances of contracting HUS.

Clues that a person is developing HUS include decreased frequency of urination and anemia, which may result in fatigue and losing pink color in cheeks and inside the lower eyelids. People with HUS should be hospitalized because their kidneys may stop working and they may develop other serious problems.

How to prevent becoming ill with E. coli:

Good hygiene, especially frequent and thorough hand washing, is important to prevent spread of the disease, particularly after using the rest room, after changing diapers, after touching animals and before eating, drinking or preparing food.

Any child with diarrhea or bloody diarrhea may have E.coli infection. Since STEC can be easily transmitted, parents should not send sick children to day care or to school. Day care centers and schools should send sick children home to avoid person-to-person spread, especially among diapered children.

E. coli is a reportable disease in North Carolina. Physicians, lab directors, day care center operators and school principals are required by law to report cases within 24 hours to the local health department, which in turn reports to the North Carolina Communicable Disease Branch, Division of Public Health.

Past Outbreaks in North Carolina

For Additional Information

  • CDC: E. coli Frequently Asked Questions External link
  • FDA: Bad Bug Book External link - Primarily technical, this handbook also provides consumer-focused "snapshots" with basic information about the major known bacteria, viruses, parasites and natural toxins that cause foodborne illness and how to avoid getting sick.
  • NC DHHS: Handwash poster (English) (PDF, 772KB)
  • NC DHHS: Handwash poster (Spanish) (PDF, 772KB)
  • NC DHHS: Hemolytic Uremic Syndrome (HUS)
  • NSF International: The Scrub Club External link - This program from the not-for-profit National Sanitation Foundation teaches children the proper way to wash their hands. Includes interactive games, educational music, downloadable activities for kids, educational materials for teachers and program information for parents.