Foodborne E coli infection

Last reviewed: 23 Aug 2023
Last updated: 11 Aug 2021



History and exam

Key diagnostic factors

  • diarrhea
  • history of travel, contact with contaminated food, or contact with infected person
More key diagnostic factors

Other diagnostic factors

  • abdominal pain or discomfort
  • volume depletion
  • fever
  • nausea/vomiting
  • anorexia
  • lethargy
Other diagnostic factors

Risk factors

  • ingestion of contaminated food products or water
  • travel
  • poor hygiene practices
  • infantile or advanced age (<5 years and >60 years)
  • contact history
  • immunocompromised state
  • contact with infected animals
More risk factors

Diagnostic investigations

1st investigations to order

  • stool cultures
  • CBC
  • renal function and electrolytes
More 1st investigations to order

Investigations to consider

  • identification of shiga toxin-producing E coli infection
  • blood cultures
  • inflammatory markers (CRP and/or erythrocyte sedimentation rate)
  • abdominal x-ray
  • endoscopy
  • abdominal CT scan
More investigations to consider

Treatment algorithm


all patients


confirmed enterotoxigenic positive

confirmed enterohemorrhagic positive

other Escherichia coli serotypes



Eli D. Ehrenpreis, MD, FACG, AGAF

Professor of Medicine

Rosalind Franklin University Medical School

North Chicago


Associate Director for Research

Internal Medicine Residency

Advocate Lutheran General Hospital

Park Ridge



EDE is CEO for E2Bio Life Sciences LLC, and CEO for G.I. Pharmaceuticals Inc.


Dr Eli D. Ehrenpreis would like to gratefully acknowledge the assistance of Dr Thomas Adam Wichelmann, who contributed to this update. Dr Ehrenpreis would also like to acknowledge Dr Alexandra Kent and Professor Satis Keshav, the previous contributors to this topic.


TAW, AK, and SK declare that they have no competing interests.

Peer reviewers

Andrew Poullis, BSc, MBBS, MD, FRCP

Consultant Gastroenterologist

St George’s Hospital




AP declares that he has no competing interests.

Fiona Cooke, MA, PhD, MSc, FRCPath, MRCP, DTM&H

Research Fellow and Medical Microbiologist

Wellcome Trust Sanger Institute

Department of Microbiology

Addenbrooke's Hospital




FC declares that she has no competing interests.

Houssam E. Mardini, MD, MPH, FACP

Voluntary Assistant Professor of Medicine

Digestive Health & Nutrition Center of Ashland




HEM declares that he has no competing interests.

  • Differentials

    • Viral gastroenteritis
    • Alternative foodborne bacterial gastroenteritis/traveler's diarrhea
    • Amebiasis
    More Differentials
  • Guidelines

    • 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
    • 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
    More Guidelines
  • Patient leaflets

    Diarrhea in adults

    Diarrhea in children

    More Patient leaflets
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