E. Coli In Children - Types, Symptoms And Treatment

E Coli In Children

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E.Coli is one of the most dreaded infections globally. Food companies are made to recall their products the moment a strain of E.Coli is found in them. The infection spreads rapidly due to the consumption of outside food prepared under unhygienic conditions, drinking of contaminated water or other liquids, and poor personal hygiene.

A bout of E.Coli infection can prove to be taxing for your child, as it makes the little one weak, taking him several weeks to recover from the after-effects. As it is better to be safe than sorry, acquaint yourself with everything related to the infection to ensure that your family is safe from it.

What Is E. Coli?

Escherichia coli or E. coli refers to a group of bacteria present in the intestines of both humans and animals [1]. A majority of E. coli bacteria is good as they play a significant role in keeping our intestines healthy. But, some strains are disease-causing, and it is these E. coli bacteria that parents have to worry about.

E. coli in children can result in a multitude of infections such as diarrhea, blood infections, respiratory illnesses, and urinary tract infections.

[ Read: Bacterial Infections In Children ]

E. Coli Infections In Children:

Children are susceptible to E. coli because they don’t pay attention to hygiene. The disease-causing bacterium is present everywhere in the environment, and children tend to collect pathogens on their hands. When children don’t wash hands with soap and water, germs enter the body through their mouth, causing infection.

One specific strain of E. coli causes infection by producing a toxin called Shiga. Hence, this strain is called STEC or Shiga Toxin-producing E. coli [2]. There also are non-STEC E. coli bacteria, but children usually get infected by STEC bacteria. This bacterial strain is present in animal feces and infects children when the feces contaminates food.

Symptoms Of E. Coli In Children:

Symptoms of E. coli infections manifest seven days after your child gets infected by the bacteria [3]. The problem begins with sudden stomach cramps, and within a few hours, it develops into watery diarrhea. This is a dangerous phase, as diarrhea results in dehydration and loss of vital electrolytes, making your child tired and sick.

Usually, watery diarrhea lasts for around a day. After that, your child suffers from bright red bloody stools for about two to five days, making his intestines sore. Expect your little one to have about 10, if not more, bowel movements a day during the bloody diarrhea stage of the infection.

Symptoms of intestinal E. coli infection in children include:

  • Bloody diarrhea
  • Vomiting
  • Irritability
  • Lethargy
  • General weakness and malaise
  • Fever

If your little one does not get the treatment for the infection, it could result in:

  • Bruising of the skin
  • Pale skin
  • Jaundice
  • Reduced urine output
  • Seizures

Types Of E. Coli Infecting The Intestines:

Several strains of E. coli that infect the intestines include:

1. Enterotoxigenic E. Coli:

This strain of the bacterium attaches itself to the intestinal cilia and produces toxins, which cause diarrhea without fever. This is more commonly called traveler’s diarrhea.

2. Enteroinvasive E. Coli:

The serotype of E. coli infects the lining of the colon, causing fever and diarrhea.

3. Enteropathogenic E. Coli:

Commonly seen in developing countries, this particular pathotype of E. coli causes infantile diarrhea. The baby suffers from watery or bloody diarrhea.

[ Read: Viral Infection In Children ]

4. Enteroaggregative E. Coli:

Forming clumps on the intestinal lining, this E. coli strain uses the toxin to prolong diarrhea. It is more prevalent in children than in adults.

E. coli infections are mostly associated with intestines but can affect other parts of the body as well. Hence, E. coli symptoms in children vary based on where the infection occurs and the strain of the disease-causing bacterium.

Symptoms Of E. Coli Infection In The Urinary Tract:

Uropathogenic E. coli is responsible for urinary tract infections in children. This strain of the bacterium usually lives in the colon, and children, who clean from back to front after a bowel movement, risk transferring the bacteria from the colon to the urethra. From the urethra, the bacteria travel to the bladder and the kidneys, resulting in a urinary tract infection.

If your child develops a UTI due to E. coli infection, he will have at least one of the following symptoms:

  • Burning sensation while urinating
  • Urge to urinate frequently
  • Fever
  • Chills
  • Odoriferous urine that may be cloudy or bloody
  • Pain in the flanks, hips or lower back

Symptoms Of E. Coli Infection In The Brain:

The K1 E. coli strain is responsible for meningitis in neonates. Usually, newborn infants get infected at the time of birth or contract the infection a little later from the hospital or at home.

Symptoms of E. coli infection leading to meningitis include:

  • Breathing difficulty
  • Diarrhea
  • Lethargy
  • Irritability
  • Refusing to feed
  • Unusually warm or cold skin
  • A bulging fontanelle at the top of the head

Symptoms Of E. Coli Infection In The Lungs:

The US Centers for Disease Control and Prevention (CDC) states that just like Streptococcus pneumonia, E. coli can also cause bacterial pneumonia.

If your child gets pneumonia brought on by E. coli, expect the following symptoms:

  • Fever
  • Chills and rigor
  • Shortness of breath
  • Pain in the chest due to deep breathing and cough
  • Cough with phlegm

Solutions For E. Coli In Children:

Usually, doctors don’t prescribe medication for E. coli, as it can result in complications, particularly with antibiotics. Hence, the best way to fight E. coli in children is to make them take rest and replenish the fluids lost due to diarrhea and/or vomiting [4].

Doctors avoid antibiotics, as your little one risks developing hemolytic uremic syndrome (HUS). This syndrome develops because the Shiga toxin kills red blood cells and platelets, resulting in kidney failure.

Make sure you don’t give your child any anti-diarrhea medication, either. This medication increases the risk of developing HUS. However, there are some healthcare practitioners, who may prescribe antimotility medication if your little one does not have severe pain in the abdomen and bloody diarrhea.

[ Read: Diarrhea In Children ]

Treatment For Hemolytic Uremic Syndrome:

If your child has STEC infection, he has a higher risk of developing HUS, calling for immediate medical intervention. Young children are prone to this complication, which is life-threatening.

Untreated HUS can cause the following problems:

  • Bruising
  • Petechia (development of purple or red spots on the skin)
  • Jaundice
  • Decreased urination
  • Seizures (rare)

Treatment for HUS involves:

1. Electrolyte Replacement:

Diarrhea and vomiting remove electrolytes from the body. So your child will receive fluids intravenously to replenish the lost fluid and restore electrolyte balance.

2. Blood Transfusion:

As the platelet count falls, it affects the blood’s clotting ability. Hence, your child will receive platelet transfusion to aid normal blood clotting, and red blood cell transfusion to up the RBC count.

3. Dialysis:

Reduced urine output is an indication that your child’s kidneys are not functioning optimally. Hence, your little one will be put on temporary dialysis to help filter the waste and remove excessive fluid from the body.

In case your child suffers from permanent kidney damage due to HUS, he would have to use ACE inhibitors to lower his blood pressure and prevent further damage to the kidneys. He also would have to stick to a low-protein diet. Depending on how extensive the damage is, he may require long-term dialysis or kidney transplant.

Treatment For Urinary Tract Infection Due To E. Coli:

If your little one develops a UTI due to E. coli, he will receive antibiotics to treat the infection. Some medications that doctors prescribe include ciprofloxacin and trimethoprim-sulfamethoxazole. However, if the infection is due to an E. coli strain that is resistant to traditional antibiotics, your child will need more aggressive treatment, using stronger antibiotics, such as fosfomycin and nitrofurantoin.

It is prudent to remember UTIs are treated with oral antibiotics only if your child does not have vomiting as one of the symptoms. The treatment will be for about ten days.

Causes Of E. Coli In Children:

  • As mentioned earlier, when foods and water come into contact with contaminated animal feces and your child consumes them, he is at a high risk of getting E. coli infection.
  • Food contamination by animal feces can occur during cultivation, where food is grown in soil contaminated by bovine feces or irrigated by contaminated water.
  • Since E. coli strains are present in certain foods such as ground beef, eating these contaminated foods can result in infection. Make it a point to cook meats thoroughly before your little one consumes them.
  • If your child is undergoing toilet training, make sure you supervise the cleaning of the bottom. It should always be from front to back. After cleaning, ensure your child washes his hands thoroughly with soap and water. Otherwise, he can acquire an E. coli infection.

Risk Factors Of E. Coli In Children:

A majority of the E. coli infections in children as well as adults occur due to:

  • Eating ground beef that is undercooked and is still pink inside
  • Drinking contaminated water
  • Consuming raw or unpasteurized milk
  • Working with cattle
  • Consuming food that is contaminated with animal feces

Healthy cattle naturally have E. coli in their digestive tract. When the cattle are slaughtered, the meat can get contaminated. If you consume meat without cooking it properly or long enough to kill the bacteria, your child can get infected.

Nursing homes and daycares are also places where adults and kids can get the infection. Here, the infection transmits from an infected adult or child to a healthy child. This usually happens if the infected person does not wash his hands properly after using the toilet and then handles food.

Remember if your child gets E. coli, he will be contagious. Hence, you should not send your child to school until your doctor gives you the go-ahead. This usually happens after the stool culture comes back negative for the bacteria.

Diagnosis & Tests For E. Coli In Children:

Diagnosis for E. coli in kids begins with a physical examination and finding out about the child’s medical history.

Physical examination involves:

  • Taking your child’s temperature
  • Checking his blood pressure and pulse
  • Looking at the skin carefully to see if your child is unusually pale
  • Palpating the stomach to check for tenderness
  • The doctor may conduct a rectal examination to check whether your little one has blood in his stool.
  • Your child’s doctor will ask you questions about the beginning and the duration of diarrhea in your kid, if the stool carried blood, and whether he has cramps, fever, nausea and/or vomiting. So make sure you write down the symptoms and take it along with you.

If the pediatrician suspects E. coli infection, he will order the following tests:

1. Stool Culture:

Your child will have to give a stool sample so that the pathologist can culture it to determine the strain of E. coli causing the infection. As the bacteria can leave the body because of diarrhea, it is important the sample is taken as soon as your child shows the symptoms of E. coli infection.

2. Urine Test:

If your child has E. coli infection, the doctor will monitor him carefully to ensure he does not acquire HUS. Hence, your little one would have to give a urine sample for testing.

3. Blood Test:

Children can develop severe blood complications, such as septicemia, due to E. coli infection. A blood test allows the doctor to monitor the parameters and makes sure your child does not get any blood-related problem.

4. Rapid Enzyme Immunoassay:

This is a non-culture test for finding STEC infection. However, this test is available just in big hospitals and laboratories. So your doctor may not recommend or prescribe it.

5. Imaging Tests:

In case, your child develops a UTI due to an E. coli infection, after excluding anatomic abnormalities and vesicoureteral reflux, the doctor may perform renal ultrasound and voiding cystourethrography.

What Will the Doctor Do?

  • The doctor will monitor the child during the infection. This will ensure your child’s condition doesn’t worsen or lead to HUS.
  • As a medication for intestinal E. coli infection is not prescribed, your doctor will tell you to make sure that your child gets adequate rest. Also, he will ask you to give your child fluids throughout the day to prevent dehydration due to vomiting and diarrhea.
  • If your child gets severely dehydrated, he may require hospitalization so that he can be given fluids intravenously.
  • The pediatrician will treat your child for UTI or meningitis due to E. coli infection based on the type of bacterium strain and clinical response.

What Can Kids Do?

You can teach your kid to avoid E. coli infections by teaching him the following:

1. Washing Hands:

Teach your child to wash his hands the moment he enters the house, after playing with animals, and after using the toilet. He should wet his hands, apply soap and lather it for about 20 seconds. During this time, he should wash between the finger and under the nails. After that, he should rinse his hands.

2. Avoiding Fingers In The Mouth:

Small children are fond of putting fingers in their mouth, sucking thumbs or biting nails. As a parent, stop your child from doing this, as it could transfer the E. coli bacteria from his hands into the mouth.

3. Keeping Away From Animal Manure:

Teach your children to avoid animal manure, as animal feces contains E. coli, which can be active long after being eliminated from the animal’s digestive tract. So it makes sense to give a broad berth to the manure.

4. Avoiding Impure Water:

If you take your child regularly to a pool, lake or pond, tell him not to swallow the water he swims in. It could be contaminated with E. coli, and swallowing will cause your child to get infected.

[ Read: Personal Hygiene For Kids ]

What Parents Should Know?

As a parent, don’t take E. coli infection lightly as it could be fatal, especially if the child acquires HUS resulting in the failure of the kidney. Sometimes, even the best medical care can be futile when it comes to E. coli infection in children.

If you suspect E. Coli infection in your child, taking him to the doctor is not enough. Make sure you request the doctor to perform an E. coli test on your child. This means taking a stool sample for culture to determine the strain of the bacterium and confirm the diagnosis.

Until your doctor says your child can go to school, keep him at home. After tending to your little one, make sure you wash your hands thoroughly with warm water and soap so that you do not infect yourself or other family members.

You also can take measures to ensure your child does not get E. coli again. Some of these measures include:

1. Hand Wash:

Wash your hands after going to the bathroom, changing your child’s diaper, and before you eat or handle food.

2. Hygienic Preparation Of Food:

Cook your meats thoroughly, particularly ground beef. This will destroy the E. coli bacteria. Don’t rely on the color of the meat to check whether it is thoroughly cooked. Instead, invest in a meat thermometer and make sure it reads 160o Fahrenheit (71o Celsius).

Defrost food in the microwave or cold water, and wash veggies and fruits thoroughly under running tap water before consuming or cooking them. Also, never drink or give your child unpasteurized juice or milk. It could be contaminated with E. coli.

If you have diarrhea, do not prepare food for your family. You could spread the infection to other members of your family.

3. Maintain Clean Kitchen:

After using utensils, cutting boards, counters, and your meat thermometer, wash them well using hot soapy water. Do not store raw meats with ready-to-eat food items.

4. Drink Treated Water:

If you and your family drink municipal water, find out whether the water is treated with chlorine (or any other disinfectant). If it is treated with chlorine, the water is safe to consume.

5. Stay Informed:

You will hear of E. coli outbreaks now and then. When an outbreak occurs in your town or city, find out more about it and avoid the source of the infection. Usually, it will be a fruit, veggie, swimming pool or some other water source causing the infection.

6. Teach Your Child:

Teach your child the importance of personal hygiene and cleanliness. Make sure your child washes hands after touching a pet. This holds true even at a petting zoo [5].

Even after taking all these precautions your child falls ill, keep a close eye on the symptoms. The moment you notice any symptom of E. coli, take him to a doctor immediately.

Has your child ever got infected with E. coli? How did you know it was E. coli and what measures did you take to overcome it? Do comment below so that other parents can learn from you.

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