Pathogen Safety Data Sheets: Infectious Substances – Escherichia coli, enteroinvasive

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Escherichia coli, enteroinvasive

SYNONYM OR CROSS REFERENCE: EIEC ^{Footnote 1Footnote 2}, intestinal pathogenic E. coli ^{Footnote 1}, bacillary dysentery ^{Footnote 1}.

CHARACTERISTICS: Enteroinvasive Escherichia coli (EIEC) are in the family Enterobacteriaceae ^{Footnote 2}. They are Gram negative, rod shaped, non-spore forming, motile with peritrichous flagella or nonmotile, grow on MacConkey agar (colonies are 2 to 3 mm in diameter and red or colorless), and are capable of aerobic or anaerobic growth ^{Footnote 3}. Strains belonging to EIEC are biochemically, genetically, and pathogenically closely related to Shigella spp. ^{Footnote 1}.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: EIEC causes bacillary dysentery ^{Footnote 1}, an acute ulcerative infection of the large intestine ^{Footnote 1Footnote 4}. EIEC invade cells of the colon and causes watery diarrhea (might be bloody), fever, and abdominal cramps ^{Footnote 2, Footnote 5}. In severe cases, the bacteria may attack the colonic mucosa, invading epithelial cells, multiplying, and causing ulceration of the bowel ^{Footnote 1}.

EPIDEMIOLOGY: EIEC is endemic in most developing countries and may cause occasional outbreaks in industrialized countries ^{Footnote 4}. Species of Shigella are the major cause of bacillary dysentery, although up to 10% of cases are caused by enteroinvasive E. coli. EIEC are rare in United States and Canada, and are less common than ETEC and EPEC strains in the developing world ^{Footnote 2}. Three large outbreaks in the United States have been reported. EIEC infections primarily affect children under 5 years living in developing countries ^{Footnote 6}.

HOST RANGE:Humans ^{Footnote 2}.

INFECTIOUS DOSE: 10⁶-10¹⁰ organisms ^{Footnote 4}.

MODE OF TRANSMISSION: EIEC are spread by the fecal/oral route ^{Footnote 1Footnote 7}. Contaminated food and water are the usual vehicles for the spread ^{Footnote 5Footnote 7}. Food-borne outbreaks have occurred ^{Footnote 7}. Person-to person transmission can also occur ^{Footnote 1}.

INCUBATION PERIOD: The incubation period is between 2-48 hours with an average of about 18 hours ^{Footnote 8}.

COMMUNICABILITY: Yes. Person-to-person transmission is possible but is uncommon ^{Footnote 1Footnote 6Footnote 7}.

SECTION III - DISSEMINATION

RESERVOIR: Humans are the only known reservoir ^{Footnote 6}.

ZOONOSIS: None reported ^{Footnote 9}.

VECTORS: None.

SECTION IV - STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY/RESISTANCE: Susceptible to carbapenem, fosfomycin-trometanol and nitrofurantoin. E. coli can be resistant to chloramphenicol, β lactams, nalidixic acid, ampicillin and ciprofloxacin ^{Footnote 1}. Fluoroquinolones such as ciprofloxacin enhance toxin production.

SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to a combination of 2,2-dibromo-2-cyanoacetamide (DBA) with sodium iodide (20:80 parts), iodine, 2 % glutaraldehyde, quaternary ammonium (20°C, 0.5 min), hypochlorite (0.525%, 20°C, 0.5 min), phenolics (20°C, 0.5 min), and ethyl alcohol (70%, 20°C, 0.5 min) ^{Footnote 10-Footnote 12}.

PHYSICAL INACTIVATION: Ozone can inactivate E. coli ^{Footnote 12}. E. coli are also sensitive to heat treatment, especially at temperatures of 70°C or higher ^{Footnote 9Footnote 13}.

SURVIVAL OUTSIDE HOST: Food and water ^{Footnote 5}. E. coli can survive for 1.5 hours to 16 months on dry inanimate surfaces ^{Footnote 14}.

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Stool culture ^{Footnote 5}, immunoassays ^{Footnote 2}, and nucleic acid-based assays ^{Footnote 2} are used for detection of EIEC. As with Shigella spp., the loci most frequently sought in molecular tests (PCR and DNA hybridization methods) are ipaH and the invasion-associated locus (ial) ^{Footnote 15Footnote 16}.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID TREATMENT: Treatment with trimethoprim/sulfamethoxazole (TMP-SMX) or quinolones reduces the duration of diarrhea ^{Footnote 6}. Treatment of fluid and electrolyte loss is usually achieved through oral rehydration ^{Footnote 7Footnote 9}. The use of the World Health Organization Oral Rehydration Salts (ORS) solution has been recommended ^{Footnote 7}. Intravenous rehydration may be necessary for infants, individuals with excessive vomiting, or those with severe dehydration. Bismuth subsalicylate may decrease the amount of diarrhea and the duration of disease. Antimicrobial therapy is generally not indicated, because of the self-limited nature of this disease.

IMMUNIZATION: None ^{Footnote 7}.

PROPHYLAXIS: TMP-SMX is recommended for a short term (< 2 weeks) for those at a high risk of disease ^{Footnote 6}. Bismuth subsalicylate provides some prophylactic benefit, but should not be used as a substitute for other preventive measures ^{Footnote 7}.

SECTION VI - LABORATORY HAZARDS

LABORATORY ACQUIRED INFECTIONS: Twelve cases of laboratory acquired infections with E. coli have been reported, the majority of which have been caused by E.coli enterohemorrhagic (EHEC) ^{Footnote 17}.

SOURCES / SPECIMENS: Stool ^{Footnote 5}, food, and water ^{Footnote 18}.

PRIMARY HAZARD: Ingestion ^{Footnote 17}.

SPECIAL HAZARD: None.

SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 ^{Footnote 19}.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures ^{Footnote 20}.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes ^{Footnote 20}.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC) ^{Footnote 20}. The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities.

SECTION VIII – HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up ^{Footnote 20}.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism by autoclave, chemical disinfection, gamma irradiation, or incineration before disposing ^{Footnote 20}.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labeled ^{Footnote 20}.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: December 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©
Public Health Agency of Canada, 2011
Canada