This document summarizes a presentation about E. coli infections in Bharatpur, Nepal. It finds that E. coli is prevalent in the area and a major cause of food/water-borne illness. A survey of local hospitals found that 11.2% of such illnesses were from E. coli. A household survey found many get their water untreated and have livestock/poultry, risk factors for E. coli transmission. Symptoms include diarrhea, vomiting and fatigue. Contamination occurs via food, water and person-to-person contact. Treatment focuses on rehydration while antibiotics can increase other risks. Prevention emphasizes hygiene, sanitation, food safety and vaccination.

1. Escherichia coli In Bharatpur
Urban Area, Nepal
Clinical Conference II
9th Semester
July 2016
Presenter:
Ganesh Adhikari

2. Preview
 Abstract
 Introduction
 E. coli and Kitchen
 Hospital Records
 Household survey
 Symptoms Due to E. coli Infection
 Source of Contamination
 Transmission
 Treatment
 Prevention and Control Measures
 References
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3. Escherichia Coli in Bharatpur Urban Area, Nepal
Adhikari, G.
Class Roll No. 15
B.V.Sc. & A.H. 9th Semester
Institute of Agriculture and Animal Science (IAAS)
Tribhuvan University
ABSTRACT
Escherichia coli are a large and diverse group of gram negative bacteria causing colibacillosis
in human and animals. They are normal inhabitants of intestine of human and animals and also
found in environment, soil, foodstuffs and almost everywhere. Most of the infectious strains can
cause diarrheoa, while others cause urinary tract infections, respiratory problems, pneumonia
and other illnesses. E. coli is well prevalent in Bharatpur sub metropolitan city of Chitwan
district. The main source of E. coli infection in humans is from kitchen which is directly related
to the contamination of utensils and foodstuffs we eat. E. coli is transmitted via the
contaminated fruits and vegetables, water, utensils with soil and fecal materials of human and
livestock. The study of cases in various hospitals and household survey of Bharatpur urban
area shows significant number of people suffer from E. coli infection annually having symptoms
like vomiting, diarrhoea, abdominal cramping, fatigue, fever and kidney problems. Antibiotics
are not recommended as they increase the chance of HUS. The treatment is generally oral
rehydration, rest with supportive fluid therapy in severe cases. The disease can be prevented
by practicing well-cooked clean feeding behavior, sanitary kitchen and house-hold, and keeping
toilet and livestock contamination away.
Key words: Colibacillosis, Infectious, Bharatpur, HUS
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4. Escherichia coli
 bacteria found in the
environment, foods, and
intestine of people and
animals
 a gram-negative, facultatively
anaerobic, non-motile rod
shaped
 can cause diarrhoea, vomition, urinary tract infections,
respiratory illness in man and animals
Source: myoclinic.org

5. Six pathotypes are associated with Colibacillosis
• Shiga toxin producing E. coli (STEC)
• Enterotoxigenic E. coli (ETEC)
• Enteropathogenic E. coli (EPEC)
• Enteroaggregative E. coli (EAEC)
• Enteroinvasive E. coli (EIEC)
• Diffusely adherent E. coli (DAEC)
STEC strains are the most common
infection causing pathotype.
Example E. coli O157:H7
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6. E. coli and kitchen
-Cooking, eating and storage unit of home
-Food borne infection are common in the kitchen
E. Coli
They are readily available in kitchen through:
 Water
 Fruits and vegetables
 Raw meat and milk
 Utensils
 Dirty hands and clothes
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Multiply and spread rapidly and
Cause contamination on foods

7. Study Area
Bharatpur sub-metropolitan city
Population: 199,867 (census 2011)
24 wards
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8. Hospital Records
Food and water borne diseases. (Jestha 2073)
Monthly record- District Public health office, Bharatpur, Chitwan
11.2% of food and water borne diseases are due to E. coli. (CDC2004)
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Hospitals No. of Cases
Bharatpur Hospital 193
Chitwan Medical College(CMC) 151
College of Medical Sciences (CMS) 97
Narayani Public Hospital 108

9. Household survey
77 households around Bypass, Krishnapur and Bhojad area:
Percentage of household on the basis of treatment of
drinking water
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Boiled (20%)
Filtered (48%)
Direct(27%)
Chlorinated(5%)

10. Livestock, poultry and pets at home
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11. Other important findings
 Toilet: Attached 49; Non attached 28
 Kitchen Wastage Disposal: Dustbin and truck 36; Pit 41
 Disinfection used at kitchen: Formalin 45; Others 8;
None 24
 Case of Diarrhoea, vomition and digestive disorder in one
year period: Yes: 29 ; No: 48
Symptoms: Diarrhoea, Stomach pain, weakness
Hospitalized: 8 cases
Recovery within 3-5 days
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12. Untreated drinking water
Attached toilet
Large number of children
Poultry and livestock at home
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Incidence of diarrhoea and digestive disorder were
found more prevalent in family members of
households with following characteristics:

13. Symptoms of Infection Due to E. Coli
 Abdominal
cramping
 Loss of
appetite/nausea
 Fever
 Decreased urine
output
 Pale skin
 Dehydration
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 Severe watery
diarrheoa..change
to bloody stools
 Vomiting
 Fatigue
 Bloody urine
 Respiratory
distress
Symptoms can last anywhere from a few days to more than a week
Source: healthline.com

14. Source of contamination
 Contaminated water
 Raw fruits and vegetables
 Raw meat
 Unpasteurized milk
 Cutting boards and utensils
 Toilet contamination
 Unwashed hands
 Pet animals and livestock faeces
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Source: cdc.gov/ecoli
www.foodsafety.gov

15. Transmission
 Direct transmission through Faeco-oral route
 Ingestion of contaminated foodstuffs
 Person to person
 Between animal and man
The incubation period is usually 3-5 days
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16. E
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E. Coli transmission paradigm
www.ecl-lab.com/ecoli/index.asp

17. Treatment
Managing complications-mainly dehydration caused
by diarrhoea: Rehydration Therapy
Jeevan jal and home preparation of salt and sugar solution.
Ns or DNS Intravenous if needed.
Antibiotics of choice are fluoroquinolones or azithromycin
Antibiotics are not recommended for STEC’s as they
increase the chance of haemolytic uremic syndrome(HUS)
Adequate water, rest and hygienic food will help recover
within a week, but some cases of HUS may suffer
permanent damage or may cause death.
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18. Prevention
Hygiene, sanitation and food safety
 Washing fruits and vegetables thoroughly
 Avoiding cross-contamination on food
materials
 Remove refrigerating leftovers immediately
 Drinking only pasteurized milk products
 Avoid consuming raw meat
 Avoid livestock contamination
 Washing hands
Vaccination
Oral inactivated vaccines consisting of rCTB and
formalin inactivated E. coli vaccines
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Foodsafety.gov

19. Review of Escherichia coli O157:H7 outbreaks
reported to CDC(2002), United States
49 states reported 8,598 cases
1,493 (17%) hospitalizations
354 (4%) hemolytic uremic syndrome
40 (0.5%) deaths
Transmission route
52% was foodborne
9% waterborne
14% person-to-person
3% animal contact
21% unknown
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Source: Center for Disease Control and Prevention, Georgia, USA

20. References
 Griffin, Patricia and Tauxe, Robert, “The Epidemiology of Infections Caused by Escherichia coli O157:H7,
Other Enterohemorrhagic E. coli, and the Associated Hemolytic Uremic Syndrome. Vol. 13
 Han MJ, Lee SY. "The Escherichia coli proteome: past, present, and future prospects“. Microbiology and
Molecular Biology Review. Jun 2006
 Prevalence and pathogenicity of shiga toxin-producing Escherichia coli in beef cattle and their products.
J ANIM SCI.
 Feng, Peter, Infection and Emergence of Phenotypic Variants,” EMERGING INFECTIOUS DISEASES, Vol.
1, No. 2 (2001)
 An outbreak of diarrhea and hemolytic uremic syndrome from Escherichia coli O157: H7
http://www.cdc.gov/ecoli/index.html
 E. coli Infection: Causes, Symptoms & Prevention – Healthline.com
http://www.healthline.com/health/e-coli-infection
 Transmission of and Infection with E. coli – Medicinenet.com
http://www.medicinenet.com/e_coli__0157h7/article.htm
 E. coli Bacteria Infection Symptoms, Causes, Treatments –WebMD
http://www.webmd.com/a-to-z-guides/e-coli-infection-treatment-overview
 Enterohaemorrhagic Escherichia coli: emerging issues on virulence and modes of transmission
http://www.who.int/foodsafety/foodborne_disease/ecoli.pdf
https://fri.wisc.edu/files/Briefs_File/FRIBrief_EcoliO157H7humanillness.pdf
http://jas.fass.org/content/85/13_suppl/E63.full.pdf
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Thank You !!
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