ETEC is a major cause of traveler’s diarrhea in adults in industrialized countries and a leading cause of infant diarrhea in developing countries. ETEC is estimated to cause 200 million episodes of diarrhea and approximately 380,000 deaths in children in the developing world and travelers to those areas. In the US, ETEC is estimated to cause approximately 17,800 foodborne illnesses annually. Enterotoxins produced by ETEC strains include heat-labile LT toxin and heat-stable ST toxin. ETEC illnesses are usually associated with acute watery diarrhea and sometimes nausea, headache, vomiting, or fever. Typical symptoms include profuse, watery diarrhea free of polymorphonuclear leukocytes, and abdominal cramping; occasional fever, nausea or vomiting, chills, anorexia, headache, muscle aches and bloating. Severe symptoms may resemble cholera with approximately 7 days of “rice-water” stools and dehydration. International travel is a risk factor and transmission is via fecal-oral route, contaminated food or water. Average incubation period is 40 hours.
Anti-motility agents are contraindicated. Antibiotics may be considered in immunocompromised or if > 4 stools daily, pus in stool, or fever, and may shorten the duration of the diarrhea by 24-36 hours. Appropriate therapies include Levofloxacin 500 mg daily for 3 days, Ciprofloxacin 500 mg twice daily for 3 days, Rifaximin 200 mg three times daily for 3 days, or Azithromycin 1 g for 1 dose or 500 mg daily for 3 days, oral rehydration therapy and symptomatic treatment for fever or muscle aches. Essential oils of Pinus sylvestris (pine), Thymus officinalis (thyme), Melaleuca alternifolia (tea tree), Coriandrum sativum (coriander seed), Cymbopogon citrates (lemon grass), Mentha piperita (peppermint), and Melissa officinalis (lemon balm) have been shown to have antimicrobial effects against E. coli in vitro. Aqueous, ethanol and methanol extracts of Triphala churna; ethanol extract of Mahsudarshan churna; and methanol extract of Sukshsarak churna have all been shown to have antimicrobial activity against E. coli in vitro.
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