Virulent strains of Escherichia coli are responsible for most diarrheal infections, meningitis, septicemia, and urinary tract infections in children worldwide. Clinicians must learn to recognize, treat, and prevent these infections.

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Escherichia coli are normal inhabitants of the human large intestine. Most strains are harmless, but some strains acquire bacteriophage or plasmid DNA-encoding enterotoxins or invasion factors and become pathogenic. These virulent strains are responsible for diarrheal infections worldwide, as well as neonatal meningitis, septicemia, and urinary tract infections (UTIs).

E coli are gram-negative bacilli of the family Enterobacteriaceae. They are facultative anaerobes and nonsporulating. E coli strains with the K1 capsular polysaccharide antigen cause approximately 40% of cases of septicemia and 80% of cases of meningitis.

Different strains of E coli are associated with a number of distinctive diarrheal illnesses (Table). Among these are the enterotoxigenic E coli (ETEC),...

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