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NAME: Escherichia coli, enteroinvasive

SYNONYM OR CROSS REFERENCE: EIEC Footnote 1, Footnote 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.


PATHOGENICITY/TOXICITY: EIEC causes bacillary dysentery Footnote 1, an acute ulcerative infection of the large intestine Footnote 1, Footnote 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 1, Footnote 7. Contaminated food and water are the usual vehicles for the spread Footnote 5, Footnote 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 1, Footnote 6, Footnote 7.


RESERVOIR: Humans are the only known reservoir Footnote 6.

ZOONOSIS: None reported Footnote 9.



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 9, Footnote 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.


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 15, Footnote 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 7, Footnote 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.


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.



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.


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.


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


Footnote 1
Baylis, C. L., Penn, C. W., Thielman, N. M., Guerrant, R. L., Jenkins, C., & Gillespie, S. H. (2006). Escherichia coli and Shigella spp. In S. H. Gillespie, & P. M. Hawkey (Eds.), Principles and Practice of Clinical Bacteriology (2nd ed., pp. 347-365). England, UK: John Wiley and Sons Ltd.

Footnote 2
Nataro, J. P., Bopp, C. A., Fields, P. I., Kaper, J. B., & Strockbine, N. A. (2007). Escherichia, Shigella and Salmonella. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. L. Landry & M. A. Pfaller (Eds.), Manual of Clinical Microbiology (9th ed., pp. 670-687). Washington, DC, USA: ASM press.

Footnote 3
Farmer, J. J., Boatwright, K. D., & Janda, J. M. (2007). Enterobacteriaceae: Introduction and Identification. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. L. Landry & M. A. Pfaller (Eds.), Manual of Clinical Microbiology (9th ed., pp. 649-669). Washington, DC: ASM press.

Footnote 4
Hsu, B. -., Wu, S. -., Huang, S. -., Tseng, Y. -., Ji, D. -., Chen, J. -., & Shih, F. -. (2010). Differentiation and identification of Shigella spp. and enteroinvasive Escherichia coli in environmental waters by a molecular method and biochemical test. Water Research, 44(3), 949-955.

Footnote 5
Jones, T. F. (2007). Investigation of Foodborne and Waterborne Disease Outbreaks. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. L. Landry & M. A. Pfaller (Eds.), Manual of Clinical Microbiology (9th ed., pp. 152-169). Washignton, DC: ASM press.

Footnote 6
Ryan, K. J. (2004). Enterobacteriaceae. In K. J. Ryan, & C. G. Ray (Eds.), Sherris Medical Microbiology: Introduction to infectious diseases (4th ed., pp. 343-371). USA: Mcgraw Hill.

Footnote 7
Wilson, W. R., Sande, M. A., & Drew, W. L. (2001). Current diagnosis & treatment in infectious diseases. New York: Lange Medical Books/McGraw-Hill. Retrieved from

Footnote 8
Jay, J. M., Loessner, M. J., & Golden, D. A. (2005). Foodborne Gastroenteritis Caused by Escherichia coli. Modern food microbiology (7th ed., pp. 637-656). NY, USA: Springer Science.

Footnote 9
Krauss, H., Weber, A., Appel, M., Enders, B., Isenberg, H. D., Schiefer, H. G., Slenczka, W., Graevenitz, A. V., & Zahner, H. (2003). Bacterial Zoonoses. Zoonoses: Infectious diseases transmissible from animals to humans (3rd ed., pp. 196-200). Washington DC: ASM press.

Footnote 10
Lehmann, R. H. (2001). Synergism in Disinfectant Formulation. In S. S. Block (Ed.), Disinfectant, sterlization and preservation (5th ed., pp. 459-472). PA, USA: Lipincott Williams and Wilkins.

Footnote 11
Scott, E. M., & Gorman, S. P. (1996). Glutaraldehyde. In S. S. Block (Ed.), Disinfection, Sterilization, and Preservation (5th ed., pp. 361-381). Philadelphia P.A.: Lipincott Williams and Wilkins.

Footnote 12
Weavers, L. K., & Wickramanayake, G. B. (2001). Disinfection and Sterilization Using Ozone. In S. S. Block (Ed.), Disinfection, Sterilization and preservation (5th ed., pp. 205-214). PA, USA: Lippincott, Williams and Wilkins.

Footnote 13
Zhao, T., Doyle, M. P., Kemp, M. C., Howell, R. S., & Zhao, P. (2004). Influence of freezing and freezing plus acidic calcium sulfate and lactic acid addition on thermal inactivation of Escherichia coli O157:H7 in ground beef. Journal of Food Protection, 67(8), 1760-1764.

Footnote 14
Kramer, A., Schwebke, I., & Kampf, G. (2006). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infectious Diseases, 6

Footnote 15
Luscher, D., & Altwegg, M. (1994). Detection of shigellae, enteroinvasive and enterotoxigenic Escherichia coli using the polymerase chain reaction (PCR) in patients returning from tropical countries. Molecular and Cellular Probes, 8(4), 285-290. doi:10.1006/mcpr.1994.1040

Footnote 16
Sethabutr, O., Venkatesan, M., Murphy, G. S., Eampokalap, B., Hoge, C. W., & Echeverria, P. (1993). Detection of Shigellae and enteroinvasive Escherichia coli by amplification of the invasion plasmid antigen H DNA sequence in patients with dysentery. The Journal of Infectious Diseases, 167(2), 458-461.

Footnote 17
Harding, A. L., & Byers, K. B. (2006). Epidemiology of Laboratory-associated infections. In Fleming, D and Hunt, D. (Ed.), Biological Safety: principles and practices (4th ed., pp. 53-77). Washington, DC, USA: ASM press.

Footnote 18
Hunter, P. R. (2003). Drinking water and diarrhoeal disease due to Escherichia coli. Journal of Water and Health, 1(2), 65-72.

Footnote 19
Human Pathogens and Toxins Act. S.C. 2009, c. 24. Government of Canada, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009, (2009).

Footnote 20
Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.