Drinking water and diarrhoeal disease due to Escherichia coli

Escherichia coli has had a central place in water microbiology for decades as an indicator of faecal pollution. It is only relatively recently that the role of E. coli as pathogen, rather than indicator, in drinking water has begun to be stressed. Interest in the role of E. coli as a cause of diarrhoeal disease has increased because of the emergence of E. coli O157:H7 and other enterohaemorrhagic E. coli, due to the severity of the related disease. There are enterotoxigenic, enteropathogenic, enterohaemorrhagic, enteroinvasive, enteroaggregative and diffusely adherent strains of E. coli. Each type of E. coli causes diarrhoeal disease through different mechanisms and each causes a different clinical presentation. Several of the types cause diarrhoea by the elaboration of one or more toxins, others by some other form of direct damage to epithelial cells. This paper discusses each of these types in turn and also describes their epidemiology, with particular reference to whether they are waterborne or not.