Which of the following describes Enterohemorrhagic Escherichia coli infection?

• A. Watery diarrhea with fever
• B. Bloody diarrhea with fever
• C. No diarrhea
• D. Bloody diarrhea, abdominal tenderness, absence of fever

Answer: (D)

Enterohemorrhagic E. coli infection causes hemorrhagic colitis, where the toxin damages the colon leading to bloody, often painful diarrhea and abdominal cramping, with fever typically absent or very mild. This lack of fever despite significant colitis helps distinguish it from many other diarrheal infections that produce fever along with diarrhea. So the presentation of bloody diarrhea with abdominal tenderness and no fever best fits this illness.

Context to help you remember: the culprit is a Shiga toxin–producing E. coli, often linked to undercooked beef, unpasteurized dairy, or contaminated foods. Because of the toxin, the illness focuses on the colon rather than causing a systemic fever response. Be aware of the risk of progression to hemolytic-uremic syndrome, especially in children, and management is mainly supportive; antibiotics and antimotility agents are generally avoided in suspected cases.