There are at least four different ways in which Escherichia coli can cause
diarrheal disease, invasion of the intestinal epithelium, enterotoxin produ
ction, STx production, and adherence with disruption of the normal function
ing of the intestinal epithelium. This article discusses the four different
ways in which E. coli can cause diarrheal disease, and the clinical syndro
mes associated with these pathogenic mechanisms. In addition, this article
reviews how the organisms are spread, with an emphasis on the types of food
that can act as a vehicle for their transmission; how they can be recogniz
ed in the laboratory; how they should be treated once the patient is found
to be infected; and how they can be prevented.