Which of the following can cause acute diarrhea through inflammatory changes in intestine induced by cytokine release?

Ans. b (EHEC) (Ref Ananthanarayan 7th1279; H-17th/ Table 122-1; Robbins 7th/834)Enterohemorrhagic E. coli (EHEC) or Verotoxigenic E. coli (VTEC): E.coli strains producing verocytotoxin (VT) or Shiga- like toxin (SLT) can give rise to diarrheal disease ranging in severity from mild diarrhea to fatal hemorrhagic colitis and HUS. The primary target for VT appears to be the vascular endothelial cells. THE typical EHEC is serotype 0157: HZ, but a few others such as 026:H1 also belong to this category.organisms causing diarrheal diseaseMechanismLocationIllnessStool FindingsExamples of Pathogens InvolvedNoninflammatory (enterotoxin)Proximal small bowelWatery diarrheaNo fecal leukocytes; mild or no increase in fecal lactoferrinVibrio cholerae, enterotoxigenic Escherichia coli (LT and/or ST), enteroaggregative E. coli, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Aeromonas hydrophila, Plesiomonas shigelloides, rotavirus, norovirus, enteric adenoviruses, Giardia lamblia, Cryptosporidium spp., Cyclospora spp., microsporidiaInflammatory (invasion or cytotoxin)Colon or distal small bowelDysentery or inflammatory diarrheaFecal polymorpho- nuclear leukocytes; substantial increase in fecal lactoferrinShigella spp., Salmonella spp., Campylobacter jejuni, entero- hemorrhagic E. coli, enteroinva- sive E. coli, Yersinia enteroco- litica, Vibrio parahaemolyticus, Clostridium difficile, ?A. hydrophila, Entamoeba histolyticaPenetratingDistal small bowelEnteric feverFecal mononuclear leukocytesSalmonella typhi, Y. enterocolitica, ?Campylobacter fetusMajor Causes of Bacterial EnterocolitisOrganismPathogenic MechanismSourceClinical featureEscherichia coliTraveler's diarrhea, including: ETEC "Cholera-like toxin, no invasionFood, waterWatery diarrheaEHEC "Shiga-like toxin, no invasionUndercooked beef productsHemorrhagic colitis, hemolytic uremic syndromeEPEC"Attachment, enterocyte effacement, no invasionWeaning foods, waterWatery diarrhea, infants and toddlersEl EC "Invasion, local spreadCheese, water, person-to-personFever, pain, diarrhea, dysenterySalmonellaInvasion, translocation, lymphoid inflammation, disseminationMilk, beef, eggs, poultryFever, pain, diarrhea or dysentery bacteremia, extraintestinal infection,ShigellaInvasion, local spreadPerson-to-person,low-inoculumFever, pain, diarrhea, dysentery, epidemic spreadCampylobacterToxins, invasionMilk, poultry, animal contactFever, pain, diarrhea, dysentery, food sources, animal reservoirsYersinia enterocoliticaInvasion, translocation, lymphoid inflammation, disseminationMilk, porkFever, pain, diarrhea, mesenteric adenitis, extraintestinal infection, food sourcesVibrio cholerae, other VibriosEnterotoxin, no invasionWater, shellfish, person-to-person spreadWatery diarrhea, cholera, pandemic spreadClostridium difficileCytotoxin, local invasionNosocomial environmental spreadFever, pain, bloody diarrhea, following antibiotic use, nosocomial acquisitionClostridium perfringensEnterotoxin, no invasionMeat, poultry, fishWatery diarrhea, food sources, pigbel" "Mycobacterium tuberculosisInvasion, mural inflammatory foci with necrosis and scarringContaminated milk, swallowing of coughed-up organismsChronic abdominal pain; complications of malabsorption, stricture, perforation,fistulae, hemorrhage