2018 E. coli Outbreak Linked to Romaine Lettuce A – Signs and Symptoms

Final Update

This outbreak appears to be over. E. coli is an important cause of illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the E. coli and Food Safety web page.

  • People usually get sick from Shiga toxin-producing E. coli (STEC) 2–8 days (average of 3–4 days) after swallowing the germ.
    • Most people infected with E. coli develop diarrhea that can be bloody, severe stomach cramps, and vomiting.
    • Most people recover within 1 week.
    • Some infections are very mild, but others are severe or even life-threatening.
  • Some people with a STEC infection may get a type of kidney failure called hemolytic uremic syndrome (HUS).
    • HUS can occur in people of any age but is most common in children younger than 5 years, adults aged 65 years and older, and people with weakened immune systems.
    • HUS develops about 7 days after symptoms first appear, when diarrhea is improving.
    • Clues that someone is developing HUS include
      • decreased frequency of urination,
      • feeling very tired, and
      • losing pink color in cheeks and inside the lower eyelids.
    • People with HUS should be hospitalized because their kidneys may stop working and they may develop other serious problems.
    • Most people with HUS recover within a few weeks, but some suffer permanent damage or die.
  • E. coli infection is usually diagnosed by testing a stool sample.
  • Antibiotics are not recommended for patients with suspected E. coli O157 infections until diagnostic testing can be performed and E. coli O157 infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli O157 infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.