<prompt> Which of the following can cause acute diarrhea through inflammatory changes in intestine induced by cytokine release?V. choleraeEHECStaphylococcus aureusAll of the above  <response>: Ans. b EHEC Ref Ananthanarayan 7th1279; H-17th Table 122-1; Robbins 7th834Enterohemorrhagic 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 enterotoxinProximal small bowelWatery diarrheaNo fecal leukocytes; mild or no increase in fecal lactoferrinVibrio cholerae, enterotoxigenic Escherichia coli LT andor 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 cytotoxinColon 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 coliTravelers diarrhea, including: ETEC Cholera-like toxin, no invasionFood, waterWatery diarrheaEHEC Shiga-like toxin, no invasionUndercooked beef productsHemorrhagic colitis, hemolytic uremic syndromeEPECAttachment, 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 