The prevalence of enterotoxigenic Escherichia coli in the feces of calves with diarrhea.

A study was undertaken to determine the prevalence of enterotoxigenicity among Escherichia coli isolated from calves with diarrhea and from a control group of normal calves. The test organisms consisted of 200 E. coli recovered from scouring calves less than two weeks of age and 100 E. coli from normal calves. The enterotoxigenicity of the cultures was evaluated by three methods, namely, injection of ligated segments of piglet intestine, injection of ligated segments of calf intestine and oral inoculation of suckling mice. Live cutures of all the test organisms were used for the ligated intestine studies whereas sterile broth culture supernatants were used in the suckling mouse tests. Of the isolates from scouring calves, 36% were enterotoxigenic in the piglet intestine and 28% in the calf intestine. Amongst the isolates from normal calves, none was enterotoxigenic in the piglet intestine and one was enterotoxigenic in the calf test system. The ligated piglet intestine was considered unsuitable for determining the enterotoxigenicity of bovine E. coli, whereas the ligated calf intestine test was satisfactory and correlated completely with the suckling mouse test. The enterotoxigenic E. coli of bovine origin produced an enterotoxin that resembled the heat stable enterotoxin of typical porcine enteropathogenic E. coli.     

Shiga-like toxin production and attaching effacing activity of Escherichia coli associated with calf diarrhea

Four hundred twenty-nine isolates of Escherichia coli from calves were tested for the production of HeLa cell cytotoxin(s). Isolates that produced enough cytotoxin to be detected in culture supernatants of iron-depleted broth were considered to produce increased amounts of cytotoxins. Isolates also were tested for homology with a DNA probe for a gene that encodes localized adherence of human enteropathogenic E coli. Four isolates produced increased amounts of cytotoxin that was neutralized by Shiga antitoxin (toxin designated as Shiga-like toxin-I [SLT-I]). A 5th isolate produced increased amounts of cytotoxin (SLT+) that was not neutralized by the Shiga antitoxin, but was neutralized by antitoxin against a variant of SLT (toxin designated as SLT-II). None of the isolates hybridized with the probe for the localized adherence gene. Three of the SLT+ isolates belonged to human enteropathogenic E coli serogroups O26 and O111. All 5 of the SLT+ isolates were from calves with diarrhea, but none of the 5 SLT+ isolates contained genes for classic heat-labile or heat-stable enterotoxins, for K99 fimbriae, or for invasiveness; neither did any of them adhere to HeLa cells in culture. Three of the 5 SLT+ isolates had attaching and effacing activities when inoculated into ligated intestinal loops of rabbits. One of the isolates with attaching and effacing activity in rabbits was originally isolated from a calf with lesions characteristic of those produced by attaching effacing E coli (AEEC). Calves inoculated with this SLT+ AEEC isolate developed focal colonic lesions characteristic of those produced by AEEC, but did not develop diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of enterotoxigenic Escherichia coli in calves in Scotland and northern England

Eighty-eight of 1529 (5.7 per cent) Escherichia coli isolates from diarrhoeic and clinically normal calves in Scotland and northern England were found to possess the K99 pilus antigen (K99+). There was complete correlation between possession of K99 antigen, heat stable enterotoxin production and ability to dilate intestinal loops. The diagnosis of calf enterotoxigenic E coli infections may therefore be based on the detection of K99 antigen alone. Enterotoxigenic E coli was isolated from 23 of 306 (7.5 per cent) diarrhoeic calves from eight of 70 (11.4 per cent) farms and was not isolated from clinically normal calves. Infected calves were between one and three days old. A survey by an enzyme-linked immunosorbent assay found 3.0 per cent and 3.9 per cent of sera from calves and cows respectively to contain antibodies to K99 antigen. The prevalence of other enteropathogenic organisms in calf faeces is also discussed.     

Identification of virulence factors by multiplex PCR in Escherichia coli isolated from calves in Minas Gerais, Brazil

In this study, multiplex PCR was employed to investigate the virulence factors of Escherichia coli strains isolated from 60-day-old calves. Faecal samples were collected from 54 calves at 12 dairy farms in the state of Minas Gerais, Brazil. A total of 156 isolates were obtained after culture and microbiological isolation and were tested by multiplex PCR for the presence of genes encoding toxins (Stx1, Stx2 and STa) and adherence factors (intimin, F41 and F5). Seventy of 156 isolates were positive for at least one virulence factor: ten (14.3?%) from diarrhoeic animals and 60 (85.7?%) from healthy calves. The virulence markers identified were: Stx1 (82.8?%), eae (24.3?%), F41 (11.4?%), F5 (10?%), STa (4.28?%) and Stx2 (4?%). In diarrhoeic animals, Stx1 (70?%) and F41 (30?%) were identified, while Stx1 (83.3?%), eae (28.3?%), F41 (8.3?%), F5 (11.6?%), STa (5?%) and Stx2 (1.6?%) were detected in isolates from healthy calves. Mixed infections with pathotypes Shiga toxin-producing E. coli (STEC)/enteropathogenic E. coli, STEC/enterohaemorrhagic E. coli and STEC/other (eae/F5, Stx1/STa) were detected in five healthy calves. Pathogenic E. coli were identified in 59.26?% of all calves and on 75?% of the dairy farms studied, not only in diarrhoeic (five of six) but also in healthy calves (27 of 48), which demonstrates the importance of this agent in the aetiology of diarrhoea in calves in the state of Minas Gerais.     

The occurrence of O-antigens of Escheria coli strains in calves suffering from diarrhea in the Eastern Bohemian Region

Coli infections in calves belong to the most serious diseases occurring in the early post-natal period and causing considerable losses to large cattle stocks. The calves affected by diarrhoea were studied as to the serological typification of E. coli. The total number of the calves examined was 1182. The examination yielded 2112 isolated strains. Twelve antisera made it possible to identify 569 strains, i. e. 26.94 %. O-antigens were found to occur with the following descending frequency: 015, 0139, 0117, 0141, 08, 0149, 09, 0101, 02, 0147, 078, and 0115. Although it is obvious that enteropathogenic strains of E. coli were not responsible for all cases of diarrhoea in the examined calves, the total set of animals was large enough to show which O-antigens could be involved in the diarrhoea in the calves kept on large cattle farms in the East Bohemian region.     

Incidence of common DNA sequences in bovine and porcine Escherichia coli strains causing diarrhoea

Seventeen bovine and 56 porcine Escherichia coli isolates from cases of diarrhoea and from healthy animals were examined for DNA sequences homologous to the genes for verocytotoxins (VT), enterotoxins and human enterohaemorrhagic E coli/enteropathogenic E coli (EHEC EPEC) sequences. VT-1 was the most common toxin among the bovine isolates and VT-2 the most common in the porcine isolates. No isolates had homologous sequences to enteropathogenic adherence factor, but 71.2 per cent hybridised to the DNA probe encoding specific EHEC sequences, and 95.9 per cent showed homology with a 23 kb DNA fragment common to EHEC and EPEC plasmids.     

Acute undifferentiated neonatal diarrhea in beef calves. I. Occurence and distribution of infectious agents.

Beef calves in a 48-cow herd were studied during one calving season from birth to ten days of age to determine the presence or absence of potentially enteropathogenic bacteria, viruses, and/or chlamydia in both normal and diarrheic calves. Calves were born and raised outside in large pens unless the ambient temperature was below minus 10 degrees F when calving was done inside. Fecal swabs, fecal aliquots, and nasal swabs were taken from each calf at 32, 128 plus or minus 3, and 248 plus or minus 3 hours of age and as soon after the onset of diarrhea as possible. Diarrhea was defined as that condition in which the feces contained less than 10% dry matter. Enteropathogenic Escherichia coli in feces were identified using the ligated gut loop procedure in calves and by feeding broth cultures to colostrum fed lambs seven to 16 hours old. Potentially enteropathogenic viruses were detected using a variety of methods which included tissue culture, fluorescent antibody, hemadsorption, and electron microscope techniques. Of the 40 calves studied, 32 (80%) developed diarrhea before ten days of age. Twenty-two strains of Escherichia coli which caused dilation of calf ligated intestinal loops were isolated from 11 scouring calves and from one normal calf. Nine out of ten strains of Escherichia coli which dilated ligated loops also caused diarrhea when fed to colostrum-fed lambs seven to 16 hours old. Using antibody technique a Reo-like virus was detected in the feces of 15 calves before, during, and after the onset of diarrhea. Four calves excreted both loop dilating strains of E. coli and Reo-like virus in the feces before ten days of age; in all cases the loop dilating E. coli were isolated from the feces prior to the demonstration of Reo-like virus. A Corona-like virus was also demonstrated in three of the 15 calves infected with Reo-like virus and a noncytopathogenic strain of bovine virus diarrhea virus was isolated from two of the 15 calves infected with Reo-like virus. A loop dilating strain of Citrobacter was isolated from one diarrheic calf. There was no consistent pattern of onset or duration of diarrhea in calves which excreted different infectious agents. Salmonella species, infectious bovine rhinotracheitis virus, parvovirus, adenoviruses, parainfluenza-3 virus, and Chlamydia species could not be demonstrated in any of the calves or their dams. No potentially enteropathogenic agents could be demonstrated in 11 of the 32 calves which scoured. These findings emphasize the complexity of the infectious aspect of the neonatal diarrhea syndrome and illustrate the difficulty in making an etiological diagnosis in field outbreaks of the calf scours complex.     

Associations between antimicrobial use and the prevalence of antimicrobial resistance in fecal Escherichia coli from feedlot cattle in western Canada

A randomized, controlled, blinded clinical trial was performed at a research feedlot in western Canada. Auction-market-derived steers (n = 288) were randomly assigned to 1 of 3 treatments: 1) no antimicrobials on arrival; 2) oxytetracycline in the starter ration for 14 d; and 3) long-acting oxytetracycline subcutaneously on day 0. Minimal inhibitory concentrations of 7 antimicrobials were determined for 3 generic fecal E. coli isolates per animal on arrival and throughout the feeding period. There was a low prevalence of antimicrobial resistance in generic E. coli isolates from calves on arrival. There were increased proportions of cattle with resistant E. coli isolates early in the feeding period among calves in groups 2 and 3. Individual animal treatments were not associated with increased proportions of cattle with resistant E. coli isolates preslaughter. There was no difference in the proportion of animals with E. coli isolates resistant to tetracycline between the treatment groups preslaughter. However, there were significantly more animals with tetracycline resistant isolates of E. coli preslaughter than at arrival.     

Occurrence and characteristics of CS31A antigen-producing Escherichia coli in calves with diarrhoea and septicaemia in Argentina

CS31A is a K88-related non-fimbrial adhesin first described on Escherichia coli strains isolated from diarrhoeic and septicaemic calves. In this report, CS31A antigen was screened by immunological methods and confirmed by PCR among bovine E. coli isolates. In addition, CS31A-producing strains were characterized with respect to different fimbrial antigens, O-serogroup and other properties related to virulence. Faecal or tissue specimens of 100 diarrhoeic or septicaemic calves and 27 older cattle with different pathologies from 71 outbreaks or individual cases that occurred in Buenos Aires province, Argentina, were examined. CS31A + E. coli strains were isolated from 21 (21.0%) calves from 16 outbreaks or individual cases. No CS31A + E. coli was detected in samples from cattle more than 1 year old. Fimbriae F5, F41, F17a and F17b were not detected among the CS31A-producing strains. Three (14.3%) of the CS31A+ E. coli strains expressed the F17c fimbria. All of the 21 isolates exhibited at least one property of septicaemic strains (resistance to serum, production of aerobactin or colicins) but none of them demonstrated heat-stable enterotoxigenic activity. CS31A + E. coli isolates belonged to 10 serogroups, more commonly O8, O7, O17 and O21. The results obtained here confirm the worldwide distribution of CS31A antigen in bovine E. coli strains. However, CS31A + or CS31A + /F17c + E. coli were less frequently isolated than they were in North hemisphere countries.     

The role of K antigens of enteropathogenic Escherichia coli in colonization of the small intestine of calves.

The colonizing and proliferating abilities of enterotoxigenic acapsular or K99- mutants of bovine enteropathogenic Escherichia coli strains were compared with those of their capsulated and K99+ parent strains in the small intestine of infected colostrum-fed calves. Calves infected with the enteropathogenic E. coli parent strains developed profuse diarrhea and severe dehydration. None of the calves which received the acapsular mutant developed diarrhea and one of three calves inoculated with the K99- enterotoxigenic mutant developed moderate diarrhea. The parent enteropathogenic E. coli strains colonized the middle and lower small intestine; in these areas a layer of specific immunofluorescence against the enteropathogenic E. coli covered most villi and 80% of the organisms were associated with the intestinal wall. The acapsular mutant strain failed to colonize the small intestine and fluorescent bacteria were not observed in any area of the small intestine. The K99- mutant proliferated to a lesser extent than did the K99+ parent strain in all areas of the small intestine but moderately colonized the lower small intestine where fluorescent bacteria were observed to cover parts of the intestinal villi.     

Virulence factors and antimicrobial susceptibility of Escherichia coli isolated from calves in Turkey

Escherichia coli isolates from calves were investigated by multiplex PCR assays for the presence of genes encoding K99, F41, F17-related fimbriae, heat-stabile enterotoxin a (STa), intimin (eae) and Shiga toxins (stx1 and stx2). A total of 120 E. coli isolates, 75 isolated from diarrhoeic or septicemic calves and 45 from clinically healthy calves aged between 1 day and 2 months were tested. Each isolate was obtained from different calves in different herds. Among the isolates from diseased animals, 12 (16%) isolates from 1- to 7-day-old diarrhoeic calves were detected as enterotoxigenic E. coli which possessed K99, F41 and STa in combination; F17-related fimbriae genes were detected in 33 (44%) isolates and they were found in combination with K99 + F41 + STa in two isolates. Of 120 isolates, 16 carried eae, eight stx1 and five stx2 genes alone or in combination. None of the eae- or stx-positive strains was identified as O157:H7. However, results indicate that calves may be carrier of Shiga toxin-producing E. coli which have potential as a human pathogen. Antimicrobial susceptibility of 75 isolates from diseased calves was determined by agar disk diffusion method for 14 antimicrobial agents. In 77.3% of the isolates, multiresistance was detected. Higher resistance rates were detected for cephalothin (72%), tetracycline (69.3%), kanamycin (69.3%), ampicillin (65.3%), nalidixic acid (53.3%), trimethoprim-sulphamethoxazole (52%) and enrofloxacin (41.3%), respectively. No resistance was found for ceftiofur and cefoxitin.     

Longitudinal prevalence study of diarrheagenic Escherichia coli in dairy calves

A longitudinal study (cohort study) elaborating 1,224 rectal swabs from 221 calves aging between 1 and 12 weeks was conducted on 11 dairy farms (i) to ascertain associations between diarrhea and shedding of diarrheagenic E. coli and (ii) to facilitate the zoonotic potential assessment of E. coli strains shed by young calves. Calves were screened weekly by PCR of swab cultures for shedding of enterotoxigenic E coli [ETEC; by detection of heat stable (est) and heat labile enterotoxin genes (elt)], diffusely adhering E. coli [DAEC; diffuse adhesion (daa)], typical enteropathogenic E. coli [EPEC; bundle-forming pili (bfpA) and intimin (eae)] as well as enterohemorrhagic E. coli [EHEC, intimin (eae) and Shiga toxin (stx)]. In addition, EHEC-hemolysin- (Hly(EHEC)) and alpha-hemolysin- (alpha-Hly) producing E. coli were detected by inoculation of blood agar plates. Within the 221 calves, prevalences were 69.7% (25.2% of the 1,224 samples) for Hly(EHEC)-producing E. coli, 55.3% (19.3%) for eae, and 18.2% (4.5%) for stx. E. coli strains exhibiting an alpha-Hly phenotype were detected in 66.5% of the calves and 21.9% of fecal samples. The est gene was detectable in 31.7% of the calves from only 9 of 11 herds and in 7.8% of the samples. Calves shedding DAEC or typical EPEC were not identified. The detection frequency of virulence traits significantly depended on the calves' age and shedding dynamics differed between the traits. A significant correlation between calf diarrhea and shedding of EHEC virulence traits was determined for several postnatal periods (1 week: Hly(EHEC); 1st & 10th week: eae; 4th week stx). Shedding of ETEC (est) was associated with diarrhea in newborn calves (1st week) only. Hly(EHEC)- and alpha-Hly-producing E. coli were shed significantly more frequently by diarrheic calves in 1st and 8th week of life, respectively. The knowledge gained in this study highlights the high prevalence of zoonotic E. coli already in calves.The age-dependent shedding dynamic of the various E. coli pathovars has to be considered regarding prophylaxis as well as planning intervention studies, both for calves and humans.     

An epidemiological study of selected calf pathogens on Holstein dairy farms in southwestern Ontario.

Fecal samples from calves on 78 randomly selected Holstein dairy farms in southwestern Ontario were screened for Salmonella, Campylobacter jejuni/coli, enteropathogenic Escherichia coli, rotavirus and coronavirus. Based on the observed prevalence, 22% of farms had calves infected with Salmonella, 13% with Campylobacter jejuni/coli, 41% with enteropathogenic E. coli, 19% with rotavirus and 5% with coronavirus. These estimates can be modified, using a method developed by Mullen and Prost (1983) for the World Health Organization, to account for the nature of the laboratory test used. If the test is assumed to have no false positives (that is, if an organism is detected it must be there), then the observed prevalence estimates seen on this study may greatly underestimate the true prevalence of infected premises. The use of nipple feeders for calves was associated with an increased probability of farms having calves shedding detectable fecal levels of Salmonella, E. coli, or one of the two viruses. The use of group pens was associated with an increased odds of finding C. jejuni. Calves with diarrhea on these farms tended to have increased odds of shedding rotavirus, and E. coli with the K99 antigen. However, at the farm level, none of the organisms was associated with above median levels of morbidity. Farms positive for one or other of the viruses had increased odds of experiencing calf mortality relative to virus-negative farms, and farms positive for C. jejuni/coli had decreased odds of mortality.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dysentery caused by Escherichia coli (S102-9) in calves: natural and experimental disease

A dysentery syndrome was recognized among the Institute's calves at 18 to 21 days of age. It was reproduced experimentally in gnotobiotic calves with an atypical Escherichia coli (S102-9) isolated from the affected calves. In both natural and experimental disease the calves passed copious bright red blood in the feces and developed diarrhea. Walls of the colon and rectum were thickened, and the mucosa was reddened and covered by an exudate that contained mucus and blood clots. Bacteria were seen closely adherent to the luminal surfaces of enterocytes, often in cup-shaped depressions or on cytoplasmic pedestals. Microvilli were distorted, disorientated or absent. There was exfoliation of infected enterocytes and a mild acute inflammation of the underlying lamina. In two of five calves with natural disease, the adherent bacteria did not stain by the immunoperoxidase method with antisera raised against E. coli (S102-9). This indicated that there was possibly more than one bacterial cause of the syndrome. Lesions in experimentally infected calves were indistinguishable from those produced by some E. coli which are enteropathogenic for man, rabbits, and pigs.     

Attaching and effacing Escherichia coli infection as a cause of diarrhea in young calves

A form of enteric Escherichia coli infection was identified in 60 calves from 59 farming operations. The E coli responsible for these infections principally colonized the colon, inducing a distinctive lesion described as attaching and effacing. Hemorrhagic enterocolitis or blood in the feces was observed on 40% of the farms. Of affected calves, 86.6% were dairy calves (average age, 11.8 days). Forty-four calves were infected concurrently with other enteropathogens (cryptosporidia, rotavirus, coronavirus, enterotoxigenic E coli, bovine viral diarrhea virus, coccidia). Verotoxin-producing E coli was recovered from 31 calves; 8 were serotype O111:NM isolates, 3 were serotype O5:NM, and 1 was serotype O26:NM.     

Virulence factors and markers in Escherichia coli from calves with bacteremia

Relative pathogenicity of 151 Escherichia coli isolates from 36 calves with bacteremia after necropsy was studied by measurement of the LD50 after mice were inoculated IP with E coli isolates. Study of virulence factors and markers revealed that the pathogenicity of E coli was associated with the production of hydroxamate siderophores and with resistance to serum bactericidal effects. Production of colicins, including colicin V, and of surface antigen 31A was correlated with virulence. The close association between phenotypic expression of virulence factors and markers was consistent with a hypothesis of a localization of genes coding for virulence factors and markers on the same plasmid.     

Carriage of potentially pathogenic Escherichia coli in chickens

DNA-DNA hybridization, cultured cell lines, and transmission electron microscopy were used to study pathogenicity traits of 64 Escherichia coli isolated from apparently healthy chickens from 18 small-scale farms in Thika District, Kenya. A total of 39 (60.9%) isolates hybridized with the eae gene probe for enteropathogenic E. coli (EPEC) whereas another 16 (25%) hybridized with the lt and st gene probes and were categorized as enterotoxigenic E. coli. Electron microscopic examination of the eae probe-positive E. coli cultures with the HT-2919A cell line confirmed that they were able to attach intimately and produced effacement typical of EPEC. In addition, negative stain electron microscopy showed that the EPEC strains produced pili that have previously been associated with increased virulence of E. coli infections in chickens. This study has also demonstrated that apparently healthy chickens may carry enteropathogenic E. coli strains.     

The pathogenesis of enteric colibacillosis in neonatal unsuckled calves.

The development of pathological lesions in the small intestine of neonatal calves is described. Seven newborn calves were challenged orally with a known enteropathogenic strain of E coli 0101k?(A) and killed at varying times after inoculation. Adhesion of bacteria to the mucosa of the small intestine was observed in all calves. A few organisms were seen in the distal small intestine at three hours after inoculation and thereafter adhesion progressed anteriorly along the intestine in calves killed from six to 36 hours. In these calves pathological changes occurred between six and 12 hours after inoculation. Villi were stunted and thickened and the epithelial surface was irregular. A further calf, anaesthetised from five-and-a-half to 10 hours after inoculation and repeatedly sampled from the distal small intestine, developed similar lesions abruptly at nine hours after inoculation. Villus and crypt lengths in the challenged calves were compared with those in three normal uninoculated control calves.     

The studies on the aetiology of diarrhoea in neonatal calves and determination of virulence gene markers of Escherichia coli strains by multiplex PCR

The purpose of this study was to determine aetiological agents of diarrhoea in neonatal calves and to investigate virulence gene markers of Escherichia coli strains isolated from calves by multiplex polymerase chain reaction (PCR). Eighty-two diarrhoeic calves and 18 healthy calves were used as subjects. Faeces were taken from the rectums of all the calves and were subjected to bacterial culture. Antigen enzyme-linked immunosorbent assay (ELISA) was performed to detect rotavirus, coronavirus and E. coli K99 in faeces of all the calves. A multiplex PCR was used to characterize E. coli strains in all the calves. Escherichia coli was isolated from 37 faeces samples, Enterococcus ssp. was isolated from 22 faeces samples and Salmonella was isolated from one faeces sample in diarrhoeic calves. Furthermore, only E. coli was isolated from all 18 faeces samples of healthy calves. Of the 37 E. coli isolated from diarrhoeic calves, K99 (18.9%), F41 (18.9%), heat-stable enterotoxin a (STa) (18.9%), Shiga toxin 1 (Stx1; 13.5%) and Shiga toxin 2 (Stx2; 5.4%) and intimin (8.1%) genes were identified by multiplex PCR. Of the 18 E. coli isolated from healthy calves, K99 (16.6%) and intimin (55.5%) genes were identified by PCR. A total of 15 rotavirus, 11 coronavirus and 11 E. coli K99 were detected in diarrhoeic calves by the antigen ELISA. As a result, this study shows that rotavirus, coronavirus, E. coli and Enterococcus ssp. were determined to play a role in the aetiology of diarrhoea in the neonatal calves. K99, F41, STa, Stx1 and Stx2 were found as the most common virulence gene markers of E. coli strains isolated from calves with diarrhoea. Multiplex PCR may be useful for characterization of E. coli isolated from calves.     

Colitis in calves: natural and experimental infection with a verotoxin-producing strain of Escherichia coli O111:NM.

Verotoxin-producing Escherichia coli O111:NM were isolated from two five week old Holstein calves with dysentery. On necropsy both calves had pseudomembranous ileitis, mucohemorrhagic colitis and proctitis. Large numbers of E. coli O111:NM were isolated from the colon and lesions typical of attaching-and-effacing E. coli were evident. The isolates from both calves had identical biochemical reactions and antimicrobial resistance patterns. Oral inoculation of a four day old colostrum deprived calf with 1 x 10(10) organisms of E. coli O111:NM produced a mild, focal colitis with typical attachment and effacement lesions. We conclude that the strain of E. coli O111:NM isolated from the clinical cases has the ability to produce colitis characterized by attachment and effacement of the colonic mucosa.