Escherichia coli is a bacterium that is carried in the gastrointestinal tract of man and in ruminants including milk-producing animals. Milk collected for human consumption can become contaminated with E. coli directly via animal feces or indirectly via contaminated farm and dairy parlor environments, equipment, and workers. While most strains of E. coli are harmless commensals, some are able to cause human gastrointestinal disease with mild to severe symptoms that may progress to long-term sequelae or fatal outcomes in high-risk individuals. In this article, pathogenic E. coli are described together with their association with human infection attributed to milk or milk products. The growth and survival of these bacteria and approaches to their control in dairy products are summarized.