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Lecture notes, cheat sheets
Infectious diseases. Escherichiosis. Rotovirus infection. Etiology, epidemiology, clinic, diagnosis, treatment (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 10. Escherichiosis. Rotovirus infection. Etiology, epidemiology, clinic, diagnosis, treatment 1. Escherichiosis Escherichiosis is an acute infectious disease caused by pathogenic Escherichia coli, characterized by damage to the gastrointestinal tract and the development of intoxication and diarrhea syndromes. Occurs with primary damage to the intestines. Etiology. The causative agent is Escherichia coli, which has many antigenic variants. The most dangerous for children are the following 0-groups: 011, 055, 026, 086, 0119, etc. Adults are more often affected by Escherichia 0124. Bacteria enter the body in the small intestine. Severe toxic damage to the intestinal mucosa is caused by Escherichia endotoxin, which has an enterotropic effect. Epidemiology. The sources of infections are sick people and healthy bacteria carriers, the transmission mechanism is fecal-oral. Children get sick more often. Clinic. The incubation period lasts 3-6 days (usually 4-5 days). Escherichiosis can occur in the following clinical forms: 1) intestinal diseases of children; 2) intestinal diseases of adults; 3) sepsis. In children, intestinal forms of escherichiosis occur in the form of varying severity of enteritis and enterocolitis in combination with a syndrome of general intoxication. In mild forms, the body temperature is subfebrile, stools are 3-5 times a day, liquid, sometimes mixed with a small amount of mucus. The moderate form begins acutely, vomiting appears, body temperature rises (38-39 ° C), the abdomen is swollen, stools are up to 10-12 times per day, liquid with mucus. Severe forms are characterized by pronounced toxicosis, stools up to 20 times a day, watery, foamy with an admixture of mucus, sometimes streaked with blood. Body temperature rises to 39-40 °C, there is no appetite, the child is restless, the skin is pale, blood pressure is reduced, and weight loss is noted. In adults, the disease caused by Escherichia 0124 resembles acute dysentery in its course and clinical symptoms. It occurs more often in erased and mild forms; moderate and severe (15%) forms are less common (20-3%). Tenesmus occurs less frequently than with dysentery. The stool is liquid with an admixture of mucus, in some patients with blood. Palpation is accompanied by symptoms of enteritis: pain in the umbilical region, rough rumbling on palpation of the cecum (except for spasm and pain in the colon). It is quite difficult to differentiate escherichiosis from dysentery and salmonella enterocolitis based only on clinical data. The diagnosis is established on the basis of complaints, clinical and laboratory data from bacteriological examination of feces. Treatment. For mild forms of escherichiosis in adults, pathogenetic and symptomatic therapy can be limited. Among etiotropic drugs, aminoglycosides and cephalosporins are mainly used. For watery diarrhea, enterosorbents are prescribed. In case of severe toxicosis, infusion therapy is used. For severe forms, coli-proteus enteral lactoglobulin and bacteriophages are used. The prognosis for adults and children over one year of age is favorable; the disease is most severe in children in the first six months of life. Prevention should be especially strict in all medical children's institutions where children are in their first year of life (especially the first six months). Attention is paid to preventing the introduction of infection into these institutions, early detection and isolation of patients. To do this, pregnant women before childbirth are examined for escherichiosis, as well as women in labor, postpartum women and newborns in whom an escherichiosis infection can be suspected, and if detected, the sick are isolated, and personnel are examined for carriage of pathogenic escherichia. For escherichiosis in adults, prophylaxis is carried out in the same way as for dysentery. 2. Rotavirus infection Rotavirus infection is an acute infectious disease caused by rotaviruses and characterized by damage to the gastrointestinal tract, symptoms of general intoxication, and dehydration with a predominant incidence in children. Causes about half of all intestinal disorders in children in the first 2 years of life. Etiology. The causative agent - rotaviruses - contains RNA, is divided into two antigenic variants, and is stable in the external environment. Epidemiology. Sources of infection - a sick person or a virus carrier. Ways of transmission - contact-household, alimentary. A pronounced autumn-winter seasonality is characteristic. Pathogenesis. Reproduction and accumulation of rotaviruses occurs mainly in the upper gastrointestinal tract, where direct damage to the cells of the intestinal epithelium of the small intestine occurs, leading to the destruction of enterocytes responsible for the synthesis of disaccharidases. In the contents of the intestine, a large amount of osmotically active unsplit disaccharides and sugars accumulates, attracting fluid into the intestinal lumen. The result is osmotic watery diarrhea. After the illness, a short-term immunity is formed. Large losses of fluid and electrolytes are characteristic, which leads to dehydration of the I-III degree. Clinic. The incubation period lasts from 15 hours to 7 days (usually 1-2 days). The disease begins acutely or gradually. Most patients simultaneously exhibit symptoms of damage to the respiratory tract (coughing, nasal congestion, hyperemia of the palatine arches and the posterior pharyngeal wall). A detailed picture of the disease is formed within 12-24 hours from the onset of the disease. Children usually do not have severe fever. Vomiting is a mandatory symptom of the disease. It appears on the first day and lasts 2-3 days. Intoxication is minor. Characterized by copious, loose, watery stools without mucus or sometimes with a small amount of thread-like mucus, without blood. Diarrhea persists for up to 5-7 days. Abdominal pain is cramping in nature and does not have a clear localization. A more severe course is usually due to the layering of a secondary infection. In adults, with severe intoxication and low-grade fever, pain in the epigastric region, vomiting, and diarrhea appear. Rarely, vomiting recurs on the 2-3rd day of illness. All patients have profuse, watery stools with a pungent odor; sometimes cloudy-whitish stools may resemble the stools of a cholera patient. There is a loud rumbling in the stomach. The urge to defecate is imperative; there are no false urges. In some patients, an admixture of mucus and blood is found in the stool, which always indicates a combination of rotavirus disease with a bacterial infection (shigellosis, escherichiosis). Such patients experience more severe fever and intoxication. With copious loose stools, dehydration may develop; In 95-97% of patients, dehydration is grade I or III; children sometimes experience severe dehydration with decompensated metabolic acidosis. Acute renal failure and hemodynamic disorders are possible here. Palpation of the abdomen is accompanied by pain in the epigastric and umbilical regions, and rough rumbling in the right iliac region. The liver and spleen are not enlarged. The diagnosis is established on the basis of complaints, clinical and laboratory data: in the blood test at the onset of the disease, there may be leukocytosis, which is replaced by leukopenia during the peak period, ESR is not changed. In the analysis of urine in some patients, albuminuria, leukocytes and erythrocytes are found, the content of residual nitrogen in the blood serum increases. The basis of laboratory diagnostics is the detection of the virus (by electron microscopy, immunofluorescent method, etc.) or its antigens in feces, as well as antibodies in blood serum (RSK, RTGA, etc.). In the coprogram, patients show signs of impaired digestion. With sigmoidoscopy, most patients have no changes. Differential diagnosis is carried out with cholera, dysentery, escherichiosis, intestinal yersiniosis. Treatment. Diet therapy (restriction of milk, dairy and carbohydrate-rich foods). The basis is pathogenetic methods of therapy, primarily the restoration of fluid and electrolyte losses, in connection with this oral rehydration is carried out. For degree I-II dehydration, solutions are given orally. According to WHO recommendations, use the following solution; sodium chloride - 3,5 g, sodium bicarbonate - 2,5 g, potassium chloride - 1,5 g, glucose - 20 g/l. The solution is given to drink in small doses every 5-10 minutes. In addition to the solution, other liquids are recommended (tea, fruit drink, mineral water). Enterosorbent therapy (enterodes, polyphepan, smecta), enzyme therapy (mezim-forte, creon) are prescribed. Prescribing antibiotics is contraindicated. Among etiotropic drugs, a complex immunoglobulin preparation or anti-rotavirus oral immunoglobulin is prescribed. The prognosis is favorable. Prevention. Patients are isolated for 10-15 days. In cases of mild forms, patients can remain at home under medical supervision if treatment and adequate isolation are provided. The apartment is subject to current and final disinfection. Specific prevention has not been developed. Author: Gavrilova N.V. << Back: Salmonellosis. Etiology, epidemiology, pathogenesis, clinic, treatment >> Forward: Amoebiasis. Balantidiasis. Etiology, epidemiology, clinic, diagnosis, treatment (Amebiasis. Balantidiasis)
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