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Infectious diseases. Escherichiosis (most important)

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1. Escherichiosis

Escherichiosis is an acute infectious disease, mainly in young children, caused by various serovars of pathogenic Escherichia coli. They are characterized by the development of pathological processes in the gastrointestinal tract with infectious-toxic and diarrheal syndrome.

Certain strains of E. coli can cause severe diarrhea in children.

They are classified into:

1) enteropathogenic (EPKP) (Escherichia coli);

2) enterotoxigenic (ETCP);

3) enteroinvasive (EICP) E. coli;

4) lining.

Etiology. E. coli is a Gram-negative motile aerobic (facultatively anaerobic) bacillus.

Pathogenesis. ETCS can produce a thermostable, thermolabile toxin, or both simultaneously, the production of which is genetically controlled by transferred plasmids.

EICP can penetrate into the cells of the intestinal epithelium and multiply in them like shigella, resulting in edema, hyperemia, ulceration of the mucous membrane and increased exudation into the intestinal lumen.

Also, the pathogenetic mechanism is adhesion, lining and damage to the villous surface of the intestinal epithelium with a decrease in the activity of parietal enzymes, but without invasion.

Clinical manifestations. Diarrhea associated with EPEC is characterized by watery stools, which can be up to 10-20 times a day, and a slight increase in body temperature. In the feces there is an admixture of mucus, but there is no blood. Spontaneous healing occurs in 3-7 days. Young children may develop vomiting, dehydration, and electrolyte disturbances with acidosis.

Traveler's diarrhea due to ETEC is characterized by the sudden onset of frequent (10-20 times per day) liquid stools 1-2 weeks after arrival in the country. Acute diarrhea is often accompanied by severe cramping abdominal pain, nausea, and vomiting.

In patients with EIKP infection, symptoms develop after 18-24 hours (incubation period), the body temperature suddenly rises, severe diarrhea appears with urges and tenesmus, an admixture of mucus and blood in the feces is observed.

The disease caused by E. coli lining strains is characterized by a gradual onset and a chronic course. Children are slow growing and intolerant of certain foods.

Diagnosis. Gastroenteritis can be suspected with a sudden outbreak of an epidemic of diarrhea, especially in a children's team. Similar serotypes of E. coli can also be found in the nasopharynx, pharynx and stomach of patients.

Treatment. The main elements of treatment in children are the correction and maintenance of water and electrolyte balance.

Neomycin has been effective in treating diarrhea associated with EEC in young children.

Traveler's diarrhea (caused by ETEC in 60% of cases) responds well to treatment with trimethoprimsulfomethoxazole or trimethoprim alone when given early.

Author: Pavlova N.V.

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