Klebsiella pneumoniae and oxytoca in an infant

Klebsiella in infants is the presence of bacteria in the urine and feces of a child, which can cause various diseases. But this is not always a cause for concern, because this microorganism is conditionally pathogenic and can be in a certain concentration and normal. However, there are diseases that can develop due to this bacteria, so you need to know about all such cases.

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Epidemiology

Statistics on the spread of Klebsiella indicate that more than 57% of children in their first year of life have Klebsiella as a representative of normal microflora. And only in 13% of children does this pathogen cause intestinal disorders. As for Klebsiella pneumoniae, this microorganism causes pneumonia in 12% of cases. This is a very large figure, which indicates the need for treatment taking into account this pathogen.

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Causes klebsiella in a baby

Why is Klebsiella so dangerous for a baby? Before talking about such dangers, we need to understand what Klebsiella is and what role it plays in the child's body.

Klebsiella is a microorganism that belongs to enterobacteria. It has the form of a medium-sized rod, does not form any spores and does not have flagella. Klebsiella can live in conditions with access to air (aerobic), but it can also exist without access to air (anaerobic). Due to these properties, it can survive in different environments of the human body. In addition, the bacterium is covered with a capsule that is very resistant to environmental factors. Due to such a dense capsule, it can live for a long time on household items, as well as on the skin and mucous membranes, without succumbing to the action of epithelial cilia. This bacterium can secrete endotoxin, which affects the clinical picture of diseases caused by Klebsiella.

Klebsiella enters the human body by airborne droplets and contact. When it comes to infants, the first exposure to this bacterium can be immediately after birth. This bacterium is found on the mucous membranes and skin of the mother, and during childbirth it gets on the skin and mucous membranes of the baby. Then Klebsiella descends into the gastrointestinal tract, where it is located together with other bacteria, providing antagonism to pathogenic factors. But in the case when Klebsiella multiplies in large quantities, it causes pathology.

There are several types of these microorganisms: Klebsiella pneumoniae, Klebsiella ozena, Klebsiella oxytoca.

Klebsiella pneumoniae can cause pneumonia, affect joints, meninges, and also cause urinary tract infection. This pathogen is a representative of the normal flora of a child, both a newborn and a child of the first year of life. The bacterium is on the mucous membranes of the respiratory tract or intestines and can cause pathology only under certain conditions. Most often, these are children born with bronchopulmonary dysplasia, having leukemia or other diseases. The development of the disease occurs due to the fact that pathogenic strains of bacteria get on the mucous membrane of the upper respiratory tract, and due to the dense capsule and adhesion factors, it is tightly attached. After this, the bacterium multiplies at the site of localization and causes disease. If we talk about urinary tract infection, then the mechanism of infection is most likely ascending. That is, upon contact with the skin and mucous membranes of the mother during childbirth, the bacterium gets on the genitals of the child and can persist there. In girls, it easily penetrates upward through the urinary tract and can cause pyelonephritis, cystitis and other inflammatory infections. Often, the clinic of pneumonia can be preceded by diarrhea or other symptoms from the gastrointestinal tract, and only after that do symptoms of pneumonia appear.

Klebsiella ozena often affects the mucous membrane of the nose and paranasal sinuses. It is dangerous in terms of the development of atrophy of the mucous membrane.

Klebsiella oxytoca can cause the same pathologies as other species, but it is more prone to damage to the oral mucosa with the development of stomatitis, gingivitis, and can also cause sepsis.

Since this organism can normally live only in the intestines in a certain concentration, the appearance of Klebsiella in an infant may be associated with external infection of the child during contact with sick people. The pathogenesis of the development of diseases caused by Klebsiella is characteristic of any infectious pathology. It penetrates the skin or mucous membranes, releases toxins and thus stimulates the immune response. This is how inflammation occurs and symptoms appear.

The reasons why the bacteria begin to multiply in large quantities are most often caused by intestinal pathology. Very often, in infants, against the background of a change in nutrition, the normal flora can be suppressed and then the opportunistic flora takes over. If the child has absorption disorders in the intestines (malabsorption syndrome, lactase deficiency), this causes stagnation of food and fermentation. In such conditions, Klebsiella can multiply. Feeding a child with formula in the first half of life can also cause an imbalance between Klebsiella and other bacteria.

If a child is treated with antibiotics, this may affect the growth of Klebsiella in the intestine. Violations of the ratio of pathogenic, opportunistic and normal microorganisms are often secondary in the case of damage to the digestive organs due to other pathologies.

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Risk factors

In infants, the disruption of the normal microflora composition is also associated with insufficiently coordinated work of various organs and their response to harmful environmental factors. Therefore, when exposed to unfavorable factors, children are especially sensitive to such influences and it is necessary to identify risk factors in order to pay attention to this in advance:

1. children who are born in pathological births and who cannot be immediately put to the breast. After all, the first contact with the mother's skin plays a major role in the development of the child's microbiocenosis.
2. antibacterial therapy without protection of microflora;
3. technical manipulations or resuscitation measures for a child with impaired protective function of the mucous membranes and skin;
4. artificial feeding of a child;
5. incorrect introduction of complementary foods or feeding regimen, which negatively affects the child’s flora.

Such risk factors must be taken into account and corrected.

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Symptoms klebsiella in a baby

Symptoms of Klebsiella in infants depend on where the pathogen is localized. If we are talking about Klebsiella pneumoniae, it causes inflammation of the lungs and is localized in the alveoli. If the inflammatory process is localized near the root of the lung, then focal pneumonia develops. When inflammation covers a separate lobe of the lung, then we are talking about croupous or lobar pneumonia.

Pneumonia caused by Klebsiella pneumoniae is more often observed in newborns with the development of early pneumonia. This pathogen belongs to the flora, which is hospital, which is a factor in the infection of the child after birth. As for pneumonia in infants, Klebsiella can cause an inflammatory process at any age, then the transmission factor can be sick people.

The first signs of pneumonia appear on the first day of the disease. The leading symptom is intoxication. The child begins to eat poorly, is capricious, and the body temperature rises. At the beginning of the disease, the body temperature may be subfebrile, but on the second day it usually rises to 39. The younger the child, the less you need to focus on the temperature indicator, since it may not rise in very young children.

Along with these symptoms, signs of shortness of breath appear. Pneumonia is characterized by the first or second degree of shortness of breath. In infants, this is manifested by pale skin and cyanosis around the mouth, which appears when the child is restless. In addition, additional muscles participate in the act of breathing - you can notice the child's nasal wings flaring, the supraclavicular areas retracting. The child is inactive, often lies down and does not want to play. It is important at this stage to give the child plenty of fluids, because with an elevated temperature, he loses a lot of fluid. In addition to these symptoms, a cough is characteristic of pneumonia. At first, it is dry if pneumonia developed without previous rhinitis. Then the cough becomes deeper and more moist. Intoxication increases with an increase in body temperature. An increase in the child's breathing rate and heart rate are also observed.

All these symptoms of respiratory failure indicate a high probability of pneumonia, which should be paid attention to immediately. The fact that can accurately indicate Klebsiella as the causative agent of pneumonia cannot be singled out at the initial stage. More accurate diagnostics can only be done after laboratory tests. Klebsiella and Staphylococcus aureus in infants, as causative agents of the inflammatory process in the lungs, are characterized by the development of severe pneumonia. The combination of these two pathogens leads to the rapid development of necrotic changes in the alveoli, which are difficult to correct in the future. Such pneumonias, as a rule, develop in children with severe concomitant pathologies or immunodeficiencies.

Klebsiella oxytoca causes stomatitis and gingivitis in infants. Under normal conditions, it can be on the skin in low concentrations, but under certain conditions it gets on the mucous membrane and begins to multiply. Therefore, the peak incidence of Klebsiella oxytoca is the age of children starting from six months. It is at this time that teething begins and the child can become infected through dirty objects and toys. The first symptoms of stomatitis caused by Klebsiella are characterized by the presence of inflammatory foci on the mucous membrane. The elements of the rash have the color of white dots that cover the entire mucous membrane from the inside of the oral cavity, or there may be isolated foci on the mucous membrane of the cheek. The rash in the oral cavity causes itching and burning, so the child cannot eat anything and refuses to breastfeed. Body temperature may rise. Such stomatitis has the risk of spreading further to the gastrointestinal tract with the development of inflammation. Therefore, it is important to immediately pay attention to the first signs of stomatitis.

If Klebsiella gets into the urinary tract and kidneys by ascending route, it can lead to the development of inflammation of the genitourinary system. And Klebsiella, as one of the possible pathogens, occupies one of the highest priority places. It causes acute pyelonephritis in girls of the first year of life in more than 45% of cases.

The first symptoms of pyelonephritis or urinary tract infection are often manifested by an increase in body temperature. The child also becomes restless and refuses to eat. There are no other symptoms, since the baby cannot tell about back pain. The only symptom that the mother may notice is a violation of the urination process. The child may urinate less or, on the contrary, more often, and the color of the urine may be cloudy. But this is difficult to diagnose if the baby wears a diaper. Therefore, the mother needs to pay special attention to this, especially if there are no other reasons for the increase in temperature.

Klebsiella, as a causative agent of intestinal infection, is the most common manifestation of infection in infants. This is explained by the fact that it is present in the baby's intestines in small quantities, and under certain conditions, with a decrease in local beneficial flora, symptoms of intestinal infection may occur. This is manifested by the fact that the child becomes restless, screams, and against this background, colic may develop. A common symptom that can alert in terms of infection with Klebsiella may be a change in the nature of the stool. Most often, loose stools develop, which should alert the mother. The stool may be normal, but an increase in the amount of stool more than five per day can also be considered diarrhea. This occurs due to the fact that the pathogenic microorganism multiplies and causes the movement of water from the intestinal cells into space - this leads to the onset of diarrhea. If diarrhea develops against the background of Klebsiella, then the body temperature may rise, as a reaction to any infection. Vomiting is a typical symptom of a severe intestinal infection in infants caused by Klebsiella. The child may vomit food that he ate the day before. In severe cases of infection, dehydration may occur with diarrhea and vomiting. The stages of dehydration that are typical for Klebsiella are limited to the first stage, since Klebsiella cannot cause severe diarrhea by its mechanism. But the main signs of dehydration may be dry mucous membranes in the child, lack of sweat in the armpits.

Different types of Klebsiella can cause different symptoms, depending on the organ in which the inflammatory process is localized.

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Complications and consequences

Consequences of persistence of Klebsiella in the body of an infant can only occur if the microorganism is present in quantities exceeding the normal limits. If Klebsiella causes pneumonia, then if diagnosis is not timely, the consequences can be very serious. Complications of pneumonia can be caused by the pathogen of the same name, or by other organisms that persist against the background of pneumonia. Frequent complications are purulent inflammatory processes of the ear with the development of otitis, as well as abscesses of the lung or other organs. If the inflammatory process in the lungs remains untreated for a long time, complications may occur in the form of the spread of inflammation to the pleura with the development of pleural empyema or purulent pleurisy. These processes are very dangerous if caused by Klebsiella, since the risk of serious purulent processes increases in this case.

Complications of diarrhea caused by Klebsiella can also be in the form of impaired absorption processes and the development of hypotrophy, microelement deficiency and the development of anemia. Allergic reactions against the background of intestinal infection also develop much more often in such children.

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Diagnostics klebsiella in a baby

Diagnosis of Klebsiella is very important, because the use of treatment agents that act specifically on this microorganism accelerates recovery.

If pneumonia is caused by Klebsiella, laboratory tests are needed for accurate diagnosis, because the clinic has no specific symptoms. Such pneumonia has a severe course, so it is necessary to start specific therapy as early as possible. Characteristic diagnostic signs of pneumonia during an objective examination are crepitation and asymmetrical moist rales in the lungs during auscultation. Percussion reveals dullness of sound. In severe pneumonia, oxygen saturation may decrease, so it is necessary to measure this indicator. Normally, it is at least 95%.

Changes in laboratory data that may indicate pneumonia caused by Klebsiella are not specific. A characteristic picture for any bacterial infection is observed - an increase in the number of leukocytes in dynamics and an increase in rods, an increase in ESR.

Instrumental diagnostics in confirming pneumonia is the main method. For this, chest X-rays are performed and inflammatory foci in the lungs can be seen as infiltrative shadows.

Klebsiella can be specifically confirmed as a pneumonia pathogen by laboratory diagnostics of the sick child's sputum. To do this, you need to examine the smear under a microscope, which can indicate Klebsiella indirectly. But the best diagnostic method is microbiological. This method allows you to grow Klebsiella on a nutrient medium and study its sensitivity to antibiotics.

Diagnosis of Klebsiella as a causative agent of intestinal infection is the simplest task, since it is quite easy to identify the causative agent. When symptoms of diarrhea or any symptoms from the intestines appear, a stool test is performed. Klebsiella in an infant's stool may be normal, but if it exceeds the indicator, then we can say that this is the cause of the disorders. For such a diagnosis, it is necessary to pass a stool test for dysbacteriosis. Dysbacteriosis tests in infants are informative only with the correct technique. The container for collecting stool must be sterile, because the content of other microbes there can affect the result. Under normal conditions, the total amount of intestinal flora is determined in a healthy child, as well as the number of E. coli, streptococci, hemolytic and non-hemolytic strains of staphylococci, fungi. The norm for Klebsiella in a baby's feces should not exceed 10 to the fifth power, and if the test result indicates a higher content, then most likely Klebsiella caused the disorders.

Klebsiella should not be detected in the urine of an infant under normal conditions. If a general urine analysis shows changes in the form of mucus, bacteria, leukocytes, and Klebsiella is detected, then along with clinical symptoms, we can talk about an acute urinary tract infection.

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Differential diagnosis

Differential diagnostics should be carried out with other pathologies that have a similar clinical picture. If a child develops pneumonia, it is necessary to differentiate this pathology from heart diseases that the child may have of congenital etiology.

Stool disorders must be differentiated from dysbacteriosis and intestinal infections of viral etiology.

Treatment klebsiella in a baby

Treatment of this pathogen, even regardless of the localization of the inflammatory process, has several mandatory conditions. One of them is the use of antibacterial agents that are effective against Klebsiella. Without antibiotics, treatment of any pathology is impossible. Klebsiella is currently resistant to some antibiotics, so to select an effective remedy, it is best to use a sensitivity test to antibiotics. But if it is not possible to obtain the growth of microorganisms, then the only possible option is considered to be the empirical prescription of antibacterial agents.

1. Ampicillin protected by clavulanic acid (Amoxiclav or Augmentin) is an antibiotic from the aminopenicillin group, which acts on Klebsiella by destroying its wall. This drug neutralizes the cell membrane of the bacteria and disrupts its reproduction. The dosage of the drug for infants is at least 45 milligrams per kilogram of the child's body weight. The course of treatment is at least one week. Method of administration - in the form of a suspension, dividing the daily dose into three doses. Side effects may be in the form of allergic reactions, and due to the action of clavulanic acid, diarrhea may occur. Precautions - do not use if you have a history of allergies to this group of drugs.
2. Neomycin is an antibiotic from the aminoglycoside group, which is effective against Klebsiella when other antibiotics are ineffective. It acts on the bacterial wall of the bacterium and increases its permeability to water, which leads to the destruction of the microorganism. The dosage of the drug is 10 milligrams per kilogram. The method of administration is intramuscular or intravenous. Side effects can be in the form of systemic or skin allergic reactions.
3. The use of probiotics in antibiotic treatment of infants is mandatory. Also, if Klebsiella causes intestinal disorders, then the use of probiotics is the main element of treatment. In this case, it is better to use probiotics with antagonistic properties.

Subalin is one of the most commonly used probiotics today. The drug contains a strain of live bacteria Bacillus subtilis. This strain helps kill Klebsiella and other pathogenic bacteria, and also helps normalize the qualitative composition of bacteria in the intestines of infants. The method of using the drug for children of the first year of life can be in the form of a sachet or in bottles. The dosage of the drug for treatment is one dose (in the form of a sachet or in a bottle) twice a day. The drug should be dissolved in a teaspoon of milk or formula and given to the child. The duration of therapy is about 10-15 days. Side effects when using the drug can be in the form of short-term constipation.

1. Enterol is recommended for infants with Klebsiella for treatment, and also two weeks later for the prevention of complications. The composition of the drug includes yeast-like fungi Saccharomycettis bullardii, which exhibit their antagonistic effect on many pathogenic microbes involved in the development of intestinal infection in the baby, including Klebsiella. Fungi also neutralize toxins that are released in the intestines and disrupt its normal functioning. The drug reduces the severity of diarrhea due to direct action. The method of using the drug for infants is best to use a sachet. Dosage - one sachet once a day for seven days. Side effects are very rare.
2. Prema is a drug from the group of synbiotics, which contains prebiotics in the form of fructooligosaccharides and probiotic Lactobacillus rhamnosus GG. This medicine is currently considered one of the most effective means for treating diarrhea in children, including that caused by Klebsiella. This drug, getting into the baby's intestines, immediately begins to work due to the content of the prebiotic. It inhibits the reproduction of pathogenic bacteria and prevents their further growth. The method of application in the form of drops - ten drops per day, dissolving them in milk. Treatment can be carried out for two to four weeks. Side effects were not observed.
3. Enterofuril is also widely used for Klebsiella in infants, when antibiotics cannot be used in treatment. The active ingredient of this drug is nifuroxazide. This drug is an intestinal antiseptic and exhibits antagonistic properties against Klebsiella. The dosage of the drug is 5 milliliters three times a day. Method of administration - in the form of a suspension for children over two years old. Precautions - use in infants only on the recommendation of a doctor.

Vitamins can be used after the child has recovered to improve digestion and better recovery from illness. For this purpose, you can use Pikovit, a complex vitamin preparation with minerals. Dosage: 2 milliliters three times a day.

Physiotherapeutic treatment is not used in the acute period.

Folk treatment of Klebsiella in infants

Traditional methods of treatment can be used for pneumonia caused by Klebsiella, in the form of decoctions for the child to drink. For urinary tract infections, decoctions with an antiseptic diuretic effect can also be used. Traditional methods of treatment can also be used to treat Klebsiella, as a causative agent of diarrhea.

1. Using homemade kefir balances the composition of microflora well and reduces the amount of pathogenic. To prepare such kefir, you need to take fresh milk, boil it and cool it. Add a special bacterial starter bought in a store to the warm milk and keep the kefir in a warm place for 12 hours. You can give your child 100 grams of such kefir two or three times a day.
2. Rowan berry juice can be used to treat the genitourinary system, as it has pronounced antiseptic properties. To make the medicine, take one hundred grams of berries, grind them into a pulp, and add the same amount of boiled water. Give the child a tablespoon, unless there is an allergy.
3. The herb of the sea thistle and the bear's ears show a very good effect in the treatment of the inflammatory process of the genitourinary system. To do this, take 30 grams of the herb of the bear's ears and the same amount of sea thistle seeds, pour boiled water over them and let it brew. Give the child two drops three times a day.

Herbal treatment can also be used to correct the child's condition.

1. Oregano herb has antiseptic and antitoxic properties, so it can be used for lung and genitourinary infections. To prepare the tincture, take 50 grams of dry leaves per glass of hot water. After infusion, dilute this glass of water in half and give the child a teaspoon to drink at night.
2. Celandine, succession and chamomile are known for their antiseptic and antibacterial properties. To prepare a medicinal tincture, take thirty grams of each herb and pour hot water over it. After it has been infused for half an hour, it can be used for washing with cystitis in girls, which is caused by Klebsiella.
3. You need to take one hundred grams of linden flowers and leaves, pour water over them and let the solution sit for two hours. After that, the tea needs to be heated and given to the child to drink warm instead of liquid.
4. Flax seed infusion also has antiseptic properties and helps normalize stool after an intestinal infection. To prepare the infusion, take 50 grams of flax seeds and pour 250 water. After the solution has been infused for two hours, the mother can take a teaspoon in the morning and evening if she is breastfeeding. For a baby, such a medicine is very allergenic.

Homeopathy can be used to normalize stool and bowel function after a Klebsiella infection. In the acute period of pneumonia or urinary tract infections, homeopathy can only be used on the recommendation of a doctor.

1. Nux vomica is a homeopathic herbal medicine used to treat acute and chronic intestinal pathology in children. It is especially effective against dysbacteriosis caused by a previous bacterial infection. The dosage of the medicine for children can be three granules, which must first be dissolved in boiled water and used three times a day for the first week, and then once a day for another three weeks. Side effects include reddening of the skin of the face, which indicates the need to reduce the dosage.
2. Sodium iodatum is a homeopathic remedy of organic origin, the main element of which is sodium iodide. The drug is used to treat infectious bowel lesions, which is accompanied by stool disorders with pronounced systemic manifestations - an increase in body temperature, spasmodic pain in the abdomen. Therefore, systemic use of the drug is recommended, and if the mother is breastfeeding, then it is recommended that the mother take it. The drug is used for the mother in a dose of one granule four times a day. Side effects can only be if the mother is intolerant, and the baby may have constipation in the first few days.
3. Sanguinaria is a well-known homeopathic remedy used to treat inflammations of bacterial etiology, as well as intestinal problems. The dosage is one granule per day, which can be used for infants by grinding and giving under the tongue. It dissolves quickly and has a sweet taste. Side effects may be a deterioration in the condition for some time.
4. Ignatia is a homeopathic remedy used to improve the condition after an intestinal infection and to improve digestion. It is available as a single-drug granule. The dosage of the drug for a child at the beginning of therapy is two granules three times, and in more severe cases the dose is doubled. There may be side effects in the form of pale skin and mucous membranes of the child. Precautions - do not use for atopic dermatitis in a child.

Surgical treatment for Klebsiella infection is not used.

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Prevention

Prevention of Klebsiella in infants consists of simple rules of proper feeding of the baby. It is necessary to use breast milk, which has all the vitamins and immune factors that protect the child's body from any pathogenic bacteria, including Klebsiella.

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Forecast

The prognosis for the presence of Klebsiella in the feces of an infant is positive, because the condition can be corrected with the right therapy. If Klebsiella causes pneumonia in a child, the prognosis is more serious, because the microorganism is aggressive during inflammation in the lungs. But the use of antibiotics to which this strain is sensitive has a good prognosis for recovery without complications.

Klebsiella in infants is an infection of the child's body with a bacterium that can cause pneumonia, inflammation of the genitourinary system, stomatitis, enteritis. Symptoms of the disease do not have specific signs, so it is important to conduct laboratory tests. Timely treatment is the main task when identifying Klebsiella in a child as a causative agent of the disease.

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