Enterohemorrhagic escherichiosis in children: causes, symptoms, diagnosis, treatment

Enterohemorrhagic Escherichia produce an exotoxin - verocytotoxin, which has a pathological effect not only on the intestinal wall, but also on other organs and tissues (kidneys, liver, hematopoietic system, etc.). The ability to produce verocytotoxin during reproduction has been established in Escherichia serovars 0157:H7, 026:H11, as well as in some strains of Escherichia 0111, 0113, 0121, 0126 and 0145.

ICD-10 code

A04.3 Enterohemorrhagic infection caused by Escherichia coli.

Epidemiology

Enterohemorrhagic escherichiosis is observed as both sporadic diseases and epidemic outbreaks. The main route of infection is food. Mostly preschool children are affected.

Symptoms of enterohemorrhagic escherichiosis

The symptoms are polymorphic - from asymptomatic infection and mild diarrhea to a severe pathological process with hemorrhagic colitis ("hemocolitis"), hemolytic uremic syndrome (Gasser syndrome) and thrombocytopenic purpura, previously considered as independent, unrelated diseases. The polymorphism of clinical manifestations and the diversity of variants of enterohemorrhagic escherichiosis are explained by the different ability of different EHEC strains to produce exotoxin - from minimal amounts found only in bacterial lysates to significant amounts corresponding to the amount of exotoxin produced by shigella subgroup A (Grigoriev-Shiga).

Manifest variants of enterohemorrhagic escherichiosis usually begin with gastrointestinal dysfunction such as enteritis or enterocolitis. At the onset of the disease, stool is infrequent (3-5 times a day), mushy or watery, without pathological impurities, symptoms of intoxication are mild or moderate (lethargy, decreased appetite, subfebrile condition, etc.). There is usually no vomiting. On the 3-5th day of the disease, the child's condition may worsen due to increasing lethargy, weakness, and vomiting. Note the sharp pallor of the skin, the appearance of a large amount of blood in the feces, and a decrease in diuresis. If the disease progresses, clinical and laboratory signs of hemolytic uremic syndrome appear (microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure).

The incidence of Gasser syndrome in epidemic outbreaks of enterohemorrhagic escherichiosis ranges from 0 to 100%.

In some cases, the onset of enterohemorrhagic escherichiosis (the first 3-5 days) is accompanied by clinical symptoms of intestinal infection with colitis, including "distal". In these cases, the clinical symptoms resemble a mild or moderate form (type B) of dysentery - moderate symptoms of intoxication and colitis syndrome. As the pathological process progresses, most often on the 3-5th day of the disease, the amount of blood in the feces increases (scarlet blood or clots), pallor of the skin, oliguria appear, and the clinical picture of hemolytic-uremic syndrome develops.

Hemorrhagic, or "ischemic" colitis, with enterohemorrhagic escherichiosis initially manifests itself as pain syndrome and watery diarrhea without a significant increase in body temperature and signs of intoxication. On the 3rd-5th day of the disease, the child's condition worsens, large amounts of blood appear in the feces and a clinical picture develops that resembles intestinal bleeding. Pathological impurities in the stool in the form of cloudy mucus, greenery, as a rule, are absent. Without adequate therapy, the disease can end in death.

Thus, three clinical syndromes (hemorrhagic or “ischemic” colitis, thrombocytopenic purpura and Gasser syndrome) can be considered as clinical variants of a single infectious disease caused by certain serovars of Escherichia coli (mainly serovars 0157:H7 and 026:H11), which produce verocytotoxin with cytotoxic, necrotic and hemolytic properties during their life cycle.

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