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

Enterohemorrhagic escherichia produce exotoxin, a verocytotoxin, which has a pathological effect not only on the intestinal wall, but also on other organs and tissues (kidneys, liver, hematopoiesis system, etc.). The ability to produce verocytotoxin during breeding was 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 Enterohaemorrhagic infection caused by Escherichia coli.

Epidemiology

Enterohemorrhagic escherichiosis is observed in the form of both sporadic diseases and epidemic outbreaks. The main path of infection is food. Mostly pre-school children are ill.

Symptoms of enterohemorrhagic escherichiosis

Symptoms are polymorphic - from asymptomatic infection and mild diarrhea to a severe pathological process with the phenomena of hemorrhagic colitis (hemoccolitis), hemolytic-uremic syndrome (Gasser's syndrome) and thrombocytopenic purpura, previously considered as independent, unrelated diseases. The polymorphism of clinical manifestations and the variety of variants of enterohemorrhagic escherichiosis are explained by the unequal ability of various strains of EGE to produce exotoxin - from the minimal quantities found only in bacterial lysates to significant ones corresponding to the amount of exotoxin produced by the shigella of subgroup A (Grigoriev-Shiga).

Manifest variants of enterohemorrhagic escherichiosis. As a rule, begin with dysfunction of the digestive tract according to the type of enteritis or enterocolitis. At the beginning of the disease, the 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.). Vomiting more often than not. On 3-5 days of illness the state of the child can worsen due to the increase in lethargy, weakness, the attachment of vomiting. Attention is drawn to the sharp pallor of the skin, the appearance of large amounts of blood in the stool and a decrease in diuresis. If the disease progresses, there are clinical and laboratory signs of hemolytic-uremic syndrome (microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure).

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

In some cases, the onset of Senterogemorrhagic Escherichiosis (the first 3-5 days) is accompanied by clinical symptoms of intestinal infection with symptoms of colitis, including "distal". In these cases, the clinical symptomatology resembles a mild or moderate form (type B) of dysentery - mild symptoms of intoxication and a colitis syndrome. With the progression of the pathological process, most often 3-5 days of the disease, the amount of blood in the feces (scarlet blood or clots) increases, the pallor of the skin, oliguria develops and the clinical picture of the hemolytic-uremic syndrome develops.

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

Thus, three clinical syndromes (hemorrhagic or "ischemic" colitis, thrombocytopenic purpura and Gasser's syndrome) can be considered as clinical variants of a single infectious disease caused by certain Escherichian serovars (mainly serovars 0157: H7 and 026: H11) producing in the process virotsitotoksin with cytotoxic, necrotic and hemolytic properties.

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