Enteropathogenic escherichiosis in children

Intestinal infections caused by enteropathogenic Escherichia coli occur predominantly in young children and newborns. The etiologic role in the pathology of young children has been established for 30 serovars, of which the most widespread are serovars 018ac:K77, 020:K84, 026:K60, 033:K, 044:K74, 055:K59, 075:K, 086:K61, 011av:K58, 0114:K90, 0119:K69, 0125:K70, 0126:K71, 0127:K63, 0128:K67, 0142:K86, etc. Some epidemic serovars of EPE are capable of exotoxin formation (018, 020:KH, 025:K98, 0114:H21, 0119, 0128:H12, 0128:H21, etc.) and can cause “cholera-like” diseases.

ICD-10 code

A04.0 Enteropathogenic infection caused by Escherichia coli.

Epidemiology

Enteropathogenic escherichiosis is widespread among young children, especially among children aged 3-12 months with an unfavorable premorbid background, weakened by various intercurrent diseases, and on artificial feeding. Newborns also get sick, especially premature babies and children from risk groups. Both sporadic cases and epidemic outbreaks are possible, usually occurring in somatic hospitals, maternity hospitals, neonatal departments, nursery groups of kindergartens, and children's homes.

The source of infection is mainly children in the acute period of the disease, when they release a huge amount of EPE into the environment. The pathogen can persist for a long time (up to 2-5 months) on household items, toys, linen, dishes. In the spread of infection, the decisive role belongs to adults when they do not comply with the rules of personal hygiene (hand washing) and the anti-epidemic regime in children's institutions.

Infection occurs almost exclusively exogenously, mainly through contact and household means. Less commonly, foodborne infection is transmitted through baby food (milk formula, juices, etc.). In these cases, epidemic outbreaks and severe forms of the disease occur, especially in somatic and infectious departments of hospitals, less commonly in maternity hospitals and physiological children's institutions (nurseries, children's homes, etc.). The possibility of airborne and dust-borne transmission has been proven, and the possibility of infection through water and during various medical procedures (through catheters, tubes, etc.) is not excluded. In case of urinary tract infection or asymptomatic carriage of EPE in the mother, the child may be infected during childbirth.

Pathogenesis of enteropathogenic escherichiosis

EPE enter the body through the mouth, then almost without losses pass through the stomach and end up in the small intestine. Possessing cytotoxicity and limited invasiveness, EPE colonize the mucous membrane of the small intestine, causing damage and rejection of areas of the apical cytoplasm, desquamation of individual epithelial cells and their groups with the development of erosions and moderate inflammation. Usually, colonization and reproduction of EPE occur on the surface of enterocytes, and pathogens that have penetrated the cell are destroyed. The most cytotoxic (epidemic) strains can be transported by phagosome-like vacuoles through the epithelial cell into the underlying tissue (like salmonella), leading to transient bacteremia and even sepsis.

Symptoms of enteropathogenic escherichiosis

The incubation period is about 5-8 days. In newborns and weakened children, as well as in cases of massive infection, it can be shortened to 1-2 days.

The disease can begin both acutely (with massive invasion and foodborne infection) and gradually, with enteritis (most often with contact-household infection). The stool is usually watery, yellow or orange, with a small amount of transparent mucus, abundant, mixed with water ("liquid gruel"), sometimes splashing, moistening the entire diaper. On the diaper, after absorbing water, the stool often seems normal, the mucus disappears. The stool can be mushy, foamy, with a small amount of greenery.

Symptoms of enteropathogenic escherichiosis

Diagnosis of enteropathogenic escherichiosis

Enteropathogenic escherichiosis can be suspected only in typical forms of the disease based on gradually increasing toxicosis with exicosis, pronounced pallor of the skin, infrequent but persistent vomiting (or regurgitation), bloating (flatulence), frequent, profuse, watery stools with a small admixture of transparent mucus, yellow or orange feces.

Diagnosis of enteropathogenic escherichiosis

Treatment of enteropathogenic escherichiosis

Therapy for patients with enteropathogenic escherichiosis is based on the same principles as for other acute intestinal infections. Patients with severe and sometimes moderate forms requiring infusion therapy are subject to mandatory hospitalization. Children with mild forms are treated at home. Children are also hospitalized according to epidemiological indications, newborns and those with severe concomitant diseases or complications.

The diet is prescribed taking into account the child's age, his feeding before the disease, the severity and period of the infectious process. The general principles of the diet are the same as for other acute intestinal infections. It should only be taken into account that EPE mainly affects the small intestine, so the disturbances in the processes of digestion and assimilation of food products are especially severe. Nevertheless, even with enteropathogenic escherichiosis, it is necessary to increase the volume of food quite vigorously (after appropriate unloading) and introduce new foods into the diet, but as the functional state of the gastrointestinal tract is restored, without allowing digestion to fail.

Treatment of enteropathogenic escherichiosis

Prevention of enteropathogenic escherichiosis

It assumes the strictest observance of sanitary and hygienic and anti-epidemic regime in maternity hospitals, departments for newborns and premature babies, nursery groups of kindergartens, in children's homes. It is necessary to use disposable underwear more widely when caring for children of the first year of life and especially for newborns. It is necessary to achieve in every possible way the natural feeding of children of the first half of life and compliance with technological and sanitary and hygienic requirements in the manufacture of baby food products.

Early detection of the source of infection, its isolation and sanitization are of crucial importance. Bacteriological examination of feces of children of the first 2 years of life with intestinal dysfunction, as well as children who have had contact with a patient in foci, and healthy children before admission to nursery groups of kindergartens and children's homes are carried out. In departments for premature babies and maternity hospitals, mothers are also subject to examination. In the source of infection, current and final disinfection and observation for 7 days are carried out. Specific prophylaxis has not been developed.

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