Enteropathogenic Escherichia in Children

Intestinal infections due to enteropathogenic escherichiosis occur mainly in young children and newborns. The etiological role in the pathology of young children is established in 30 serovars, among them the serovars 018ac: K77, O20: K84, O26: K60, 033: K, 044: K74, 055: K59, 075: K, 086: K61, Separate epidemic serovars EPE are capable of exotoxin formation (018, O20: KH, 025: K58, O114: K90, 0119: K69, O125: K70, 0126: K71, 0127: K63, 0128: K67, 0142: K86, 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 in children 3-12 months with an unfavorable premorbid background, weakened by various intercurrent diseases, which are on artificial feeding. The newborns, especially premature infants and children from at-risk groups, also suffer. Possible sporadic cases, as well as epidemic outbreaks, usually occurring in somatic hospitals. Maternity homes, departments for newborns, nursery groups of kindergarten, children's homes.

The source of infection is mainly children in the acute period of the disease, when they release into the environment a huge amount of EPE. The causative agent can be kept 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 observe the rules of personal hygiene (washing hands) and anti-epidemic regimens in children's institutions.

Infection occurs almost exclusively exogenous, mainly contact-household way. Less often mark the food path of infection through products of baby food (milk mixtures, juices, etc.). In these cases, epidemic outbreaks and severe forms of the disease occur, especially in the somatic and infectious departments of hospitals, less often in maternity homes and physiological institutions (nurseries, children's homes, etc.). The possibility of an air-dust transmission route has been proved, it does not exclude the possibility of infection through water, as well as during various medical manipulations (through catheters, tubes, etc.). In case of urinary tract infection or asymptomatic carriage of EPE in the mother, infection of the child and during childbirth is possible.

Pathogenesis of enteropathogenic escherichiosis

EPE enters the body through the mouth, then almost without a loss overcomes the stomach and find themselves in the small intestine. Possessing cytotoxicity and limited invasiveness, EPE colonize the mucosa of the small intestine, causing damage and rejection of areas of the apical cytoplasm, sloughing of individual epithelial cells and their groups with the development of erosion and mild inflammation. Usually, colonization and multiplication of EPE are carried out on the surface of enterocytes, and pathogens penetrated into the cell are destroyed. The most cytotoxic (epidemic) strains can be transported by phagosome-like vacuoles through the epithelial cell to 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 with massive infection, it can be shortened to 1-2 days.

The disease can begin as acute (with massive infestation and the food pathway of infection), and gradually, with the phenomena of enteritis (most often with a contact and household way of infection). Stools usually watery, yellow or orange, with a small amount of transparent mucus, abundant, mixed with water ("liquid gruel"), sometimes splashing, wet the entire diaper. On the diaper after soaking the water, the stool often seems normal, the mucus disappears. Exercises can be mushy, foamy, with a small amount of greenery.

Symptoms of enteropathogenic escherichiosis

Diagnosis of enteropathogenic escherichiosis

To suspect enteropathogenic escherichiosis is possible only with typical forms of the disease on the basis of gradually increasing toxicosis with excoxicosis. Severe pallor of the skin, infrequent but persistent vomiting (or regurgitation), bloating (flatulence), frequent, plentiful, watery stool with a small admixture of clear mucus, feces of yellow or orange.

Diagnosis of enteropathogenic escherichiosis

Treatment of enteropathogenic escherichiosis

Therapy of patients with enteropathogenic escherichiosis is built on the same principles as in other acute intestinal infections. Mandatory hospitalization is subject to patients with severe, and sometimes with moderate forms, requiring infusion therapy. Children with mild forms are treated at home. Children are also hospitalized for epidemics, newborns and those with severe concomitant diseases or complications.

Diet is prescribed taking into account the age of the child, feeding him to the disease, the severity and the period of the infectious process. The general principles of the diet are the same as in other acute intestinal infections. It should only be taken into account that EPE affects predominantly the small intestine, therefore, disturbances in digestion and digestion of food products are especially severe. Nevertheless, even with enteropathogenic escherichiosis, it is necessary to increase the amount of food sufficiently (after appropriate unloading) and introduce new foods into the diet, but as the functional state of the digestive tract recovers, preventing digestion.

Treatment of enteropathogenic escherichiosis

Prevention of enteropathogenic escherichiosis

Supposes strict adherence to the sanitary and hygienic and anti-epidemic regime in maternity hospitals, departments for newborn and premature babies, nursery groups of the kindergarten, in the homes of the child. It is more common to use disposable linen 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 the observance of technological and sanitary-hygienic requirements in the manufacture of baby food products.

The early detection of the source of infection, its isolation and sanitation are crucial. A bacteriological study of the feces of children of the first 2 years of life with bowel dysfunction, as well as children who had contact with the patient in the outbreaks, and healthy children before entering the nursery groups of the kindergarten and the child's home. In the departments for premature infants and maternity homes, mothers are also subject to examination. In the focus of infection, the current and final disinfection and monitoring are carried out for 7 days. Specific prophylaxis is not developed.

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