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Enterotoxigenic escherichiosis in children
Last reviewed: 07.07.2025
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Enterotoxin-associated escherichiosis occurs in children and adults of any age. The isolated enterotoxigenic escherichiosis belong to 48 serogroups and 61 serovars, of which the most significant in human pathology are 06:K15:H16, 015:H11, 027:H7 (H20), 078:H12, 0112av, 0114:H21, 0148:H28, 0159H4.
In addition to colonization factors that ensure bacterial adhesion, ETE produce exo-enterotoxins during their life processes. Enterotoxigenicity of Escherichia coli is associated with thermolabile and thermostable toxins.
ICD-10 code
A04.1 Enterotoxigenic infection caused by Escherichia coli.
Epidemiology of enterotoxigenic escherichiosis
It is widespread throughout the world, especially in Asia, Africa and Latin America, and occurs among both local residents and visitors ("traveler's diarrhea"). It occurs in the form of sporadic cases or epidemic outbreaks.
The main route of infection is food. It is also possible to transmit the infection through water and by contact. The pathogen and its enterotoxins accumulate in food products. Sometimes the disease can be caused only by the exotoxin without the presence of the pathogen. This usually happens when a lot of exoenterotoxin has accumulated in the product and it has not been thoroughly cooked.
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Pathogenesis of enterotoxigenic escherichiosis
Enterotoxigenic Escherichia coli are not invasive (like the cholera vibrio ), but multiply on the surface of the microvilli of the small intestine without developing an inflammatory process. During colonization, hypersecretion of the epithelium begins and progresses, the absorption of water and electrolytes from the intestinal lumen is disrupted, which is due to the cytotonic (stimulating) effect of exotoxins secreted by the pathogen.
Symptoms of enterotoxigenic escherichiosis
The incubation period of enterotoxigenic escherichiosis is from several hours to 1-2 days. Symptoms of enterotoxigenic escherichiosis vary from mild forms with moderate diarrhea to severe cholera-like disease. The disease begins with repeated vomiting, abdominal discomfort and "watery" diarrhea. Diarrhea syndrome appears simultaneously with vomiting or several hours later. Intoxication, convulsions, tenesmus are absent. Body temperature is most often subfebrile or normal, which makes the disease similar to cholera. When palpating the abdomen, rumbling along the small intestine (throughout the abdomen) can be noted. The sigmoid colon is not spasmodic, the anus is closed, there are no signs of sphincteritis. Feces are devoid of a specific fecal odor. In severe cases, the frequency of stool reaches 15-20 times a day or more. There are no pathological impurities (blood, mucus, pus) in the feces. Frequent vomiting and abundant watery stools quickly lead to dehydration and aggravation of the patient's condition. The total duration of the disease usually does not exceed 5-10 days and in most cases recovery occurs even without treatment. However, in children of the first 2 years of life with exsicosis of II-III degree, a fatal outcome is possible.
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Diagnosis of enterotoxigenic escherichiosis
The diagnosis is established only on the basis of the results of laboratory research methods: isolation of ETE, provided that they grow to 10 6 microbial bodies and above in 1 g of feces and have the ability to produce exoenterotoxin. Conventional serotyping of Escherichia coli, carried out in ordinary bacteriological laboratories, can be successfully used for the diagnosis of enterotoxigenic Escherichia coli disease.
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Treatment of enterotoxigenic escherichiosis
Treatment of enterotoxigenic escherichiosis is carried out in accordance with the severity of the patient's condition, it includes diet therapy, oral, and in severe forms - parenteral rehydration. The appointment of antibacterial drugs is considered inappropriate, but in severe forms they are given in a short course (3-5 days). Of the antibiotics, neomycin, colistin, polymyxin, nevigramon are more effective for this escherichiosis. As with other acute intestinal infections, syndromic, pathogenetic and symptomatic therapy is carried out, including enterosorbents (smecta, enterodesis, filtrum-STI, etc.) and symptomatic antidiarrheal drugs (enterol, loperamide, tannacomp, etc.), probiotics (atsipol, bifistim, bifidumbacterin, etc.).
How to prevent enterotoxigenic escherichiosis in children?
The possibility of using anatoxin prepared from the exotoxins of enterotoxigenic Escherichia coli for prophylactic purposes is being discussed.
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