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Enterotoxigenic escherichiosis in children
Last reviewed: 23.04.2024
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Enteroksotitenny esherichiosis occurs in children and adults of any age. It was established that the isolated enterotoxigenic Escherichia belongs to 48 serogroups and 61 serovars, the most important of them in human pathology are 06: К15: Н16, 015: Н11, 027: Н7 (Н20), 078: Н12, 0112ав, 0114: Н21, 0148: Н28 , 0159H4.
In addition to colonization factors that ensure the adhesiveness of bacteria, ETEs in the process of life produce exoterotoxins. The enterotoxigenicity of Escherichia 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 all over the world, especially in countries of Asia, Africa and Latin America, is found both among locals and among visitors ("travelers' diarrhea"). It happens in the form of sporadic cases or epidemic outbreaks.
The main path of infection is food. It is also possible to transmit the infection through water and by contact. In food the accumulation of the pathogen and its enterotoxins takes place. Sometimes the disease can cause only exotoxin without the presence of an agent. Usually this happens when a lot of exoenterotoxin has accumulated in the product and it has not been subjected to thorough heat treatment.
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Pathogenesis of enterotoxigenic escherichiosis
Enterotoxigenic Escherichia do not have invasiveness (like the cholera vibrio ), but multiply on the surface of small intestine microvilli without developing an inflammatory process. During colonization, episode hypersecretion begins and progresses, water and electrolytes are absorbed from the intestinal lumen, which is caused by the cytotonic (stimulating) action of exotoxins excreted by the pathogen.
Symptoms of enterotoxigenic escherichiosis
The incubation period of enterotoxigenic escherichiosis - 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, unpleasant sensations in the abdomen and "watery" diarrhea. Diarrheal syndrome occurs simultaneously with vomiting or a few hours later. Intoxication, convulsions, tenesmus are absent. Body temperature is often subfebrile or normal, which brings the disease closer to cholera. With palpation of the abdomen, rumbling can be noted along the course of the small intestine (throughout the abdomen). The sigmoid colon is not spasmodic, the anus is closed, there are no phenomena of the sphincter. Exacerbations are devoid of a specific stench smell. In severe cases, the frequency of stool reaches 15-20 times a day or more. Pathological impurities (blood, mucus, pus) in the excrements are absent. Frequent vomiting and an abundant watery stool quickly lead to dehydration and weighting 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 II-III degree, a lethal outcome is possible.
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Diagnosis of enterotoxigenic escherichiosis
The diagnosis is established only on the basis of the results of laboratory methods of investigation: the release of ETE under the condition of their growth of 10 6 microbial bodies and higher in 1 g of feces and the ability to produce exoenterotoxin. Ordinary serotyping of Escherichia. Conducted in ordinary bacteriological laboratories. Can be successfully used for diagnosis and enterotoxigenic escherichiosis.
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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 dietotherapy, oral, and in severe forms - parenteral rehydration. The appointment of antibacterial drugs is considered inexpedient, but in severe forms give a short course (3-5 days). Of antibiotics in this escherichiosis are more effective neomycin, colistin, polymyxin, nevi. As with other acute intestinal infections ,. Postindromnoy, pathogenetic and symptomatic therapy, including enterosorbents (smecta, enterodez, filterram-STI, etc.) and symptomatic antidiarrheal drugs (enterol, loperamide, tannacomp, etc.), probiotics (acipolum, bifystim, bifidumbacterin, etc.) ).
How to prevent enterotoxigenic escherichiosis in children?
They discuss the possibility of using an anatoxin prepared with exotoxins of enterotoxigenic Escherichia with the preventive purpose.
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