Symptoms of escherichiosis

Symptoms of escherichiosis depend on the type of pathogen, the age of the patient, and the immune status.

Clinical classification of Escherichia coli infections

• According to etiological signs:
  • enterotoxigenic;
  • enteroinvasive;
  • enteropathogenic;
  • enterohemorrhagic;
  • enteroadhesive.
• By form of disease:
  • gastroenteric;
  • enterocolitic;
  • gastroenterocolitic;
  • generalized (coli-sepsis, meningitis, pyelonephritis, cholecystitis).
• By severity of the course:
  • lung;
  • moderate severity;
  • heavy.

In case of escherichiosis caused by enterotoxigenic strains, the incubation period is 16-72 hours, it is characterized by a cholera-like course of the disease, occurring with damage to the small intestine without pronounced intoxication syndrome (“traveler's diarrhea”).

Escherichiosis begins acutely, patients are bothered by weakness, dizziness. Body temperature is normal or subfebrile. Typical symptoms of escherichiosis appear: nausea, repeated vomiting, diffuse cramping abdominal pain. Stool is frequent (up to 10-15 times a day), liquid, plentiful, watery, often resembling rice broth. The abdomen is bloated, rumbling and slight diffuse pain are detected upon palpation. The severity of the course is determined by the degree of dehydration. A fulminant form of the disease with rapid development of exsicosis is possible. The duration of the disease is 5-10 days.

Enteroinvasive Escherichia coli cause a dysentery-like disease that occurs with symptoms of general intoxication and predominantly affects the large intestine. The incubation period is 6-48 hours. The onset is acute, with an increase in body temperature to 38-39 ° C, chills, weakness, headache, muscle pain, and loss of appetite. In some patients, body temperature is normal or subfebrile. After a few hours, the following symptoms of Escherichia coli join in: cramping pain, mainly in the lower abdomen, false urge to defecate, tenesmus, loose stools, usually fecal in nature, up to 10 or more times a day with an admixture of mucus and blood. In more severe cases of the disease, the stool is in the form of "rectal spit". The sigmoid colon is spasmodic, compacted and painful. Rectosigmoidoscopy reveals catarrhal, less commonly catarrhal-hemorrhagic or catarrhal-erosive proctosigmoiditis. The course of the disease is benign.

Fever lasts 1-2, rarely 3-4 days, illness - 5-7 days. After 1-2 days, the stool returns to normal. Spasm and pain in the colon persist for 5-7 days. Recovery of the mucous membrane of the colon occurs by the 7-10th day of illness.

In children, enteropathogenic escherichiosis caused by E. coli class 1 occurs in the form of enteritis, enterocolitis of varying severity, and in newborns and premature babies - in a septic form. The intestinal form observed in children is characterized by an acute onset of the disease, a body temperature of 38-39 ° C, weakness, vomiting, watery diarrhea, yellow or orange stool. Toxicosis and exicosis develop quickly, body weight decreases. The septic form of the disease has pronounced symptoms of escherichiosis and intoxication (increased body temperature, anorexia, regurgitation, vomiting). Multiple purulent foci occur.

Enteropathogenic escherichiosis caused by E. coli class 2 is registered in adults and children. The incubation period is 1-5 days. The disease is characterized by an acute onset (body temperature 38-38.5 °C, chills, infrequent vomiting, abdominal pain, stool without pathological impurities, liquid, up to 5-8 times a day), the course is benign. Some patients experience hypotension and tachycardia.

In case of escherichiosis caused by enterohemorrhagic strains, the disease manifests itself as a syndrome of general intoxication and damage to the proximal colon. The incubation period is 1-7 days. Symptoms of escherichiosis begin acutely: with abdominal pain, nausea, vomiting. Body temperature is subfebrile or normal, stool is loose, up to 4-5 times a day, without blood. The condition of patients worsens on the 2nd-4th day of the disease, when the stool becomes more frequent, blood and tenesmus appear. Endoscopic examination reveals catarrhal-hemorrhagic or fibrinous-ulcerative colitis. More pronounced pathomorphological changes are found in the cecum. The disease caused by strain 0157:H7 is the most severe. In 3-5% of patients, hemolytic uremic syndrome (Gasser syndrome) develops 6-8 days after the onset of the disease, which is manifested by hemolytic anemia, thrombocytopenia, progressive acute renal failure and toxic encephalopathy (convulsions, paresis, stupor, coma). Mortality in these cases can be 3-7%. Gasser syndrome is more often recorded in children under 5 years of age.

The characteristics of colibacillosis caused by enteroadhesive strains have been poorly studied. The disease is registered in patients with a weakened immune system. Extraintestinal forms are most often detected - damage to the urinary (pyelonephritis, cystitis) and biliary (cholecystitis, cholangitis) tracts. Septic forms are possible (coli-sepsis, meningitis).

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Complications of Escherichia coli

Most often, escherichiosis is benign, but complications are possible: ISS, hypovolemic shock with dehydration of grade III-IV, acute renal failure, sepsis, pneumonia, pyelocystitis, pyelonephritis, cholecystitis, cholangitis, meningitis, meningoencephalitis. Fatal outcome as a result of acute renal failure (Gasser syndrome) is recorded in children under 5 years of age in 3-7% of cases. In Moscow, there have been no fatal outcomes over the past 10 years.

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