Escherichiosis (from lat. Escherichia ) - the collective name of the group of intestinal infections caused by E. coli E. coli and, less commonly, by other Escherichia: E.fergusonii , E.paracoli (paracolonic stick), E.hermannii , E.vulneris . [1] . Enteropathogenic , enterotoxigenic , enteroinvasive , enterohemorrhagic , enteroadhesive infections and other infections are distinguished. [2] The most frequent causative agents of travelers' diarrhea [3] .
| Escherichiosis | |
|---|---|
| ICD-10 | A 04.0-04.4. |
Not all E. coli cause disease. There are no morphological differences between pathogenic and non-pathogenic Escherichia, they are distinguished by the presence of certain antigens on the surface. In accordance with the structure of antigens, there are five main groups of pathogenic Escherichia: [1] enteropathogenic - cause diarrhea in children, the pathogenesis is due to the ability of bacteria to adhere to the intestinal epithelium and damage microvilli; entero - invasive - cause inflammation of the mucous membrane of the colon, similar in their properties to Shigella; enterotoxigenic - cause cholera-like diarrhea; produce stable enterotoxin, similar in structure to cholera; enterohemorrhagic - cause hemorrhagic diarrhea; form a cytotoxin similar to dysenteric toxin; enteroadhesive - violates absorption, attaching to the mucous membrane and lining the lumen.
Content
Clinical picture
There are intestinal, parakishechnye, septic escherichiosis.
Intestinal escherichiosis.
The colibacillosis caused by enterotoxigenic strains is an acute intestinal diarrheal infection of the cholera-like course, occurring with lesions of the small intestine without a pronounced intoxication syndrome.
The disease is the main nosological form, the so-called traveler's diarrhea. The incubation period is 16-72 hours.
The disease begins acutely. Patients feel general weakness, dizziness. Body temperature is normal or subfebrile. At the same time there are spilled pains in the stomach cramping character. All patients have frequent, fluid, profuse stools, which quickly become slimeless, watery, and have no fetid odor. Some patients are worried about nausea and repeated vomiting at first eaten by food, then by a cloudy whitish liquid.
The abdomen is swollen, palpation is slightly painful, a strong rumbling is determined, the large intestine is not changed. The disease can have both mild and severe course. The severity of the condition is determined by the degree of dehydration. Sometimes the disease proceeds with lightning speed with the rapid development of exsicosis .
Escherichiosis caused by enteroinvasive intestinal sticks is an acute intestinal infection, occurring with symptoms of general intoxication and a primary lesion of the colon. The incubation period lasts 6-48 hours. General toxicity phenomena develop - chills, general weakness, weakness, headache, loss of appetite, pain in the muscles of the extremities, but in many patients the state of health during the course of the disease remains relatively good. The body temperature in most patients is normal or subfebrile, in 1/4 of patients - within 38-39 ° C, and only in 10% - above 39 ° C. After a few hours from the onset of the disease, symptoms of gastrointestinal damage appear. The initial short watery diarrhea is replaced by a kolitichesky syndrome. Abdominal pain is localized mainly in the lower abdomen, accompanied by false urge to defecate. The stool becomes frequent up to 10 times a day, rarely more, the stools have a pasty or liquid consistency, contain an admixture of mucus, and sometimes blood. With a more severe course of the disease, feces lose their fecal character, consist of one mucus and blood. An objective examination of the patient in the midst of the disease of the colon in the distal or throughout spasmodic, compacted and painful. Liver and spleen are not enlarged.
When sigmoidoscopy revealed catarrhal, rarely catarrhal-hemorrhagic or catarrhal-erosive proctosigmoiditis.
The disease is characterized by short-term and benign course. Fever persists for 1-2 days, at least 3-4 days. After 1-2 days the chair becomes decorated, without pathological impurities. Spasm and tenderness of the colon during palpation disappear in most cases by the 5-7th day of the disease. Full restoration of the mucous membrane of the colon occurs by the 7-10th day of the disease. [four]
Para-intestinal colibacillosis.
Non-pathogenic Escherichia, normally in large numbers inhabiting the intestines, can, however, cause the development of pathology when it enters other organs or cavities of the human body. If the bacterium enters through the hole in the digestive tract into the abdominal cavity, peritonitis may occur. Once in the woman’s vagina , and multiplying, the bacteria can cause or complicate the colpitis . In such cases, the treatment involves the use of antibiotics , carried out in such a way as not to suppress the normal intestinal microflora, otherwise dysbacteriosis may develop. In weakened individuals, it can cause pneumonia , pyelonephritis , meningitis , sepsis .
E. coli is very sensitive to antibiotics such as streptomycin or gentamicin . However, E. coli can quickly acquire drug resistance [5] .
Septic escherichiosis.
May be caused by both pathogenic and conditionally pathogenic Escherichia. In children, colibacillosis caused by enteropathogenic intestinal sticks, occur in the form of varying severity of enteritis, enterocolitis, and in newborns and premature babies - and in a septic form. The septic form of the disease in children occurs with severe symptoms of general intoxication, fever, anorexia, regurgitation, vomiting, and the occurrence of multiple purulent foci. In this case, intestinal syndrome may be poorly expressed.
Treatment
When cholera-like course of colibacillosis in children, the main therapeutic measure is the restoration of water-electrolyte balance. It is achieved by oral rehydration with glucose-electrolyte solutions, and in severe cases by intravenous administration of polyionic solutions. Patients are also prescribed intestinal antiseptics (nitrofuran preparations, oxyquinolines).
The principles and methods of treating patients with dysenteria-like colibacillosis are the same as bacterial dysentery . The same principles are used in travelers' diarrhea.
In the treatment of enteropathogenic escherichiosis, intestinal antiseptics are used, in severe cases, antibiotics (polymyxins, aminoglycosides , third generation cephalosporins, rifacol, fluoroquinolones , kanamycin ) are used. Pathogenetic therapy is similar to that used in the treatment of osmotic hypofermentative diarrhea. Intravenous infusion therapy of severe forms of the disease (especially with late admission to the hospital) is carried out taking into account the possible trophic (protein) deficiency and reduction of albumin in the blood plasma. [6]
Treatment of patients with enterohemorrhagic escherichiosis includes etiotropic agents and vigorous pathogenetic therapy. Etiotropic therapy in mild cases includes intestinal antiseptics, in severe cases, fluoroquinolones , third-generation cephalosporins, rifacol. In the pathogenetic treatment of severe forms of the disease, large doses of glucocorticosteroids ( prednisone 200 mg / day), plasmapheresis , hemodialysis are used .
Septic forms are treated according to the general principles of treatment of sepsis. Correction of DIC is carried out according to its stage.
Pathogenesis
Prevention
The system of preventive measures for colibacillosis is determined by its belonging to one category or another and is similar to the prevention of other acute intestinal infections with a corresponding epidemiological component. Specific prevention is not developed.
Experimental methods of treatment and prevention.
Therapy and prophylaxis with bacteriophage of colibacillosis was developed more than 80 years ago in the Soviet Union , where it was used to treat and prevent diarrhea caused by E. coli [7] . Currently, phage therapy is available only at the Phage Therapy Center in Georgia and in Poland [8] .
Bacteriophage T4 is a well-studied phage infecting E. coli .
Researchers are developing effective vaccines to prophylactically reduce the number of cases of infection by pathogenic E. coli strains worldwide [9] .
In April 2009, researchers at the University of Michigan announced that they had developed a vaccine for one of the E. coli strains. Patent application filed [10] .
See also
E. coli
Notes
- ↑ 1 2 Etiology and pathogenesis - Escherichiosis - E - Medical encyclopedia - Medkurs.ru - medical server
- ↑ ICD-10
- ↑ Travelers' diarrhea | Medical newspaper "Health of Ukraine", Medical publication, medical publishing houses in Ukraine
- ↑ http://www.infectology.ru/nosology/infectious/bacteriosis/escherichiosis.aspx Escherichiosis
- ↑ Gene Sequence Of Deadly E. Coli Reveals Surprisingly Dynamic Genome (not available link) . Science Daily (January 25, 2001). The appeal date was February 8, 2007. Archived February 21, 2007.
- ↑ http://medkarta.com/?cat=article&id=19158 Treatment
- ↑ Therapeutic use of bacteriophages in bacterial infections (inaccessible link) . Polish Academy of Sciences. The date of circulation is January 10, 2013. Archived on February 8, 2006.
- ↑ Medical conditions treated with phage therapy (inaccessible link) . Phage Therapy Center. The date of circulation is January 10, 2013. Archived on October 23, 2012.
- ↑ Girard, M., Steele, D., Chaignat, C., Kieny, M., Vaccine: journal. - 2006. - Vol. 24 , no. 15 - P. 2732-2750 . - DOI : 10.1016 / j.vaccine.2005.10.014 . - PMID 16483695 .
- ↑ Researchers develop E. coli vaccine