In the distant 1885 Austrian pediatrician Theodore Escherich, exploring the intestinal microflora, discovered a new kind of bacteria - E. coli. A little later, in 1894, the Russian microbiologist Georgy Gabrichevsky convincingly substantiated the participation of this microorganism in the development of diarrhea.
It can be said that from this moment the history of a whole group of intestinal infections called esherichiosis begins.
The causative agents of Escherichiosis and the group of Escherichia
The term escherichiosis, like many other infections, comes from the name of the pathogen. In this case it is bacteria of the genus Escherichia, the main representative of which is E. coli.
There is a huge amount of serovars of this microorganism, and, depending on the toxigenic properties, there are two biological variants: conditionally pathogenic and diarrheic( "unconditionally" pathogenic).
Morphologically, the causative agents of the Escherichiosis are small, rounded rods that grow well at a pH of 7.2 to 7.4 and a temperature of 37 ° C and are highly resistant to environmental factors, as well as sensitivity to disinfectants and rapid loss atboiling.
Depending on which pathogenicity factor prevails, 5 groups of diarrhea-born Escherichia are distinguished: enteropathogenic, enterotoxigenic, etero-invasive, enterohemorrhagic and enteroaggregative.
Pathogenesis( mechanism of origin) of the escherichiosis
Intestinal rods enter the digestive tract through the oral cavity, reach the small intestine and either are adsorbed on the cells of its epithelium or enter into them with the enteroinvasive variant. And further pathogenesis( the mechanism of nucleation) of escherichiosis, in fact, is associated with the release of toxins.
The main manifestations of the disease in the form of symptoms of general intoxication cause endotoxin. The action of exotoxin causes more severe symptoms.
With enteroinvasive escherichiosis, the absorption of toxins into the blood increases due to damage to the intestinal epithelium.
Enterotoxigenic Escherichia colonizes mainly the distal part of the small intestine and secrete a high molecular weight thermolabile toxin, the action of which does not differ from the cholera toxin.
Enterohemorrhagic intestinal rods produce shiga-like toxins under the influence of which processes of local necrosis and hemorrhage occur. Also, these toxins, penetrating the blood, increase the toxicity of the LPS complex, which can cause hemolytic-uremic syndrome and multi-organ failure.
Symptoms accompanying esherichiasis
Symptoms accompanying escherichiosis depend on the group belonging of the pathogen.
The main in the clinic of enteropathogenic escherichiosis is diarrhea, vomiting, severe intoxication and rapid development of exsicosis.
Enteroinvazivnye bacteria cause manifestations similar to dysentery. Incubation period 1-3 days, acute onset with moderate intoxication( increase in body temperature, sensation of weakness, headache), then pains appear in the abdomen( their character is cramped), liquid stools, possibly even with pathological impurities in the form of mucus or veinsblood.
Clinic of diseases caused by enterotoxigenic strains, similar to manifestations of food toxic infections, salmonellosis and cholera of light form. The incubation period is 1-2 days, intoxication is moderate, cramping pains in the epigastrium and near the navel. In the future, nausea builds up, there is repeated vomiting, an abundant liquid stool joins.
If enterohemorrhagic escherichiosis develops, the symptoms are expressed by moderate intoxication manifestations, on the 3-4th day intense cramping pains in the abdominal region develop, the stool becomes watery with blood impurities or becomes blood-purulent.
The emergence of Escherichia in children
The occurrence of Escherichia in children is most often due to the defeat of enteropathogenic and enterohemorrhagic E. coli.
The clinical picture is similar to that of adults. However, in children under 5 years of age with enterohemorrhagic form with severe course after normalization of the stool for 7-10 days of the disease, hemolytic-uremic syndrome may be associated with thrombocytopenia, hemolytic anemia and acute renal failure. Cerebral disorders can also occur: such as muscle rigidity and limb cramps, hemiparesis, sopor and coma.
Features of treatment of Escherichia in children
Treatment of escherichiosis should be carried out, considering the period of the disease, the severity of the infection process and the age of the patient. Therapy in this case is determined by the types of pathogens. Hospitalized sick people, as a rule, according to clinical and epidemiological indications.
The best diet in this case - table number 4, and with the normalization of the chair - table number 13.You can not do without detoxification therapy and rehydration of the body.
Antibacterial agents must be used for effective control of escherichiasis. With a prolonged course of infection, eubiotics and enzymes are used.
Treatment of Escherichia in children has some features: children from newborns to one year are hospitalized without fail;Children under 2 years of age( with severe or moderate forms of the disease) and children attending institutions of closed type are also sent to the hospital.
The optimal regime for the acute period of the disease will be bed rest. In the diet, preference is given to breastfeeding, the use of lactic acid and lactose-free mixtures.
Antibiotic therapy is applied only to infants if they suffer from generalized forms of the disease or have bacterial complications.
As in adults, the treatment of Escherichiosis in children must include the fight against dehydration and hemodynamic disorders in the form of ongoing rehydration and detoxification activities.