KOLI-INFEKTSIYA

From Big Medical Encyclopedia

KOLI-INFEKTSIYA ([Escherichia] of coli + infection; synonym: prick - a bacteriosis, esherikhioz) — the group of infectious diseases called by opportunistic and pathogenic serotypes of colibacillus, which is characterized by localization of pathological process preferential in intestines is more rare in urinary, biliary tract, lungs; generalization of an infection and development of sepsis is possible. Meets more often at children of early age.

Escherichia coli opened in 1885 by T. Esherikh is a resident of a large intestine of the person and many animals, one of representatives of a normal indestinal flora (see. Intestines, microflora ).

Intestinal if - an infection

Intestinal if - an infection (a synonym: colienteritis if - dyspepsia). Children of the first year of life are surprised preferential (especially the first 3 — 5 months). Children of advanced age and adults are ill seldom.

An etiology

the Activator — pathogenic forms colibacillus (see) from which serotypes 0111 B4, 055 B5, 025 B6, 026, 0145, 0125, 0124 and some other are most widespread in the USSR. The important role in developing of a disease and its especially heavy current is played by a number of the factors weakening an organism of the child: prematurity, artificial feeding, existence of various accompanying diseases.

Epidemiology

the Source of a contagium are the children sick with a colienteritis allocating the activator in enormous quantities. Big danger is constituted by the patients having a disease in the easy and erased forms. Much less often infection can come from convalescents and healthy carriers. According to L. B. Hazenson et al. (1969), among children of the first year of life the carriage of pathogenic escherichias comes to light at 3,2 — 5,6% inspected. The carriage occurs among adults seldom and has rather small epidemiol, value. However mother bearer of pathogenic serotypes of colibacillus can infect the newborn child at the time of delivery and soon after them.

The mechanism of infection — the fecal and oral way inherent to intestinal infections. Contagiums are transmitted through hands of mother and the looking after personnel, and also through various objects of leaving. The objects surrounding patients usually are exposed to massive planting by the activator which, having the expressed stability, can keep the viability rather long time (months). Also infection with a food way and occasionally through water is observed. The disease can arise also at increase in pathogenicity of colibacillus in an organism of the child as a result of decrease in resilience of a children's organism.

In children's departments of maternity homes, in nurseries-tsakh, at disturbance a dignity. - epidemiol, the mode, untimely isolation of patients there can be epid, flashes intestinal To. - and.

A pathogeny

concerning a pathogeny intestinal To. - and. there are different points of view. One authors connect process with the beginning of settling of morphologically not changed mucous membrane of a small bowel enteropathogenic bacteria which, allocating if - toxin, cause development of dystrophic changes. Others hold the opinion on the allergic nature of changes (like Shvarttsman's phenomenon); the opinion they support a wedge, observations (blood in a chair, an oliguria, spasms and a coma) and pathoanatomical changes (circulatory disturbance). Observations show a possibility of direct toxic action E. coli on a mucous membrane of a small bowel, however and allergic reaction as Shvarttsman's phenomenon undoubtedly has huge value.

Pathological anatomy

For the correct assessment of changes of intestines opening needs to be carried out not later than 4 — 6 hours after death since intestines first of all are exposed to processes of a cadaveric autolysis. In sharply proceeding cases of a loop of guts are blown unevenly up; the peritoneum is brilliant, on a serous cover of intestines easily separated threads of fibrin, and also spotty or dot hemorrhages, especially on the course of an attachment of a mesentery of a small bowel are found.

In a mucous membrane thin (less) in mucous membranes of a stomach and a large intestine, and also in a liver, kidneys, a myocardium the phenomena of a circulatory disturbance in the form of a plethora, hypostasis and hemorrhages are observed. The hyperpermeability of vascular and epithelial barriers arising under influence if - bacterial toxins, defines morfol. the changes found in different terms of a disease. Histologically preferential in an ileal gut mucous regeneration and massive desquamation of an epithelium of fibers (reliable is found only at early opening), but prevailing in a picture of changes there are hemorrhages and hypostasis. Hypostasis is expressed most brightly on the course of an attachment of a mesentery. Dystrophic changes of nervous cells in nodes intermuscular (auerbakhovsky) and submucosal (meyssnerovsky) textures — from disappearance of basphilic substance (Nissl's granularity) before death of nervous cells and formation of so-called cells shadows are noted; the quantity of nervous cells decreases, observed proliferation of glial satellites.

Uneven inflation of loops of guts and change of the fibers of a gut losing ability to reduction and absorption is explained by these changes.

Fig. 1. Microdrug of a wall of a small bowel at a colienteritis: the expressed leukocytic infiltration in a submucosa of a gut (it is specified by shooters).

At To. - and. in some cases, except neurovascular and dystrophic changes, also proliferation of stromal cells of a mucous membrane and focal inflammatory infiltration of a submucosa of a gut by limfogistiotsitarny elements with bigger or smaller impurity of polinuklear (fig. 1) is observed. For detection of the inflammatory centers it is necessary to investigate a gut on a big extent since process develops in places of the greatest accumulation of bacteria and toxins.

Fig. 2. Macrodrug of a small bowel at an ulcer colienteritis: a preferential arrangement of ulcers on the course of an attachment of a mesentery (are specified by shooters).
Fig. 3. Microdrug of a wall of a small bowel at an ulcer colienteritis: 1 — a bottom of an ulcer; 2 — hypostasis of a submucosa; 3 — poorly expressed leukocytic infiltration.

The ulcer colienteritis develops against the background of hypostasis of a gut, ulcers are located on a mucous membrane, is preferential on the course of an attachment of a mesentery (fig. 2) that is explained by more expressed hypostasis of a wall in this area and, therefore, the worst conditions of food. Ulcers of rounded or irregular shape with slightly raised edges and a pale or plethoric bottom, take only a mucous membrane, in day of ulcerations find usually weak inflammatory infiltration against the background of hypostasis and a plethora (fig. 3). At long existence of ulcer process in day and edges of ulcerations the sclerosis develops. At colienterites, especially ulcer, the pneumatosis of a mucous membrane, submucosal and muscular layers of a gut, and sometimes and limf, nodes is quite often observed that, apparently, it is connected with gas-forming properties E. coli.

Fig. 4. Microdrug of a mucous membrane of a small bowel at an atrophic colienteritis: substitution of a mucous membrane granulyatsionny fabric (it is specified by shooters).
Fig. 5. Microdrug of a cardiac muscle at a colienteritis: shooters specified the centers of dystrophy of a myocardium.

The atrophic colienteritis is observed at long and recurrent disease. At the same time the small bowel is sharply thinned. Histologically all layers of a wall of a gut of an atrofichna, a mucous membrane in the field of the former ulcers it is replaced with granulyatsionny fabric (fig. 4), in a submucosa — scanty infiltrate from limfogistiotsitarny elements.

Fig. 6. Microdrug of a papillary muscle of heart at a colienteritis: shooters specified the centers of a necrosis.

At gistol, a research changes of a myocardium in the form of focal fuchsinophil dystrophy (fig. 5), micronecroses (fig. 6) are observed, and at long disease — the centers of a cardiosclerosis. These changes of a myocardium at children are explained by disturbance of a water salt metabolism and major deficit of potassium owing to ponos and vomiting.

The complicated forms intestinal To. - and. (staphylococcus, pyocyanic stick, Candidiasis, etc.) are characterized by existence of necroses, deepening of ulcer defects of a mucous membrane. To pathoanatomical exclude accession to To. - and. a fungal or staphylococcal coloenteritis it is possible by coloring of cuts across Gram or McManus.

The clinical picture

the Incubation interval proceeds more often than 4 — 5 days. The disease begins sharply, is more rare gradually: temperature increases, the general state is broken, the diarrhea and vomiting develop. A chair frequent (from 5 to 10 — 15 times a day), excrements liquid, sometimes watery and often have golden-yellow, orange or green coloring; small impurity of slime is occasionally observed. Vomiting is rare, but usually persistent, repeating during many days. The meteorism is often observed. In hard cases primary neurotoxicosis is noted; as a result of the accruing intoxication, frequent defecations and persistent vomiting there is a considerable loss of water and salts, develops eksikoz various type (see. Toxic syndrome ). Scarce dehydration prevails Saul. Often arises acidosis (see). In an onset of the illness the short-term hyperpotassemia can be observed, and then there is a bystry, progressing loss of potassium to urine and a stake (see. Hypopotassemia ). Temperature even at a medium-weight form remains raised within 4 — 5 days. The wavy current and periodic aggravations which can be partially caused by accession of an acute respiratory infection is characteristic. Sometimes the disease accepts a long current and proceeds up to 2 — 6 months. Also easy and erased forms are observed. Disease, its weight generally are defined by age of the child, his premorbidal state, existence of the weakening factors. The heaviest current is observed at infection with serotypes E. coli 0111.

The colibacillus 0124 and some other its serotypes close on a number of the antigenic and other properties to dysenteric bacteria, cause the disease clinically similar with dysentery (see). Flashes are possible epid, To. - and. both at children, and at adults in connection with the use of the food massivno infected with colibacillus (is more often serotipny 0124). The main a wedge, the same manifestations, as at other food toxicoinfections (see. Toxicoinfections food ). Depending on conditions of infection and properties of the activator weight the wedge, manifestations varies.

The diagnosis

Intestinal To. - and. it is necessary to differentiate with dyspepsia (see) and dysentery. Persistence of fever and vomiting, gradual increase of toxicosis, a meteorism, plentiful, quite often watery and a peculiar color a chair with scanty impurity of slime or absence it in excrements, and also epidemiol, data give the grounds to suspect a colienteritis or even to make this diagnosis to bacterial, inspections. Datas of laboratory have crucial importance: detection in excrements of a pathogenic serotype of escherichias (see. Colibacillus ).

Treatment

Treatment of a colienteritis is based on the same general principles, as at other acute intestinal infections at children of early age.

Are of great importance the correct appointment to lay down. food, attentive individual care for the child and creating favorable conditions of the environment. The complex of actions for fight against intoxication and a regidratation are provided: intravenous, drop injections of salt solutions and solutions of glucose, Haemodesum (Neocompensanum), Polyglucinum, plasma transfusion. At heavy toxicoses use of glucocorticoid hormones is recommended (Prednisolonum on 1 — 1,5 mg/kg a day within 5 — 8 days with a gradual dose decline and a concomitant use of salts of potassium). In perhaps early terms (excepting patients with very easy disease) apply antibiotics (polymyxin, Sigmamycinum, ampicillin, etc.)» drugs of a nitrofuran row (furasolidone, etc.). To children of early age, especially newborn, it is not necessary to appoint levomycetinum, streptomycin, drugs of a tetracycline row in connection with a possibility of their toxic action. Course of treatment antibiotics of 7 — 10 days. For the purpose of fight against dysbacteriosis appoint kolibakterin (see). In a stage of recovery apply vitamins, massage, gymnastics, in certain cases appoint transfusions of plasma, blood, gamma-globulin.

Forecast at modern methods of treatment favorable.

Prevention

Prevention generally same, as at other acute intestinal infections. The prevention of diseases of a colienteritis in child care facilities requires strict observance a dignity. - a gigabyte. mode. All children, and also the women in labor and women in childbirth having dysfunction of intestines are isolated and exposed bacterial, to inspection, including and on pathogenic serotypes of colibacillus. In case of suspicion on intestinal To. - and. the patient is hospitalized in diagnostic department, and at establishment of the diagnosis placed in special department or chamber. Children with not severe forms of a disease and under favorable living conditions at the discretion of the doctor can be treated at home. An extract from-tsy the children who transferred To. - and., the wedge, recovery and in the presence of negative takes of a triple research of excrements on pathogenic serotypes of escherichias is made after full. The children of early age communicating with the patient if - enteritis in life, bacterial, inspections are allowed in child care facility after isolation of the diseased and receiving at them a negative take.

Kolya infection of other bodies and systems

In addition to the processes which are localized in went. - kish. a path, colibacillus can cause damages to other systems and bodies (cystitis, pyelonephritis, cholecystitis, a cholangitis, otitis, pneumonia, meningitis, peritonitis, a wound fever), and also sepsis. The general features of these abenteric processes is: a) usually (at children of early age as a rule) they have an endogenous origin — a tank of the activator are intestines; b) at children of the first months of life acute forms quite often develop in the presence of a colienteritis and therefore are considered as its complications; their primary emergence is in certain cases observed though this «primacy» can be seeming if damage of intestines is looked through or regarded as the secondary phenomenon; at adults if - the bacteriosis of various localization arises usually out of communication with damage of intestines; c) the association with other microorganisms is quite often observed (staphylococcus, a streptococcus, etc.), but often escherichias are allocated in pure or almost pure growth; d) a condition of development is weakening of an organism, considerable decrease in its protective mechanisms; abenteric localization To. - and. it is especially often observed at premature, newborn children and children of the first months of life; e) the applied chemotherapy expected to influence gram-positive coccal flora usually is inefficient.

These patol, processes are described as independent nozol, forms by the principle of a local systematics, without their etiology. Their kolibakterialny nature comes to light not always in this connection they are not always registered.

Kolya infection of urinary tract (cystitis, pyelitis, pyelonephritis). Colibacillus among these other activators patol, processes both at children, and at adults takes the main place (60 — 80%). Pyelonephritis results from autoinfection, by a drift of escherichias in an urethra (the ascending infection). It is more often observed at girls and women, especially in the presence of vulvit and a vulvovaginitis. At the same time the large role is played by disturbance of outflow of urine at a vesicoureteral reflux which in some cases can develop for the second time in connection with inflammatory process in a bladder. The hematogenous way of penetration of the activator to kidneys and uric ways from any extrarenal center of an infection is possible. Data on a possibility of a lymphogenous way of penetration of the activator are contradictory. Enteropathogenic serotypes of colibacillus are found in children of early age. They occur at adults seldom, other serotypes, hl prevail. obr. 04, 06, 075, 025. Consider that the asymptomatic bacteriuria also plays a significant role in developing of pyelonephritises. At pyelonephritis it is necessary to refrain from use of the antibiotics possessing nephrotoxic action (Monomycinum, Neomycinum, Kanamycinum); gentamycin, and also ampicillin is recommended. At an infection of uric ways use also drugs of a nitrofuran row, Negramum, 5-HOK (see. Pyelonephritis, at children ) .

Kolya-bacterial pneumonia, caused by pathogenic serotypes of escherichias, occur at children of early age quite often. Due to the broad use of chemotherapy etiol, the structure of pneumonia at children changed and colibacillus began to be emitted to a thicket (in 4,5 — 10% of cases). The drift of the activator in lungs can occur by aspiration of emetic masses or gematogenno. The possibility of an aerogenic (air and dust) way is not proved, though is not excluded. Etiotropic treatment with use of the means applied at treatment To is carried out. - and., and also pathogenetic treatment pneumonia (see).

Are described also prick - bacterial cholecystitises, cholangites, otitises, purulent meningitis, a wound fever. At purulent meningitis at newborns among other activators from 21 to 85% are the share of colibacillus, according to various authors; the lethality is very high.

Kolya-bacterial sepsis. The heaviest manifestation generalized To. - and. is sepsis (see). At newborns, the premature and weakened children it proceeds as a toksiko-septic state with a high leukocytosis or without it, temperature increases to 40 °, rash, uneven abdominal distention develops various character. The lethality is very high.

Kolya infection at adults it is shown most often by inflammatory changes in the bodies located near intestines — an urethra, a bladder, a vagina, a uterus (an urethritis, cystitis, a colpitis, an endometritis) or reported with intestines — a gall bladder, bilious ways (cholecystitis, a cholangitis).



Bibliography: Gulman L. A., etc. Toxicoses at intestinal infections at children of early age, Pediatrics, No. 5, page 53, 1974, bibliogr.; Kauffman F. Family of colibacilli, the lane with English, M., 1959, bibliogr.; Colienterites, under the editorship of O. V. Baroyan, M., 1962; The Multivolume guide to microbiology, clinic and "epidemiology of infectious diseases, under the editorship of H. N. Zhukova-Verezhnikov, t. 6, page 126, M., 1964; Premature children, under the editorship of N. Koyevoy-Slav-kova and E. Novikova, lane with bolg., page 75, Sofia, 1971, bibliogr.; The guide to gastrointestinal diseases at children, under the editorship of N. I. Nisevich, page 297, M., 1969; The Guide to infectious diseases at children, under the editorship of S. D. Nosov, page 323, M., 1972; Speransky N. P. The hidden natural immunization at children of early age against if - infek-tsii, Pediatrics, No. 2, page 17, 1973, bibliogr.; Strutsovskayaa. L. Philosophy of treatment of acute intestinal diseases at children, Vopr. okhr. mat. also it is put., t. 20, No. 9, page 9, 1975, bibliogr.; Hazensonl. B. and Loseva A. G. Kolienterit at children of early age, M., 1976, bibliogr.; Since of a n e L. R. a. L e-n of e r A. M. Gram negative pneumonia in hospitalized patients, Postgrad. Med., v. 58, p. 85, 1975; Escobar J. A. a. o. Etiology of respiratory tract infections in children in Cali, Colombia, Pediatrics, v. 57, p. 123, 1976; T u r with k M. and. lake of Studies on the epidemiology of Escherichia coli, 1960 — 1968, J. infect. Dis., v. 120, p. 13, 1969.


S. D. Nosov; V. M. Afanasyeva (stalemate. An.).

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