Acute enteric infections: etiology, clinical features, principles of treatment

Lecture for the V year foreign students Assistant professor T. Sirotchenko Chair of pediatrics and children¶s infection disease

‡ Acute enteric infections are infections poly-etiological diseases (virus, bacterial, fungal, parasitical) with fecal ± oral mechanism of the transmissions and with morbid affection on the different parts of the intestines.

‡ According the international classification all diarrheal diseases may be dividing on two groups: infection and non-infection. The infection diarrhea may be dividing on invasive group (inflammatory, bleeding) and secretory (noninflammatory, watery).

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Rotavirus, Adenovirus, Coronavirus, Reovirus, Vibrio Cholerae, Escherichia coli (some types), pathogenic fungi, protozoa cause the secretory diarrheas. Shigella, Salmonella, Escherichia coli (some types), Yersenia enterocolitica, Campylobacter, Clostridium, Staphylococcus, lamblias, entmoebas cause the invasive diarrheas.

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Pathogenesis of diarrhea of AEI have such mechanisms as: osmotic, secretory, inflammatory

Osmotic mechanism of diarrhea (under virus AEI).
Virus
damages epithelium of the intestines

increases the level of the disaccharidases (lactase, maltase, sucrase).

Disaccharides accumulate in the cavity of intestines, decrease the osmotic pressure, hinder absorption of the water

Secretory mechanism (AEI with the enterotoxin Enterotoxin activates ferment (adenylatcyclase) increases the synthesis of the cyclic nucleotides stimulates the penetration of the cell¶s membranes and increases he secretion of the water and electrolytes .

protein. intestinal motility is intensified. the microcirculation is broken. mucus) are in the cavity of intestines. dimension enteric contents are increased. quantity of the fluid is increased too. serotonin and cytokines) cell¶s membranes are damaged. . histamine. of the inflammation¶s Invasion the pathogen in the wall of the intestine mediator (prostaglandins. exudates (with the blood.Inflammatory mechanism synthesis (invasive diarrheas).

O124. Enteropathogenic (O111.forming bacteria. . O9). O6. O25. non spore .Echerichiosis Echerichia coli. O143). Enterohaemorrhagic (O159. O55. O2. O151. O126. O44.negative colibaccilius. O121. O127) Enteroinvasive (O28. gram . O145) Enterotoxigenic (O1.

Echerichiosis ‡ The sources of infection are ill person and bacteriocarries. watery. .6 days. ‡ Mechanism of the transmissions is fecal ± oral. contact and domestic. ‡ Incubation period . ‡ The ways of the transmissions are alimentary.3 .

regurgitation ‡ faeces ± watering. canary with the glassy mucous admixtures ‡ pain in stomach.Clinical algorithm: Echerichiosis ‡ intoxication ‡ vomiting. haemorrhagic colitis .

Echerichiosis ( clinic course) ‡ Beginning of disease is increase of temperature (37. vomiting. disorders of the function of the intestines (remiss faeces.decreasing of the temperature and intoxication. vomiting 1-2 times during day. canary faeces with the glassy mucous or blood¶s admixtures. prolonged and persistent bloating of stomach and palpatory tenderness. recovery . increasing of the appetite) during first 5 days. normal faeces. decreasing of body¶s mass. dehydration.5-380C). ‡ Next faze ( 2-5 days) watering. intoxication. regurgitation. ‡ Next faze.

epithelial cells ‡ haemoagglutination reaction (HGA) ± on the 2-3.days and on the 10-12 days of disease ‡ express ± test ( method of the luminescence) ± detection of the Escherichia . leucocytes.Laboratory tests: ‡ epidemiological anamnesis ‡ blood ad urinal tests ‡ coprocytogramm ( microscopy of faeces) ± presence of the mucus.

Flexnery) D (Sh. Sonnei) C (Sh. Boydi) .Shigellosis Pathogen ± Shigellae. gram .negative colibaccilius. aerobe A (Sh. Dysenteriae) B (Sh.

. ‡ The ways of the transmissions are alimentary (Sh.Sonnei). Flexnery).Shigellosis ‡ The sources of infection are ill person and bacteriocarries. contact and domestic. ³alimentary line´ take place ± from beginning to end ‡ Incubation period ± 0 (some hours) .6 days. ‡ Mechanism of the transmissions is fecal ± oral. watery (Sh.

blood and purulent admixtures.Shigellosis: Children of the preschool and school age ‡ acute beginning of disease ( increasing the temperature ± 38-40C. with mucous. head ache. frequent. nonplentiful. decreasing of the appetite. ³dysenteric or rectal spit´ relaxation of the external sphincter muscle of anus or incompletely closed anus ‡ ‡ ‡ ‡ . toxic encephalopathy) periodical pain in the stomach spasm and pain in the sigmoid colon faeces ± green. regurgitation. vomiting. remiss.

disorders of the consciousness. convulsions. disorders of microcirculation ‡ enterocolitis ‡ prolonged clinical course . affections of the nervous and cardiovascular system ‡ toxic encephalopathy .Shigellosis: Children of the early age ‡ acute beginning of disease. severe toxicosis.

Rectoromanoscopic picture of shigellosis. .

forms Clinical course Acute ( under 1 month) Prolonged ( under 3 month) Bacteriocarrier .Clinic classification of the dysentery Type Typical form Atypical forms: low-grade dyspeptic subclinic hypertoxic Severity slight moderate severe: with the toxic symptoms with the local process mixed .

epithelial cells ‡ bacteriologic tests ± until beginning the treatment ± inoculation of the some mediums (agar and so on) ‡ haemoagglutination reaction (HGA) ± on the 2-3.days and on the 8-10 days of disease (uninformative) ‡ express ± test ( method of the luminescence) ± detection of the Shigella ‡ .Laboratory tests: ‡ epidemiological anamnesis ‡ blood ad urinal tests ‡ coprocytogramm ( microscopy of faeces) ± presence of the mucus. leucocytes.

gram . typhimurium) D C (Salm. infantis B London (Salm. anatum) F ( Salm.Salmonellosis Pathogen ± Salmonellae .negative facultative colibaccilius. enteritidis) . A (Salm. virchov) E (Salm. (Salm.

eggs and egg¶s dishes. beef. animals. ‡ The ways of the transmissions are alimentary. contact and domestic. ‡ Mechanism of the transmissions is fecal ± oral. . Factors of transmissions are pork. watery. meat of poultry.Salmonellosis ‡ The sources of infection are ill person and bacteriocarries.

septic) Atypical forms: low-grade subclinic Severity Clinic course slight moderate severe Acute ( under 1 month) Prolonged ( under 3 month) Chronic ( more than 3 month) With the . generalized ( such a typhus.Salmonellosis TypClinic classification of the typhoid fevere Typical forms: a. localized (gastritis entheritis gastroenteritis and so on) b.

Salmonellosis: Children of the preschool and school age ‡ prolonged fever. blood and stinking odor ‡ heratosplenomegaly . vomiting ‡ coated tongue abdominal swelling morbidity and borborygmus in the right iliac part ‡ faeces have green mucus.

Faeces of patient with salmonellosis. .

mixed ± infections. heratosplenomegaly ‡ .gradual clinical course ‡ .severe toxicosis and exycosis ‡ . complications ‡ .heamocolitis.septic form of disease ‡ .incidence of the forming of the bacteriocarrier .Salmonellosis: Children of the early age: ‡ .

inoculation of the some mediums (bile salt agar and so on) . leucocytes. epithelial cells ‡ bacteriologic tests of faeces. blood and vomit masses.Laboratory tests: ‡ epidemiological anamnesis ‡ blood ad urinal tests ‡ coprocytogramm ( microscopy of faeces) ± presence of the mucus. foodstuff± in first days.

Typhoid fever ‡ Pathogen is Salmonella typhi. contact and domestic. Factors of transmissions are use of the water or swimming in the indoor reservoir . gram negative facultative colibaccilius from D group. ‡ The ways of the transmissions are alimentary. ‡ The sources of infection are ill person and bacteriocarries. ‡ Mechanism of the transmissions is fecal ± oral. watery.

heamorrhagic. early. with purulent the nervus syndrome With the acute condition with the etnteric syndrome With the relapse with cardiovascular syndrom . allergic. late.Typhoid fever Type Typical forms Atypical forms: septic with the separated affections rudimentary Severity slight moderate severe: Clinic course Without the complications With the complications: toxic.

status typhosus ‡ pale skin. dizziness. dry and bubbling rales in the lungs ‡ constipation . nonplentiful pink maculopapular rush. which disappears after thumb pressure ‡ coated dry reinforced tongue with the imprint of the teeth ‡ hepatosplenomegaly ‡ bradicardia.Typhoid fever: Children of the preschool and school age ‡ acute beginning with the high temperature ‡ head ache with the disturbances of the sleep.

maculopapular rush is very pale or is absent ‡ . enteroparesis ‡ . diarrhea ± 10-15 time during day.vomiting.severe toxicosis and exycosis. stomatitis . mental confusion ‡ .bad appetite. green mucus ‡ . nervoness ‡ .Typhoid fever: Children of the early age: ‡ . bacterial complications ± otitis. dyssomnia.hepatosplenomegaly.taxicardia. spasms.acute clinical course with high fever ‡ . pneumonia.

. Roseoles ("rose spots") in patient with typhoid fever .

Laboratory tests: ‡ epidemiological anamnesis ( village stay. use the milk or milk¶s product) ‡ blood ad urinal tests ‡ bacteriologic tests of blood ( three times during first days on the height of the fever). Vidal µs reaction ± after 2 weeks of disease. and urine (during third week of the disease) ‡ serological tests ± reaction of the indirect haemagglutination (RIG) with the erythrocytic antigen± after 6-7-days of disease.antigen ± after 3 weeks of disease ± for the diagnostic of bacteriocarries. RIG with the Vi. swimming in the reservoir. faeces ( during second week of the disease). .

contact and domestic. water. ‡ Factors of transmissions are foods (milk. anaerobe colibaccilius from A. household goods .B and C ‡ Pathogen is Salmonella paratyphii.Paratyphoid A. berries and vegetables). gram ± negative. ‡ The sources of infection are ill person and bacteriocarries. ice-cream. ‡ The ways of the transmissions are alimentary (paratyphoid B). salads. watery (paratyphoid A).B and C group. ‡ Mechanism of the transmissions is fecal ± oral.

morbidity along the full length and borborygmus ‡ .Main clinical sings of the paratyphoid A ‡ children of the preschool and school age ‡ incubation period ± 5-20 days ‡ .enteric bleeding.catarrhal inflammation on the fauces. herpes. conjunctivitis ‡ . necrosis of intestine.abdominal swelling. pain in the stomach ‡ . enteric perforation . fever.diarrhea .acute beginning. head ache.

vomiting. fever.Main clinical sings of the paratyphoid B ‡ children of the early age ‡ incubation period ± 1-14 days ‡ specific intoxication with the gastroenterocolitis or enterocolitis ‡ acute beginning. maculopapular rush after 3-5days of disease ‡ hepatosplenomegaly . diarrhea ‡ pale skin. head ache.

.Laboratory tests: ‡ epidemiological anamnesis use the milk or milk¶s product or some another products) ‡ blood ad urinal tests ‡ bacteriologic tests of blood ( three times during first days on the height of the fever).antigen ± after 3 weeks of disease ± for the diagnostic of bacteriocarries. and urine (during third week of the disease) ‡ serological tests ± reaction of the indirect haemagglutination (RIG) with the erythrocytic antigen± after 6-7-days of disease. faeces ( during second week of the disease). Vidal µs reaction ± after 2 weeks of disease. RIG with the Vi.

crabs. ‡ Mechanism of the transmissions is fecal ± oral. shrimp. watery. Factors of transmissions are fruits. fish. clams . aerobe vibrions. infection water. ‡ The sources of infection are ill person and bacteriocarries. berries and vegetables. gram ± negative. contact and domestic. ‡ The ways of the transmissions are alimentary.Cholera ‡ Pathogens are Vibrio choleare and Vibrio El -Tor .

grow subclinic fulminant dry Severity slight moderate severe Clinic course Acute Without complications With the complications: pneumonia. shock .Clinic classification of cholera Type Typical forms Atypical forms: low.

laundress¶s hands ‡ aphonia. anuria . vomiting.Cholera : Children of the preschool and school age ‡ acute beginning with the severe diarrhea. tachypnea. without pain in the stomach and spasms ‡ vomit masses are rice ± water or lactoserum ‡ subnormal temperature ‡ acrocyanosis. tachycardia. husky voice.

hypoglycemia .Cholera :Children of the early age ‡ ‡ ‡ ‡ ‡ severe clinic course with the complications beginning of disease with the high temperature and intoxication quickly developing of the hypotonic exicosis affects of the CNS hypocaliemia.

urea. faeces under beginning the treatment ‡ express ± diagnostic ( method of the luminescent antibodies) .after 3-5 hours ‡ ± method of the immobilization and micro agglutination with the specific anticholera 01 ± serum) . creatinine. crabs. clams or some another products) ‡ blood ad urinal tests ‡ biochemical tests: level of the Na and K. general protein ‡ microscopy of the native smears of the feces ( may be find of the morphological virions) ‡ bacteriologic tests of blood.Laboratory tests: Cholera ‡ epidemiological anamnesis (use the fish. shrimp.answer after some minutes .

. caw. ‡ The sources of infection are ill person and mouse. pig. cat. aerobe. sheep ‡ Mechanism of the transmissions is fecal ± oral.Yersinia¶s infections ‡ Pathogens are Yersenia enterocolitica and Yersenia pseudotuberculosis. watery. contact and aerogenic. ‡ The ways of the transmissions are alimentary. gram ± negative. rat. dog.

around the joints. pain in the joints. pain and borborygmus in the iliac parts. hepatomegaly. chill ‡ exanthema ( punctulated. in the axillary region and on the chest. may be with hemorrhagic character ‡ icteritiousness of the skin. sickness ‡ general intoxication ± head ache. hepatitis ‡ hyperemia of the plants and palms ‡ fever ‡ diarrhea ± with the green mucus.Yersenia enterocolitica: main clinical sings ‡ acute beginning with the pain in the stomach. 10-15 time in day ‡ lymphadenopatia .

lymphadenopatia . axillary and inguinal regions. cough. fever. pain in the stomach. vomiting ‡ diarrhea ± 2-3. sickness.time in day ‡ hepatitis. scratch in the throat ‡ exanthema ± little maculas on the skin of the throat.Yersenia pseudotuberculosis: main clinical sings ‡ Incubation period ± 3-18 days ‡ acute beginning with the general symptoms of intoxication ( head ache. hyperemia and edema of the face ( symptoms of the ³ hood´ and ³ glasses´ hyperemia and edema of the plants and palms ( symptoms of the ³ gloves´ and ³ socks´) ‡ pain and borborygmus in the iliac parts. pain in swallowing. pain in the muscles and joints. scleritis. arthritis. white dermographism ‡ hyperemia of the conjunctivas. catarrh of the respiratory tracts. splenomegaly.

Pseudotuberculosis .

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Pseudotuberculosis .

milk¶s and meat¶s products without the thermal treatment) ‡ blood (leucocytosis. urine. pus and faeces ( three times during first days on the height of the fever) ‡ serological tests ± RHA during dynamic of disease . mucus. lymphopenia. eosinophilia) ad urinal tests ‡ bacteriologic tests of blood. neuthrophylosis.Laboratory tests: ‡ epidemiological anamnesis (use the dirty fruits and vegetables.

‡ Entry of infection is peptic (digestive) tract. especially ± babies . ‡ Epidemiology¶s features ± winter .Rotavirus infection ‡ Rotavirus infection is acute infection disease it is caused by viruses from family of REOVIRUS. high contagiously. water. it is characterized by disorders from digestive tract and respiratory tracts.oral ‡ Ways of transmission is contact-domestic ± by food. ‡ Mechanism of transmission is fecal . early age of the children.spring seasonality. ‡ The sources of infection are ill person or virus carrier.

Clinic classification TYPE Typical: Gastroenteritis Gastritis Enteritis Atypical: Low ± grow Sub clinical Severity Slight Middle weight Severe Clinic course Acute Prolonged Without complications With complications .

‡ Urges to defecate arrear suddenly.BASIC CLINICAL SINGS OF TYPICAL FORM: ‡ Acute beginning with the febrile temperature and vomiting during 1-2 days. is accompanied by grumbling in the intestine. Faeces are liquid. ‡ Respiratory syndrome is beginning from the 2days of illness without tendency to growth. . from 5 20 times per days. with heavy smell. without pathological admixtures or with the mucus. ‡ Signs of exicosis. meteorism. watery and foamy with light color.

. In this case pathological admixtures appear in the faeces (mucus. ‡ Duration of illness may be to10-14 days. blood. ‡ Rotaviral infection can be connected with the bacterial affects of intestine.FEATURES OF CLINIC COURSE (children of the early age): ‡ Beginning from the severe symptoms of intoxication (languor. cyanosis. and pus). adinamia. and cardiovascular disorders. mottled skin ). cramps. ‡ On 2-3 days of illness child has maximum of the exicosis of 2-3 degrees.

result during 2. accumulated with the rotaviral antibodies.SPECIFIC METHODS OF LABORATORY DIAGNOSTIC Rotatest ± RHA with erythrocytes.4 hours. Express method. ‡ Serological method ± diagnostically titers is more then 1: 16 ‡ IFA( IgM) .