Esherikhioza (if - infections) – the sharp, mainly intestinal infections caused by some serovara of a bacterium of Escherichia coli. Esherikhioza are shown in the form of enteritis and an enterokolit, can generalizovatsya and proceed with extra intestinal symptomatology. Way of transfer of colibacillus fecal and oral. More often infection occurs at the use of the infected dairy and meat products. Also the contact and household way of transfer of intestinal infection is possible. The diagnosis of an esherikhioz is established at identification of escherichias in emetic and kalovy masses, and at generalization of an infection - in blood. Treatment of esherikhioz consists of a diet, rehydration therapy, application of antimicrobic means and eubiotik.
Esherikhioza (if - infections) – the sharp, mainly intestinal infections caused by some serovara of a bacterium of Escherichia coli. Esherikhioza are shown in the form of enteritis and an enterokolit, can generalizovatsya and proceed with extra intestinal symptomatology.
Characteristic of the activator
Escherichia coli (colibacillus) represents short polymorphic gramotritsatelny rhabdoid bacteria which not pathogenic strains are present at structure of normal intestinal flora. Esherikhioz cause diareegenny serovara of the following groups: enteropatogenny (EPKP), enterotoksigenny (ETKP), enteroinvazivny (EIKP), enterogemorragichesky (EGKP), enteroadgezivny (EAKP). Escherichias are steady in the external environment, can keep viability in the soil, water and excrements up to several months. In foodstuff (in particular in milk) breed, forming numerous colonies, easily transfer drying. Colibacilli perish at boiling and effect of disinfectants.
The tank and source of an infection are sick people or healthy carriers. In distribution of the activator persons have the greatest epidemic value, sick esherikhiozam, the caused types of EPKP and EIKP, other groups of bacteria are less dangerous. Sick esherikhiozam, caused by infection with kontagiozna ETKP and EGKP only in the first days of a disease while EIKP and EPKP of group of colibacilli are allocated with patients 1-2 (sometimes 3) weeks. Allocation of the activator can continue long enough, in particular at children.
The colibacillus transfer mechanism – fecal and oral, most often is implemented a food way of infection for ETKP and EIKP and household for EPKP. Besides, infection can be carried out by the waterway. Food infection generally occurs at the use of dairy products, meat dishes, drinks (kvass, compotes) and boiled vegetables salads. In children's collectives and among the persons neglecting rules of hygiene colibacillus distribution through the polluted hands, objects, toys is possible in the contact and household way. Infection with EGPK group activators often results from the use insufficiently kulinarno of the processed meat, raw not pasteurized milk. Flashes of the esherikhioz caused by the use of hamburgers are noted.
Realization of the waterway of infection is a little widespread now, infection of reservoirs with colibacillus usually occurs when dumping sewage without preliminary neutralization. The natural susceptibility to esherikhioza high, after transferring of an infection is formed unstable group-specific immunity. EPKP group escherichias – mainly cause esherikhioza in children, in particular on the first year of life. The flashes caused by this group of colibacilli, as a rule, arise in day nursery, kindergartens, maternity hospitals and nurseries of office of hospitals. Infection usually occurs in the contact and household way.
The infections caused by EIKP group colibacilli cause the enterokolita proceeding as dysentery at children is more senior than year and adults, infection occurs in the water and food way, aestivo-autumnal seasonality is noted. Are mainly widespread in developing countries. ETKP cause infections of a holeropodobny current, children of two years and adults catch, incidence is high in the countries with hot climate and low hygienic culture. Infection occurs food and the waterway.
Epidemiological data concerning the infections resulting from defeat by the EGKP group activator are not enough for the detailed characteristic now. In epidemiology of esherikhioz major importance is played by hygienic actions as the general, and individual character.
Classification of esherikhioz
Esherikhioza are classified by the etiologichesky principle depending on group of the activator (enteropatogenny, enterotoksichesky, enteroinvazivny, and enterogemorragichesky). Besides there is a clinical classification allocating gastroenterichesky, enterokolitichesky, gastroenterokolitichesky and generalized forms of a disease. The generalized form can be presented if - sepsis or defeat by colibacillus of various bodies and systems (meningitis, an encephalomeningitis, pyelonephritis, etc.). Esherikhioz can proceed in an easy, medium-weight and severe form.
Symptoms of an esherikhioz
EPKP I of a class develops usually at children of younger age, the incubatory period makes several days, is shown mainly by the vomiting, a liquid chair expressed by intoxication and dehydration. There is a probability of development of a generalized septic form. Adults get sick with class EPKP II, the disease proceeds as salmonellosis.
The current like dysentery or a shigellez is characteristic of defeat of EIKP. The incubatory period lasts from one to three days, the beginning sharp, moderate intoxication (a headache, weakness), fever ranging from subfebrilny to high values, a fever is noted. Then there are belly-aches (mainly around a navel), diarrhea (sometimes with blood streaks, slime). The palpation of a stomach notes morbidity on the course of a thick gut. Quite often this look proceeds in the easy and erased form, the medium-weight current can be noted. Usually duration of a disease does not exceed several days.
Defeat of ETKP can be shown by the clinical symptoms similar to those at salmonellosis, a food toksikoinfektion or remind an easy form of cholera. The incubatory period makes 1-2 days, intoxication is poorly expressed, temperature usually does not raise, noted repeated vomiting, plentiful enteritny diarrhea, dehydration gradually accrues, the oliguriya is noted. Take place of pain in epigastralny area, having skhvatkoobrazny character.
This infection is often called "a disease of travelers" as from it the people who left in a business trip or on rest to the countries with tropical climate quite often suffer. Climatic conditions promote developing of the expressed fever with a fever and intoksikatsionny symptoms, to intensive dehydration.
EGKP develops most often at children. Intoxication at the same time moderate, body temperature subfebrilny. Nausea and vomiting, a liquid watery chair takes place. At a heavy current by 3-4 day, diseases develop severe pains in a stomach of skhvatkoobrazny character, diarrhea amplifies, in the excrements losing kalovy character can note impurity of blood and pus. Most often the disease in a week passes independently, but at a heavy current (in particular children of younger age) for 7-10 day, after disappearance of diarrhea, have a probability of development of a gemolitiko-uraemic syndrome (a combination of hemolytic anemia, thrombocytopenia and sharp renal failure). Violations of brain regulation are frequent: spasms of extremities, a rigidnost of muscles, violation of consciousness up to a sopor and a coma. The lethality of patients with development of this symptomatology reaches 5%.
Complications of an esherikhioz
Usually esherikhioza are not inclined to complications. In case of the infection provoked by the EGKP group activator there is a probability of emergence of complications from an urinary system, hemolytic anemia, cerebral frustration.
Diagnostics of an esherikhioz
Allocation of the activator from a calla and emetic masses, in generalization cases – from blood, urine, bile or a likvor is made for diagnostics of an esherikhioz. Then the bacteriological research, crops on nutrient mediums is made. Due to the anti-gene similarity of activators of an esherikhioz to the bacteria which are a part of a normotsinoz of intestines, serological diagnostics of a maloinformativn.
Identification of bacterial toxins in excrements of patients can be applied to laboratory diagnosis of the infections caused by EGKP. At this type of esherikhioz in blood test symptoms of hemolytic anemia, increase in concentration of urea and creatinine can be noted. The analysis of urine usually shows a proteinuria, a leykotsituriya and a gematuriya.
Treatment of an esherikhioz
Treatment is mainly out-patient, hospitalization are subject patients with severe forms and high risk of development of complications. The diet is recommended to patients. For sharp clinical manifestations (diarrhea) – a table No. 4, after the termination – a table No. 13. Moderate dehydration is corrected by reception of liquid and rehydration mixes orally, at increase and the expressed degree of dehydration make intravenous injection of solutions. Pathogenetic treatment is chosen depending on a type of the activator.
As antimicrobic therapy medicines of a nitrofuranovy row (furasolidone), or (are usually appointed at the heavy course of the infection caused by EIKP) ftorkhinolona (ciprofloxacin). Medicines are appointed to 5-7 days. It is expedient to perform treatment of esherikhioz of EPKP at children by means of a combination of a sulfametoksazol and a trimetoprim, antibiotic treatment. Generalized forms treat tsefalosporinam of the second and third generations.
At the long course of a disease for normalization of digestion and restoration of a biocenosis of intestines include fermental medicines and eubiotik in complex therapy. The modern principles of treatment of the esherikhioz provoked by EGKP group bacteria include application of anti-toxic therapeutic measures (serum, extracorporal adsorption of antibodies).
Forecast and prevention of an esherikhioz
The forecast for adults and children of advanced age – favorable, at an easy current cases of independent recovery are noted. Children of early age can suffer esherikhiozy in a severe form that worsens the forecast. There is a recovery in case of generalization and development of complications also much more difficultly. Some especially severe forms of esherikhioz can end without due medical care with death.
Esherikhioza – the diseases connected with low hygienic culture. Personal prevention of these infections consists in following to hygienic norms, in particular at communication with children, washing of hands, foodstuff, toys and household items. The general prevention is directed to control of observance of the sanitary and hygienic mode in child care facilities, the enterprises of the food industry, treatment and prevention facilities, and also control over a drain of sewer waste and a condition of sources of water.
Patients after transferring of an esherikhioz are written out from a hospital after clinical recovery, and also by results of triple bacteriological test. The admission in group of the children contacting to the patient is also carried out after performing bacteriological diagnostics and confirmation of lack of allocation of the activator. The faces excreting pathogenic escherichias are subject to isolation for the entire period of contageousness. Employees of the food industry are exposed to regular inspections regarding allocation of the activator, in case of positive test – are discharged of work.