Intestinal infection acute - Causes, symptoms and treatment. MF.
Intestinal infections are one of the most common diseases in the world. Their prevalence among the population is extremely high, both in the children's age group and in adults. When we talk about an intestinal infection, we mean an acute intestinal disease.
Acute intestinal infections( OCI) are a group of acute infectious diseases caused by various infectious agents( mainly bacteria), with an alimentary mechanism of infection, manifested by fever and intestinal syndrome with the possible development of dehydration and severe course in the children's age group and in the elderly.
The incidence of intestinal infections in the world, and in particular in Russia, is quite high. More than 500 million people fall ill every year on the planet. The incidence rate in Russia reaches 400 or more cases per 100 thousand of the population. The structure of child morbidity and mortality allows us to speak of the third place of acute intestinal diseases.
Causes of intestinal infections
The digestive tract consists of the oral cavity, the pharynx, the esophagus, the stomach, the small intestine( including the 12-типерстную intestine, jejunum, ileum), the large intestine. In the saliva of the oral cavity there is a substance - lysozyme, which possesses bacteriostatic action. This is the first protective barrier. The mucous membrane of the stomach has glands that produce gastric juice( consisting of hydrochloric acid and pepsin).Hydrochloric acid is the second barrier to pathogenic microorganisms, which can perish in it( but this does not always happen).The mucosa of the small intestine is covered with numerous villi involved in parietal digestion, performing protective and transport functions. In addition, the intestinal mucosa contains a secretory immunoglobulin - IgA, which plays a role in the immunity of the human body.
The microflora inhabiting the intestine is divided into the obligate one( obligatory for the presence in the intestine), which includes bifidobacteria, lactobacilli, E. coli, bacteroides, fusobacteria, and peptococci. The loan flora is 95-98% of all representatives. The function of obligate flora is protective due to a competitive presence and participation in digestion processes. Another group of microorganisms inhabiting the intestine is called an optional flora, including staphylococci, fungi, opportunistic microorganisms( Klebsiella, Streptococcus, Proteus, Pseudomonas aeruginosa, Clostridia and others).Supplementary flora can also participate in the digestion process by producing certain enzymes, but the opportunistic pathogen with a certain growth can cause the development of intestinal syndrome. The rest of the flora that comes from outside is called pathogenic and causes an acute intestinal infection.
Which pathogens can cause acute intestinal infection?
There are several types of intestinal infections depending on the etiology:
1. Intestinal bacterial infection : Salmonella infection( Salmonellae enteritidis et spp.), Dysentery( Shigellae sonnae et spp.), Yersiniosis( Iersiniae spp.), Esherichiosis( Esherihiae coli enteroinvasive strains), Campylobacteriosis( Campylobacter-induced enteritis), Acute intestinal infection caused by Pseudomonas aeruginosa( Pseudomonas aeruginosa), Clostridium, Klebsiellae, proteus( Proteus spp.), Staphylococcal food poisoning( Staphilococcus spp.), typhoid fever(Salmonellae typhi), cholera( Vibrio cholerae), botulism( poisoning botulotoxin) and others.
2. OCI of the viral etiology of ( rotaviruses, Norfolk group viruses, enteroviruses, coronaviruses, adenoviruses, reoviruses).
3. Fungal intestinal infections ( more often fungi of the genus Candida).
4. Protozoal intestinal infections ( giardiasis, amebiasis).
Causes of intestinal infections
Source of infection - a patient with a clinically expressed or erased form of intestinal infection, as well as a carrier. Infectious period from the time of the onset of the first symptoms of the disease and the entire period of symptoms, and in case of a viral infection - up to 2 weeks after recovery. Patients excrete pathogens in the environment with feces, vomit masses, less often with urine.
The mechanism of infection is alimentary( that is, through the mouth).Ways of infection - fecal-oral( food or water), household, and with some viral infections - airborne. Most pathogens of acute intestinal infection are highly stable in the external environment, they retain their pathogenic properties well in the cold( in a refrigerator, for example).Transfer factors - food products( water, milk, eggs, cakes, meat depending on the type of intestinal infection), household items( dishes, towels, dirty hands, toys, door handles), swimming in open water. The main place in the spread of infection is the observance or non-compliance with personal hygiene standards( washing hands after toilet, caring for the patient, before eating, disinfecting household items, allocating personal utensils and towels to the sick person, reducing contacts to a minimum).
Susceptibility to intestinal infections is universal regardless of age and sex. The most susceptible to intestinal pathogens are children and people of advanced age, people with diseases of the stomach and intestines, people suffering from alcoholism.
Factors predisposing to the development of intestinal infection in children: children on artificial feeding, premature infants;violation of rules for introducing complementary foods without the necessary heat treatment;a warm season( usually summer);various kinds of immunodeficiency in children;pathology of the nervous system in the perinatal period.
Immunity after the infection is unstable, strictly type-specific.
Common Symptoms of Acute Intestinal Infections
The incubation period( from the moment the pathogen enters the first signs of the disease) lasts from 6 hours to 2 days, less often longer.
For almost any intestinal infection, the development of 2 main syndromes is characteristic, but in varying degrees:
1. The infectious-toxic syndrome ( ITS), which manifests itself as a fever from a low-grade figure( 37º and above) to febrile fever( 38 ° and above).With some infections, there is no temperature at all( for example, cholera), also a lack of temperature or a slight short-term rise is characteristic for food poisoning( staphylococcal, for example).The temperature can be accompanied by symptoms of intoxication( weakness, dizziness, aches in the body, nausea, sometimes against a background of high fever vomiting).Often an infectious-toxic syndrome is the onset of an acute intestinal infection lasts until the appearance of the second syndrome from several hours to days, less often longer.
2. Intestinal Syndrome .The manifestations of the intestinal syndrome may be different, but there is a similarity in symptoms. This syndrome can manifest itself as a syndrome of gastritis, gastroenteritis, enteritis, gastroenterocolitis, enterocolitis, colitis.
Syndrome of gastritis is characterized by the appearance of pain in the stomach( epigastrium), constant nausea, vomiting after eating and drinking water, and it can cause even a sip of liquid. Vomiting can be multiple, bringing short-term relief. It is possible to dilute the stool and for a short period of time, sometimes only once.
Gastroenteritis syndrome is accompanied by abdominal pain in the stomach and near-the-buccal region, vomiting, the appearance of a frequent stool first of a mushy nature, and then with a watery component. Depending on the cause of the onset in the stool, the color may change( greenish with salmonellosis, light brown with escherichiosis, for example), and mucus, undigested remnants of food.
The enteritis syndrome is characterized by the appearance of only stool disorders in the form of frequent watery stools. The frequency depends on the type of pathogen and the degree of the infectious dose of it, which has fallen to a specific patient.
Gastroenterocolitis syndrome is manifested by vomiting and frequent liquid stools, abdominal pains become diffuse and almost constant, acts of defecation become painful, not bringing relief, often impurities of blood and mucus in the stool. Some acts of defecation with scanty mucous discharge.
The syndrome of enterocolitis is characterized by only a pronounced pain syndrome along the entire perimeter of the abdomen, a frequent stool mixed with a scanty discharge.
Syndrome of colitis manifests itself in bouts in the lower abdomen, mainly on the left, acts of defecation are painful, the contents are meager with an admixture of mucus and blood, false desires on the stool, lack of relief at the end of defecation.
Such syndromes as gastroenteritis, gastroenterocolitis and enterocolitis are characteristic for salmonellosis, enterocolitis and colitis for dysentery, escherichiosis is accompanied by the development of gastroenteritis, enteritis is a leading syndrome of cholera, gastritis syndrome can accompany food poisoning, however it can be gastroenteritis, viral intestinal infections occur more oftenin the form of gastroenteritis.
Features of acute intestinal infection in children
• more severe acute intestinal infection,
• rapid development of dehydration symptoms,
• higher proportion of viral intestinal damage than in the adult age group.
When an acute intestinal infection occurs, the child develops dehydration and desalination faster, resulting in a high lethality;besides, the ability of even conditionally pathogenic microorganisms to cause a severe process in the intestines of babies is characteristic.
Complications of acute intestinal infections
1) Dehydration( dehydration) - abnormal loss of water and salts by unnatural means( vomiting, loose stools).There are 4 degrees of dehydration in adults:
- 1 degree ( compensated) - weight loss of up to 3% of the original; 2 degree ( transitional) - weight loss of 4-6% of the original; 3 degree ( subcompensated) - 7-9% of the original; 4 degree ( decompensated) - more than 10% of body weight loss from the initial.
Children of the 3rd degree: 1 degree ( weight loss up to 5% of the original), 2 degree ( 6-9%), 3 degree ( algid) - more than 10% of body weight loss from the baseline.
In addition to weight reduction, dry skin and mucous membranes, thirst, decreased skin elasticity, hemodynamic disturbances( rapid pulse, decreased blood pressure).Thirst is not always: if there is a solderingitis type of dehydration( this happens more often with repeated vomiting), then thirst may not be. If water-deficient type of dehydration, then thirst is the main symptom.
2) One of the manifestations of fulminant dehydration: dehydration shock with possible fatal outcome. There is deep dehydration and hemodynamic disorders( a critical drop in blood pressure).
3) Infectious-toxic shock: occurs against the background of high temperature, often at the onset of the disease and is accompanied by high toxemia( high concentration of bacterial toxins in the blood), severe hemodynamic disorders and possible fatal outcome.
4) Pneumonia ( pneumonia).
5) Acute renal failure .
Differential diagnosis( non-infectious "masks" of intestinal infections)
At the stage of preliminary diagnosis in acute intestinal infection, the doctor has to differentiate the intestinal infection with other conditions and diseases, the symptoms of which can also be vomiting and diarrhea( liquid stools).An important role is played by the correctly collected history of the disease( history of the disease), in which it is necessary to describe in as much detail the symptoms and timing of their appearance, the severity of complaints and their duration.
Gastroenteritis syndrome can accompany poisoning with fungi, heavy metal salts, fish and shellfish poisons. In contrast to infectious diarrhea, with the above poisonings there will be no ITS( infectious-toxic syndrome) - neither the temperature nor the symptoms of intoxication.
Syndrome of enterocolitis or colitis( with blood in feces) occurs with NNa( ulcerative colitis), neoplasms of the intestine, Crohn's disease, diverticular disease and others. Each of these states has other specific symptoms that characterize the disease. In particular, with Crohn's disease, diarrhea will be chronic, prolonged, cramping in the abdomen, weight loss, anemia. With NNC - a long subfebrile condition, prolonged diarrhea with blood, weight loss, pain in the lower left abdominal area and others.
Most often the practical doctor has to differentiate acute intestinal infection with poisoning with mushrooms, NJC, acute appendicitis, rectal cancer, mesenteric mesenteric vessels, acute intestinal obstruction.
With significant pain in the abdomen, especially in children, the first step is to visit the surgeon's doctor of emergency medical care to exclude surgical pathology.
It's no secret that the appearance of a frequent liquid stool for most people - not an excuse to see a doctor. Most people try different drugs and methods to stop diarrhea and restore the disturbed state of health. At the same time, simple( as it seems at first glance) intestinal infection can turn into a serious problem with long-term disability.
Symptoms to be addressed immediately:
1) early childhood( up to 3 years) and preschool age of the child;
2) persons of advanced age( over 65 years);
3) frequent loose stools more than 5 times a day in adults;
4) repeated vomiting;
5) high fever with diarrhea and vomiting;
6) blood in the stool;
7) cramping abdominal pain of any location;
8) severe weakness and thirst;
9) the presence of chronic comorbidities.
What can not be done categorically in case of suspected acute intestinal infection:
If there is a frequent loose stool, accompanied by abdominal pain and temperature, then:
1) Do not use painkillers. In the case of hidden symptoms of any surgical pathology( cholecystitis, appendicitis, intestinal obstruction, and others), the removal of the pain syndrome can complicate the diagnosis and postpone the provision of timely specialized care.
2) You can not use self-fixing agents( binders) - such as immodium or loperamide, londium, and others. In acute intestinal infection, the bulk of toxins of pathogens is concentrated in the intestine, and the use of such drugs contributes to their accumulation, which will worsen the patient's condition. The course of intestinal infection will be favorable with timely emptying of intestinal contents along with toxins of pathogens.
3) You can not do your own enema, especially with hot water.
4) Do not apply heating procedures to the stomach( hot water bottle, for example), which certainly contributes to the intensification of the inflammatory process, which will aggravate the patient's condition.
5) In the presence of symptoms of acute intestinal infection and suspected surgical pathology, one should not hesitate and try to treat improvised drugs( folk, homeopathic and others).The consequences of delay in seeking medical help can be very sad.
Laboratory diagnosis of acute intestinal infection
A preliminary diagnosis is made after a clinical and epidemiological survey, which includes contact with the patient, possible cases of intestinal infection among the nearest environment, eating poor-quality products, products without water treatment and heat treatment, non-observance of personal hygiene rules, as well as on the symptoms of the disease( the onset of the disease, the main symptoms characteristic of a particular infection).
Already at this stage it is possible to correctly determine the diagnosis( for example, with the outbreak of the disease and the presence of such patients in the infectious disease clinic, with specific symptoms - blood in the stool, false desires on the stool, temperature in dysentery, for example, a plentiful, watery stool without odor andimpurities, without temperature - with cholera), due to which in some cases, after taking all materials for laboratory testing, specific treatment is prescribed already at the stage of preliminary diagnosis.
An experienced doctor in the presence of obvious symptoms may suspect a certain intestinal infection and prescribe adequate treatment.
The final diagnosis is made after laboratory confirmation:
1) Bacteriological methods( seeding of materials for research into special media and cultivation of bacterial colonies).Materials can be feces, vomit, gastric flushing, food remnants, water samples. The preliminary seeding and the result can be issued on the 2nd-3rd day.
2) Serological methods( detection of specific antibodies in the blood) ELISA, RNGA - necessarily take paired blood sera with an interval of 10-14 days.
3) PCR diagnostics in biological fluids( eg L-form salmonella).The result is issued on the same day.
Instrumental diagnostic methods: sigmoidoscopy, colonoscopy, iriscopy.
Treatment for acute intestinal infection
1. Organizational and regime measures. All children of the early
age with any severity of intestinal infection due to the danger of rapid development of dehydration syndrome are liable to hospitalization. Adults are hospitalized with moderate and severe form of acute intestinal infection, as well as when it is impossible to isolate the patient( living in small families with a shared toilet, dormitories, closed organized institutions - orphanages, etc.).For the entire period of the fever bed rest, then until the liquid stool is terminated, it is semi-bed.
Dietotherapy( table number 4 in Pevzder).In the acute period of the disease - slimy soups, weak meat broths, wiped lean meat, boiled lean fish, scrambled eggs, porridge, white stale bread and crackers, dry uneaten cookies, baked apples without peel.
Excluded: milk, spices, spices, smoked products, canned food, garlic, green onions, radish, alcohol. On the general table is transferred carefully and gradually within 3-4 weeks. Such products as milk and refractory fats are poorly digested for another 3 months.
2. Medical treatment of acute intestinal infection.
1) Rehydration therapy ( replenishment of fluid loss and detoxification of the body).It is performed for any acute intestinal infection in 2 stages: 1) elimination of symptoms of dehydration at the present time, 2) replenishment of continuing losses.
You can take fluid through the mouth( drinking regimen in the absence of vomiting and urges on it), as well as parenterally( intravenous infusion solutions).How to calculate the volume of oral rehydration at home with 1 degree of dehydration and outpatient treatment: it is 30 ml / kg of weight per day in an adult, and 30-50 ml / kg / day in children. Drink liquid should be divided every 5-10-15 minutes in a warm form. These are solutions of rehydron, citroglucosolan, enterodease. Intravenous rehydration is performed only in hospital conditions under strict control of water-salt metabolism.
2) Pathogenetic and postdromatic therapy.
- Antidiarrhoeal drugs: enterosorbents
Enterosorbents are used as first aid for poisoning, they bind toxic substances in the stomach and intestines. Further poisons are excreted from the body naturally. Enterosorption is used for acute and chronic poisoning in children and adults. An example of a modern effective enterosorbent for first aid for various poisonings is Enterosgel.
- Probiotics( lynex, acipol, acylac, bion3, bifidumbacterin forte, bifiform, bifystim and many others),
- Intestinal antiseptics( intetriks, enterol, entero-sed, intestopan, enterofuril)
- Enzymes( pancreatin, creon,mikrazim, mezim and others).
- Antibacterials of the group of fluoroquinolones are prescribed only by a doctor!
- Probiotics( lynex, acipol, acylac, bion3, bifidumbacterin forte, bifiform, bifystim and many others).
Rehydration therapy should be performed with the first symptoms of intestinal infection, as well as with the first symptoms begin treatment with enterosorbents. Intestinal antiseptics and antibacterial agents will not help with a viral infection, but they can be prescribed by a doctor before confirming an accurate diagnosis or for preventing a secondary bacterial infection. On the third day of treatment with antibacterial agents, it is necessary to start taking probiotics to restore the intestinal microflora.
Forecast of acute intestinal infection
Outcomes can be either a favorable outcome( recovery) or adverse( formation of chronic forms, carriers).In the children's age group, the outcomes of intestinal infection can be in 25% of cases the formation of pathology of the gastrointestinal tract in the form of pancreatic function disorders, bile duct disorders, intestinal dysbiosis, functional dyspepsia.
Prevention of acute intestinal infection is as follows:
1) compliance with personal hygiene rules;
2) the use of boiled, bottled water;
3) washing vegetables, fruits before consuming running water, and for small children - boiled;
4) careful heat treatment of necessary food before consumption;
5) short-term storage of perishable food in the refrigerator;
6) do not collect garbage;
7) to monitor the maintenance of cleanliness in the dwelling and sanitary maintenance of the toilet room and the bathroom.
The doctor infektsionist Bykova N.I.