Mar 06, 2018
Staphylococcal infection has for many years been one of the most important for public health. It is a group of very different diseases caused by staphylococci, occurring both in localized and generalized forms, and characterized by skin, subcutaneous fat, respiratory, nervous, kidney, liver, and intestinal damage.
Infecting the staphylococcal infection affects all age groups of the child population. In newborns and children of the first year of life, the contact path of infection through the care items, mother's hands and hospital personnel, linen prevails. Possible and food pathway through staphylococcus milk infected in the presence of mothers mastitis. Older children are infected through staphylococcus infected foods.
Etiology. Lesions of the gastrointestinal tract S. aureus, accompanied by the development of enteritis, enterocolitis, gastroenteritis and gastroenterocolitis, are observed mainly in newborns and children of the first year of life, as well as in children with weakened immune system.
Lesions can be primary, associated mainly with exogenous infection of S. aureus, and secondary, occurring against the background of existing foci of inflammation and prolonged antibiotic therapy. Lesions of the gastrointestinal tract are observed in septic patients as manifestations of sepsis.
Primary lesions are much less common than secondary lesions. Secondary are a manifestation of the infectious process of staphylococcal etiology of extraintestinal localization.
Pathogens of staphylococcal lesions of the gastrointestinal tract - bacteria of the species Staphylococcus aureus - globose, immobile, asporogenous, facultative anaerobic gram-positive bacteria. A yellow or orange pigment is produced that is carotenoids, insoluble in water. The optimum growth of staphylococci at a temperature of 37 ° C.
S. aureus, isolated from enterocolitis, usually produce enterotoxin B, and with gastroenteritis and gastroenterocolitis - enterotoxin A and, as a rule, are the causative agents of foodborne toxic infections.
Enterotoxin B resembles thermolabile intestinal enterotoxins. Enzymes directly or indirectly involved in the pathogenesis of the disease include hyaluronidase, DNase, fibrinolysins, coagulase.
S. aureus, as a rule, are sensitive to cephalosporins of the 3rd generation, carbopenems, vancomycin, and fluoroquinolones.
The source of infection are patients and carriers. The greatest epidemiological danger is represented by patients with staphylococcal infection with open foci in the acute period of the disease, as well as "healthy" bacterial carriers among the personnel of maternity hospitals, departments for newborns, and workers in the food units.
Infection is spread by contact, airborne and food pathways. An endogenous pathway of infection is possible, in particular in patients with primary and secondary immunodeficiency.
Laboratory confirmation of staphylococcal gastrointestinal lesions is based on bacteriological and serological data.
Isolation of S. aureus feces, including pathogenic ones, is not an indisputable proof of staphylococcal intestinal lesions.
The following indicators are important in the evaluation: massive release of staphylococci, repeated isolation of the same phagotypes, its pathogenicity.
Serological studies are secondary, complementing bacteriological data. The most important are RA with autostams, RNGA and ELISA.
From the serological methods of diagnosis of purulent-septic diseases apply the reaction of direct hemagglutination and ELISA.Diagnosis is considered to increase the titer AT at 7-10 days when examining paired sera. A single study of diagnostic value has no, because in almost 100% of adults in the serum there are ATs to staphylococci.
The definition of AT for staphylococci is used to diagnose purulent-septic processes caused by Staphylococcus aureus, with the following diseases:
?inflammatory diseases of the lungs;
?phlegmon, abscesses, furunculosis, sore throat;
?peritonitis, sepsis, pyelonephritis;
?staphylococcal food poisoning.
The ways of spreading the staphylococcal infection of are different, but basically it's airborne and dusty.
The contact and household way of transmission is also very important, the infection can occur through objects, hands, dressings, dishes, linens, etc. There is also a food way of transmission through contaminated food when consumed in food.
Finally, an injection method of infection is possible, with staphylococcus entering the body during medical manipulations, due to insufficient processing of tools, defects in injection techniques, and introduction of inferior medicines. In this respect, glucose solutions, which are a good nutrient medium for staphylococci, are especially dangerous, they can easily be infected with defects in cooking or storage.
The source of infection may be domestic animals, but their epidemiological significance is negligible. In the external environment of independent reservoirs of pathogenic staphylococci, apparently, does not exist.
Susceptibility to staphylococcal infection of is different and depends on age and condition. It is highest in newborns, infants, the elderly, and also in patients.
Patients with acute viral diseases( influenza, measles, viral hepatitis), blood diseases, diabetes, post-operative patients and patients with extensive skin lesions( eczema, burn) are particularly susceptible to staphylococci. Susceptibility to staphylococci increases with prolonged use of corticosteroids and cytostatics.
The incidence of staphylococcal infections of is very high, but there is no precise data. Staphylococcal infections often occur sporadically, but there may be family, group diseases and significant epidemic outbreaks that occur most often in hospitals - in child's homes, maternity homes, etc.; there may be outbreaks of staphylococcal foodborne infections.
Mortality with staphylococcal infection is kept on significant figures and as the mortality decreases in other diseases, the proportion of staphylococcal infection among the causes of death is high.
According to the hospitals of different countries and different cities, staphylococcal infection as the immediate cause of death is in the first place.
Staphylococcal infections have always been dangerous as hospital-acquired diseases, they can take on the nature of disasters, sometimes even damaging well-equipped institutions.
The in-hospital dissemination of staphylococci is facilitated by inadequate detection and elimination of sources of the disease( patients with mild staphylococcal processes and carriers, including personnel), crowding, violation of the sanitary regime, insufficient sterilization of instruments, dressing material, etc.
Clinical manifestations of staphylococcal lesions of the intestine are diversehave specific symptoms. The following classification of staphylococcal lesions of the digestive tract was adopted:
3. Intestinal manifestations of staphylococcal sepsis:
Primary staphylococcal gastroenteritis and gastroenterocolitis, enteritis and enterocolitis usually begin with an increase in body temperature to subfebrile and febrile digits, rarely subacute, usually with normal temperature. They are accompanied by vomiting up to 5-6 times a day, with frequent liquid stool up to 5-10 times a day with impurities of mucus and greens. The frequency of the colitis and dyspeptic stool is the same. Often there is an admixture of blood in the stool, which in combination with vomiting, loose stool, temperature reaction and other symptoms of intoxication simulates the shigellosis clinic. However, unlike shigellosis, there are no tenesmus, spasms of the sigmoid part of the intestine, compliance and gaping of the anus.
Staphylococcal infection of the gastrointestinal tract is diverse in the place of localization of the process: stomatitis, gastritis, enteritis, colitis. Combined forms are possible: gastroenteritis, enterocolitis, gastroenterocolitis.
The clinical manifestations of staphylococcal lesions of the gastrointestinal tract, the severity of the flow depend on the nature of the infection( food, contact, endogenous), age and premorbid background of the patient, the properties of the pathogen, the magnitude of the infecting dose.
Food toxicosis of staphylococcal etiology, more often developing in older children, is characterized by a short incubation period( 2-5 hours), acute sudden onset, the appearance of pain in the epigastric region, repeated or repeated vomiting. The patient is concerned about severe weakness, dizziness, nausea. When examination reveals a sharp pallor of the skin, it is possible acro- and perioral cyanosis. The skin is covered with cold sweat. From the cardiovascular system: pulse of weak filling, heart sounds are muffled, arterial pressure is reduced. Quite often signs of intestinal involvement are added, a liquid, watery, abundant stool is noted, mucus admixtures, blood veins are possible. The mild form ends in recovery after 1-3 days. In patients with severe forms develop toxicosis and exsicosis.
In the children of the first year of life, the primary staphylococcal enteritis and enterocolitis are characterized by an acute, less frequent gradual onset, an increase in body temperature, repeated vomiting, the appearance of a liquid watery stool, often with impurities of mucus, blood. Typical long-term bowel dysfunction( up to 2-3 weeks or more).Diarrhea is more often invasive, less secretory.
Secondary lesions of the gastrointestinal tract are possible on the background of other manifestations of staphylococcal infection( sepsis, phlegmon, pneumonia).Long-persisting high body temperature, vomiting, a loose stool with mucus, and blood are observed. The course of the disease is long, wavy. With the progression of the septic process, especially in children of the first year of life, it is possible to develop pseudomembranous or ulcerative enterocolitis with perforation of the intestinal wall and development of peritonitis.
Treatment of staphylococcal diseases is a surprisingly difficult task, because there is no microbe that can be compared with staphylococcus by its ability to develop resistance to antibiotics and other antibacterial agents. The experience of the first use of penicillin showed its effectiveness in relation to staphylococci. About 70 years have passed, and now you can only dream about such staphylococci. Pharmacologists synthesize more and more new antimicrobial agents, and microbiologists, with no less frequency, detect staphylococci to these drugs are not sensitive.
The main reason for this phenomenon is not only the staphylococcus itself, but also the unreasonably widespread use of antibiotics in situations when it is quite possible to do without it. Paradox, but even some staphylococcal diseases in the treatment of antibiotics do not need - for example, food poisoning, associated, as we have said, not with the microbe itself, but with its toxins. Staphylococcus aureus Staphylococcus. The most dangerous and resistant to many medicines live in hospitals. Life there is not easy( and for bacteria as well), but staphylococci surviving in the constant use of disinfectants and mass use of antibiotics are the most serious risk factor, the basis of the so-called hospital infection.
Treatment of staphylococcal diseases is a complex task, the path to solving it is long and expensive, but it is quite real. Concrete staphylococcus, resistant to all antibacterial agents, is a very rare phenomenon. Bacteriological methods allow not only to identify the culprit of the disease, but also to determine its sensitivity to drugs, after which to conduct a course of effective therapy. Purulent foci in the appropriate organs are eliminated by surgical interventions, antistaphylococcal plasma and immunoglobulins are also used, through which already prepared antibodies are introduced into the body. Of great importance is the elimination of provoking factors, those that reduce immune defense and determine the principle possibility of the onset of the disease.
It is sad, but the transferred staphylococcal infection does not leave after itself a long-term immunity. Already too many possible factors of pathogenicity. To the toxins of a single staphylococcus, antibodies appeared in the blood, but the result of a meeting with another microbe is not predictable, because it can possess other toxins, the body is not yet familiar.
Prevention of diseases caused by staphylococcus includes several directions. These include measures to combat the source of infection, which are people who suffer from purulent inflammatory processes and bacterial carriers, whose treatment causes certain difficulties. Especially important in the complex of preventive measures is the prevention of staphylococcal diseases in medical institutions. This is primarily the organization of the operating mode of the hospital departments. The departments in which patients with open purulent-inflammatory processes are located should be serviced by individual staff. To prevent the occurrence of staphylococcal diseases in persons at risk of injury or infection, it is recommended to use the method of immunization with sorbed anatoxin or the introduction of immunoglobulin.
A special problem is the prevention of staphylococcal diseases in newborns. They still have up to the present time staphylococcus is one of the main pathogens of infection. In this case, prophylaxis includes the immunization of women in labor with staphylococcal anatoxin, as well as quantitative and qualitative analysis of the distribution of milk in the puerperas, with a view to a more rigorous approach to the transfer of the newborn into feeding with boiled breast milk. Normally, human milk contains three classes of immunoglobulins - IgG, IgM and IgA, which break down during boiling.
Despite numerous enzymes and dangerous toxins, despite the amazing stability in the environment, the microbe can do nothing with the immune protection of a healthy person: there is an antidote against each poison, the systems of general and local immunity are able to neutralize factors of pathogenicity, inhibit the reproduction of staphylococci, prevent the onsetdiseases!