Intestinal bacillus( escherichiosis) - Causes, symptoms and treatment. MF.

Intestinal bacillus is a fairly common microorganism that causes numerous problems of the digestive tract, urinary and reproductive systems in humans, which has the ability to be present on the skin and mucous membranes of various body systems as a variant of the norm.

E. coli( Escherichia coli or E. coli) is a gram-negative bacterium( smear-stained Gram stain) that belongs to the Enterobacterium family, which has the shape of a rod, which is an optional anaerobic( i.e., mainly develops without oxygen, but incertain conditions for the intake of oxygen also does not lose its viability).The E. coli was discovered in 1885 by the German bacteriologist Theodor Escherich. Rods have rounded ends, the size of 0.4 to 3 microns. Some strains have mobility due to the presence of flagella, the rest are immovable.

Three-dimensional image of E. coli

The optimal temperature of growth of E. coli is 37 °.E. coli is fairly stable in the external environment, in environments such as water, soil, and stool, it retains viability for a long time. Have the ability to multiply in food( for example, milk).Boiling dies almost immediately, at a temperature of 60º for 15 minutes, disinfectants( solutions of chloramine, formalin and others) have a detrimental effect on the E. coli for a short time.

There are numerous strains( varieties) of Escherichia coli, of which the majority of representatives are harmless and under normal conditions are located on the mucous membranes of the digestive tract, and mainly in its lower parts.

Intestinal bacillus normal

Under normal conditions, E. coli colonizes the human intestine( its safe strains), the average amount varies from 106 to 108 cfu / g of the contents of the distal intestine( CFU-colony-forming unit).The content of E. coli in the other intestinal microflora is no more than 1%.Under normal conditions, E. coli takes part in the normal functioning of the intestine, synthesizes vitamins K, B1, B2, B3, B5, B6, B9, B12.A very important function is the competitive interaction with the conditionally pathogenic flora of the intestine( restriction of reproduction of conditionally pathogenic microorganisms).

The non-pathogenic strain Nissle 1917( Mutaflor) is used with a therapeutic purpose in children as a probiotic for intestinal dysbacteriosis. The so-called lactose-positive colibacillus is more useful in the intestine, the lactose-negative amount should not exceed 105 cfu / g, and haemolytic E. coli should not be present at all.

Qualitative and quantitative composition of E. coli of the large intestine in healthy people of different ages, as in children under the age of 60 years and older, does not differ. For typical E. coli, this is 107-108 cfu / g fecal, E. coli lactose-negative & lt; 105, hemolytic intestinal bacilli are normally absent. The composition of the rest of the intestinal flora differs in age by other parameters.

Deviations in the content of nonpathogenic E. coli strains in the intestine are called dysbiosis and have several degrees.

Degrees of microbiological disorders of E. coli with intestinal dysbacteriosis

1st degree of microbiological disorders of : typical of Escherichia up to 106-105 cfu / g, an increase in the content of typical Escherichia to 109-1010 cfu / g is possible
2nd degree of microbiological disorders :increase of hemolytic Escherichia content to a concentration of 105-107 cfu / g
3rd degree of microbiological disorders : detection of E. coli in association with other opportunistic microorganisms at a concentration of 106-107 cfu / g and above

Pathogenic intestines

sticks. There are more than 100 strains of pathogenic E. coli, which are classified into 4 classes:
- enteropathogenic E. Coli( ETEC);
- enterotoxigenic E. coli;
- enteroinvasive E. coli( EIEC);
- enterohemorrhagic E. coli( EHEC).

Morphologically they are no different. A feature of pathogenic strains is the ability, when ingested, to produce enterotoxins( thermostable or resistant to high temperatures and thermolabile or rapidly disintegrating), which causes diarrhea. For example, E. coli O157: H7, which produces such toxins. In addition, each group has its own characteristics of the symptoms of the disease.

Escherichia coli intestinal tract

Escherichiosis is a disease that occurs as a result of ingestion of pathogenic strains of Escherichia coli characterized by intoxication and lesion mainly of the gastrointestinal tract, but sometimes affecting the urinary system, bile ducts and other organs with the possibility of somepatients developing sepsis.

The mechanism of infection is alimentary, the path is fecal-oral. Transmission factors are contaminated water and food products. Most of them fall ill with young children.

The incubation period( from the moment of infection to the appearance of a clinical picture) is from 48 to 72 hours most often( less often shortened to 1 day or prolonged to 10 days).

Escherichiosis caused by enteropathogenic E. coli : newborns and children of the first year of life are more often affected. They cause diarrhea in the maternity homes. In small patients, vomiting or regurgitation, frequent loose stools without pathological impurities( blood), severe abdominal pain, child's anxiety, refusal to eat, disturbed sleep.

Escherichiosis caused by enterotoxigenic E. coli : these strains have the ability to attach to intestinal epithelial cells, significantly impairing their function and causing severe watery diarrhea. Also often manifested in children, adults and the so-called "travel diarrhea".Patients have a watery stool, no blood, a urge to vomit, and tenderness in the abdomen.

Escherichiosis caused by enterohemorrhagic E. coli : causes hemorrhagic colitis, in severe cases of hemolytic-uremic syndrome( HUS).With hemorrhagic colitis , patients have a high fever up to 39-39.5º, symptoms of intoxication, cramping( or spastic) abdominal pain, and the appearance of a watery stool with an admixture of blood. Complications can be the development of hemolytic anemia, acute renal failure and hemorrhagic syndrome.
Hemolytic-uremic syndrome( HUS) is a specific syndrome characterized by a triad of symptoms - hemolytic anemia, acute renal failure and a critical drop in the number of platelets. It occurs more often in the children's age group from 6 months to 4 years, as well as in elderly patients. In 90% of cases it occurs in intestinal infections( E. coli, producing verotoxin, Shigellae and others).The reason is damage to the endothelial cells of the vessels. Occurs an average of one week after the infection. Clinically, lemon color of jaundice, a violation of the outflow of urine, swelling, hemorrhages on the skin and other severe manifestations may appear. However, with the appearance of this symptomatology, one can speak of a detailed clinical picture of the HUS.Early signs of it are laboratory: the appearance of protein in the urine - proteinuria, the appearance of erythrocytes in the urine - erythrocyturia, increased serum creatinine, and the reduction of red blood cells and hemoglobin in the blood.

Escherichiosis caused by enteroinvasive E. coli : according to biochemical properties, enteroinvasive E. coli is similar to shigella - causative agents of dysentery, in particular they have the ability to penetrate into the epithelial cells of a certain part of the intestine( colon) and multiply there. This explains the appearance of a certain symptomatology in such escherichiosis: pain in the iliac region to the left( lower abdominal left), a copious, watery stool with an admixture of blood. Unlike dysentery, it is often a watery stool, and not lean with mucus and blood( as in shigellosis).
Summarizing the foregoing, it is clear that there is no single specific pattern of escherichiosis, patients' complaints can be different: temperature, vomiting, watery stools without any impurities and with blood, abdominal pains of different localization of aching character.

Infection with the intestinal rod of the urinary tract

The mechanism of infection is more often associated with the direct ingestion of Escherichia coli from the large intestine due to non-observance or inadequate personal hygiene, as well as using non-traditional methods of sexual intercourse( using anal sex).

Up to 80-85% of urinary tract infections are associated with E. coli. More than 60% of acute processes associated with inflammation of the prostate gland is associated with this pathogen. The vast majority of chronic prostatitis is associated with E. coli.

Clinical forms of the lesions of the urinary system are different. It can be urethritis, cystitis, pyelonephritis, prostatitis.

Infection of the intestinal rod of the reproductive system

Most of the inflammatory processes in the epididymis( epididymitis), testicular inflammation( orchitis), as well as their combined damage, inflammation of the ovaries( adnexitis) is associated with the E. coli.

Diagnosis of infections caused by Escherichia coli

1) Bacteriological method - sowing of biological material on special nutrient media. The material is used for infections of the intestines - bowel movements and vomit, urinary system infections - urine, with infections of the reproductive system - swabs and scrapings from the mucous genitalia. After identification of the pathogen, an antibioticogram( determination of sensitivity to antibiotics).
If the content of Escherichia coli is deflected in feces, a certain degree of microbiological disturbances( dysbiosis) or a pathogenic strain of Escherichia coli are detected. The presence of E. coli in the urine is called bacteriuria. In the absence of symptoms, a diagnosis is made when the appearance of microorganisms in the amount of 105 and above CFU / ml of urine. If their number is less, they consider this as a sign of contamination( contamination of urine in the fence).If the symptoms of the disease are clearly expressed, then enough 102-104KOE / ml of urine.

E. coli on the nutrient medium

2) General clinical methods of the study ( coprogram, general urine test, blood tests, biochemical blood test and others) are additional.
3) Instrumental research methods ( sigmoidoscopy, urography, ultrasound and others).

General principles of the treatment of infections caused by Escherichia coli

1. Organizational and regimen measures( hospitalization according to clinical indications), diet regime according to the defeat of certain body systems( table № 4 with intestinal lesion, table № 7 with defeat of the genitourinary system).

2. Drug therapy includes etiotropic therapy( antibiotics, bacteriophages), pathogenetic therapy( more often infusion), and postdromatherapy.

Antibiotic therapy should be performed taking into account the antibioticogram of the isolated E. coli. The sensitivity of the E. coli to the fluoroquinolone group( ciprofloxacin, levofloxacin), amoxicillin, nitrofuran, and others is more often detected. And the drug itself, and its dose, and the duration of the course of treatment is prescribed only by a doctor. Self-medication for the prevention of the development of resistance of the E. coli to antibiotics is unacceptable!

Also effective against E. coli are bacteriophages( used for bowel damage) - it's a bakeryophage if it's liquid, intestibacteriophage, coliprotein bacteriophage, pyobacteriophage combined liquid, pyobacteriophage polyvalent combined liquid and others.

Especially obtained strains of Escherichia coli are part of some drugs that are used for dysbacteriosis with a deficiency of E. coli in the intestine( chelate forte, bifikol, colibacterin).Also, for dysbacteriosis with excess growth of the E. coli, probiotics( linex, acipol, acylact, lactobacter, bifiform, bifystim and others) are prescribed.

Pathogenetic therapy is reduced to the introduction of infusion therapy - the introduction into the bloodstream of various solutions of a certain volume and concentration for the purpose of detoxification and replenishment of fluid losses in the lesions of the gastrointestinal tract, as well as detoxification of the body in kidney damage.

Asynchronous therapy is appointed by the physician individually depending on the leading syndrome of the disease.

Features of treatment for children and pregnant women: in these groups of patients, treatment regimens start with the use of biakteriophages and probiotics, and only with ineffectiveness of these drugs are antibacterial drugs given the age and degree of injury.

Prevention of infections caused by Escherichia coli

Prevention of personal hygiene and the rules of cooking and storing food, washing vegetables and fruits, as well as preventing the consumption of water from unknown sources is the first priority in prevention.

Doctor infectious diseases Bykova N.I.