Download Lecture 03. Acute intestinal infections

Acute Intestinal Infections.
Lecturer: ass.prof. Gorishna I.L.
Etiology of Acute Intestinal Diseases
• bacterial agents
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Escherichia coli
Shigella,
Salmonella,
Campylobacter jejuni
Yersinia enterocolitica.
Clostridium difficile
Vibrio cholerae
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Rotavirus
Coxsackie viruses
ECHO (Enteric Cytopathogenic Human Orphan) viruses
Astrovirus
Parvovirus
• enteroviruses (infectio enteroviralis)
- Parasites
• Giardia lamblia
• Cryptosporidium
Escherichia Coli Infection
• is an acute infectious disease mainly of
early age children, caused by different
pathogenic strains of Escherichia coli
(Enterotoxigenic, Enteropathogenic, Enteroinvasive,
Enterohemorrhagic, Enteroaggregative)
Etiology
• Escherichia coli, a facultatively anaerobic
gram-negative bacillus, is a major
component of the normal intestinal flora
and ubiquitous in the human environment.
Transmission
The way of transmission
• Contact
• Alimentary (by water, milk,
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food)
Localisation of the process
– in small intestinum
Enterotoxigenic E.coli infection
• Acute beginning from the repeated
vomiting, watery diarrhea.
• Intoxication is absent; body
temperature is normal or subfebrile.
• grumbling along thin intestine during
palpation.
• Feces 15-20 time per days, watery
without pathological admixtures, of
rice-water character.
• Development of severe dehydration
• Duration of the disease 5-10 days.
Lab Studies:
• Routine stool cultures
• Rapid enzyme immunoassays for E
coli 0157:H7
• Stool test (koprogram): inflammatory
changes, intestinal enzymopathy
• Electrolyte changes in blood
• Full blood count
stool
cultures
Shigellosis (dysentery)
• An acute human infectious diseases
with enteral infection that is
characterized by colitic syndrome
and symptoms of general
intoxication, quite often with
development of primary
neurotoxicosis.
Etiology of Shigella Infection
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Shigella dysenteriae
Shigella sonnei
Shigella flexneri
Shigella boydii
Transmission
Shigella is spread through fecal-oral
mechanism of transmission.
The way of transmission
• Contact
• Alimentary
• Watery
Localisation of the
process
Classification of Shigella
Infection
I. Clinical Form
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With dominance of toxicosis
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with dominance of local inflammation
II. Severity (mild, moderate and severe)
III. Course
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acute (up to 1.5 mo)
subacute (up to 3 mo)
chronic (about 3 mo)
– recurrent
– constantly recurring
IV. Complicated or uncomplicated
V. Bacterium carrying
Toxicosis, marble skin
With dominance of local inflammation
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Sudden onset of high-grade fever
abdominal cramping
abdominal pain,
tenesmus,
and large-volume watery diarrhea →
fecal incontinence, and small-volume
mucoid diarrhea with frank blood
Sunken abdomen,
dehydration
Shigella
Infection
false
urge to
defecate
Stools with greenish and
mucous
Rectal spit
Rectal
prolapse
Lab Studies:
• The white blood cell count is often within
reference range, with a high percentage of
bands. Occasionally, leukopenia or leukemoid
reactions may be detected.
• If HUS, anemia and thrombocytopenia
occur.
• Stool examination
• Increasing of red blood sells and leukocytes
• Stool culture
• Specimens should be plated lightly onto
MacConkey, xylose-lysine-deoxycholate, or
eosin-methylene blue agars.
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Serological test in dynamics with
fourfold title increasing in 10-14 days
Shigella
colonies
Salmonellosis
• an acute infectious disease of human
and animals, that is caused by the
numerous strains of Salmonella and
more frequent courses as gastrointestinal, rare – as typhoid or septic
form
Classification
1.
Local form
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2.
Gastrointestinal form
Bacterium carrying
General form
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Like typhoid fever
Sepsis
3. Asymptomatic form
II. Severity (mild, moderate and severe)
III. Course
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acute (up to 1.5 mo)
subacute (up to 3 mo)
chronic (about 3 mo)
IV. Complicated or uncomplicated
Salmonella Infection typical
color of feces, hemocolitis
Salmonella Infection,
severe hemocolitis
Salmonella Infection Typhoid form
Lab Studies:
• Complete blood count with differential
• Cultures: fecal, blood, urine, or bone
marrow.
• Stools examination: hemoccult positive
and positive for fecal polymorphonuclear
cells.
• Chemistry: Electrolyte tests may reveal
abnormalities consistent with
dehydration.
• Serologic tests in dynamics with fourfold
title increasing in 10-14 days
Dehydra
tion
Dehydration
Breast feeding
• In infants breast feeding must continue,
those, who are bottle feeding – receive
adopted milk formulas, better with low
lactose content
Lactosefree or
dairy
formulas
Probiotics
• during acute
period and for
3-4 weeks in
the recovery
period
Enterosorption
• For 5-7 days, in case of stools
normalization or constipation
development enterosorption should be
discontinued.
– Smecta
– Enterosgel
– Polysorb