Acute enteric infections in children: symptoms, treatment, prevention

Among all diseases in pediatric patients with acute enteric infection in children takes second place after colds. The disease is seasonal, peaking in summer and autumn. This contributes to the long stay of children on the street, eating unwashed fruits and vegetables, improper storage of cooked food.

Acute intestinal infections in children is a group of diseases of infectious nature with enteral (oral) mechanism of transmission of pathogenic and conditionally pathogenic microorganisms. The most common routes of transmission:

• alimentary or food – the bacteria is transmitted from dairy products;
• water – drinking contaminated water;
• contact-household – microorganisms get into the digestive tract through the dirty dishes, dirty hands, household items.

Classification of acute intestinal infections (AII) in Pediatrics

All infectious diseases affecting the intestine, it is common to classify by type of pathogen, whose presence is confirmed by laboratory tests. If pathogens are detected, but there are signs of acute illness, the state is diagnosed as "intestinal infection is not established etiology". Be sure to indicate which part of the digestive tract is damaged (thin or thick sections of the intestine).

When emergency hospitalization of the child, when there is no possibility to wait for the results of the diagnosis, but it is necessary to urgently carry out remedial measures, resorted to the classification by type of diarrhea, where all enteric infections are divided into three main groups.

Invasive

The first group – invasive. This type of infection is caused by bacteria that are able to multiply not only in the lining (epithelium) of the intestine, but also within the cell, which reaches. Pathogens – Salmonella, Clostridium, Shigella. In severe cases, these microorganisms enter the bloodstream and cause sepsis. Invasive infection suggests that inflammation develops in the thin or thick intestine (or covers the entire area of the body).

The severity of the invasive type is different, from mild inflammation (catarrhal enterocolitis), lesions and leaf tissue becoming necrotic wall of the intestine. Distinctive symptoms:

• vomiting;
• Express peristalsis and the release of intestinal contents;
• the impaired absorption of minerals and water, dehydration of the body;
• the increased formation of gases due to fermentation dyspepsia:
• stools numerous impurities – mucus, blood, parsley.

This group OKI is causing the child severe intoxication. It depends on the severity and outcome of the disease.

Non-invasive

The second group – secretory or non-invasive. The causative agents of these infectious diseases are parasitic only on the mucosal surface of the intestine – Escherichia, Vibrio cholerae, Streptococcus pneumoniae, Klebsiella, Campylobacter. A distinctive feature – the excessive secretion of salts and water in the epithelium of the bowel and the violation of their further absorption of the toxins of the bacteria.

In the pathological process involves only the small intestine, its mucosa is not inflamed. The main symptom is copious diarrhea. Stool thin, watery, but without any impurities. Related signs:

• body temperature rises slightly, to a maximum of 37.8°;
• joins vomiting;
• rapid dehydration child's body.

Osmotic

The second group of osmotic. Pathogens – Cryptosporidium, viruses (rotavirus or adenovirus infection). Actively multiplying in the cells of the mucosa, viruses inhibit the digestion and absorption of carbohydrates and water. With the participation of the intestinal microflora sugar begins to ferment, and in the intestine accumulates a lot of gas (flatulence).

The disease recorded in children of early age. More common in cold season (autumn-winter). The main symptom ─ sharp and intense abdominal pain. Express peristalsis and provoke profuse liquid diarrhea. The chair is yellow or green, with foam, with various impurities. The frequency of bowel movements up to 15 times a day. In babies symptoms of osmotic OKI appear suddenly, body temperature rises to 39°. Observed repeated vomiting.

Causes of infection in children

Susceptibility to infection varies and depends on several factors – age, immunity, social status and quality of life. Acute intestinal infection, the child develops in contact with the bacteria through your mouth. To infection occurred, the organism should get a certain number of pathogenic microbes. When introducing a foreign body the immune system of the child includes a protective function, killing bacteria under the action of saliva, gastric juice, immunoglobulins in the intestine. Children under 5 years are more susceptible to infection, as the protective forces of their organism has not yet been formed.

Factors contributing to the development of infectious disease:

• the use of water, which is not subject to filtration or boiling (dysentery);
• improper storage of food (a violation of the temperature regime), the failure of the technology of preparation of culinary dishes, use one cutting Board for foods that are eaten raw, and meat, fish;
• unwashedfruits, berries, vegetables (salmonellosis aureus, Streptococcus, E. coli);
• poor personal hygiene unwashed hands after walking in the street, using the toilet, before every meal (shigellosis, rotavirus infection, hepatitis a);
• contact in preschool institutions, General toys, a towel, a lack of processing of ware, the personnel carrier;
• swimming in prohibited places, polluted water bodies.

The symptoms of acute intestinal infection

In children the incubation period of the disease is short, from 30 minutes to several hours. In adolescence the first signs of infection can occur within hours after infection (depends on the cause, extent of injury, the body's immunity).

Signs of acute intestinal infections in children of the same type, regardless of the type of pathogenic organisms. The disease begins acutely. The first symptoms from the digestive system, then in children increases the dehydration of the entire body. Clinic develops on the background of severe intoxication.

Lesion syndrome

Pathological process developing in the lining of the intestine and leads to functional disturbances and morphological changes.

Functional changes:

• failures in the production of enzymes leads to insufficient breakdown of food;
• due to inflamed mucous membranes breaks down the process of absorption of nutrients, water, electrolytes;
• violation of the motility and peristalsis of all sections of the intestine.

Morphological or structural changes – hyperemia of the mucosa, thinning of the epithelium, formation of ulcers on the walls, the death (necrosis) of small sections of the inner shell.

Bowel syndrome in children is manifested by the reaction of the digestive system infectious agent:

• on the part of the stomach (gastritis), nausea, single or repeated vomiting, not bringing relief, heaviness in the epigastric region, the emergence of a gag reflex to the attempts of the receiving water or food, infants immediate regurgitation after ingestion of breast milk or infant formula;
• from the small intestine (enteritis) – bloating, pain of varying intensity in the region of the umbilicus with pressure on the abdomen, rumbling in the intestines;
• on the part of the colon – profuse diarrhea, liquid stool, contains impurities, pain when defecating, pain in waist circumference, is given in the rectum, cramps, nausea defecation.

Dehydration

Rapid dehydration is a dangerous symptom for the child's body. Lack of water leads to oppression of the kidneys, liver, brain. Rapidly changing quantitative and qualitative composition of the blood, which leads to disruption of intracellular metabolism. Lack of fluids contributes to the growth of concentration of toxic substances in the body, intoxication and poisoning can cause lethal outcome of the disease.

How to recognize the signs of dehydration in young children:

• dry mucosa of mouth and nose, dry lips, due to insufficient production of saliva expressed swallowing, the tongue speaks out;
• viscous saliva;
• the absence of tear fluid – a child cries without tears;
• from-for disorders of the kidneys urinating less than 1 time in 2 hours;
• vomiting, diarrhea, sweating – signs of dehydration;
• dry skin, independently folded.

Intoxication

Toxins produced by the bacteria quickly enter the bloodstream and spread throughout the body of the child. The presence in the blood of toxic substances leads to fever, causes pain and aching muscles, and bones. The kids can manifest itself twitching in the limbs. Because of the increased muscle tone head thrown back, eyelids closed bad. An important symptom of intoxication is a discoloration of the skin. The integuments turn pale, blue-tinted, cold to the touch. The skin may appear spots.

Failure of the kidneys causes an increase of acetone in the blood. This affects the vomiting center in the brain and causes vomiting, not associated with lesions of the gastrointestinal tract. In severe cases affects the large nerves and the trunks of the neurotoxicity. For this condition characterized by a disturbance of consciousness up to its loss, severe headaches, impaired motor activity, acute sensitivity to sounds and light.

Rash

If intestinal infection lasts a long time, the children appear on the skin rash:

• pustular – pustular formation rounded shape, the surface is white or yellowish formation (pus), is localized mainly on the face, neck, back, is observed in staphylococcal infection;
• maculopapular – a rash that is slightly raised above the skin, red, pink in color, sometimes with a brownish tinge, the elements may merge to form large spots, localized not only on the skin and mucous membranes, manifested in rotavirus infections;
• scarlatiniform – small, petechial rash all over the body, bright red color, the highest concentration on the face and neck, is observed in infections caused by gram-negative bacteria (Shigella).

On the background of the main symptoms of the child increases the liver and spleen. Anemia and vitamin deficiencies.

Complications of infectious process

According tofrom the disease, complications of intestinal infections can be vulnerable or to present a real threat to the life of the child.

The most frequent consequences of the disease:

1. Goiter – deficiency of conditionally pathogenic microflora, which lives in the intestine and participates in the processes of digestion. This imbalance of the quantitative composition of the flora occurs as a result of prolonged inflammatory process due to antibacterial drug therapy.
2. Perforation of the intestinal wall (the gap) infection thins and destroys the wall. Perforation is characterized by acute pain that you cannot tolerate blood loss, the development of peritonitis. Elimination only by surgery.
3. Intestinal bleeding is a common complication of intestinal infections. Their intensity is different. Often with the OKA blood loss is minor and does not pose a threat to the lives of young patients, provided timely stop. For staining of feces in the blood determine the localization problem. If the blood is scarlet on the surface of the stool, the damaged lower parts of the colon. When bleeding from the small bowel feces soaked with blood. If the stool stool painted maroon go with dark brown color, it says bleeding in the duodenum or stomach.
4. Accession bacterial infection of the middle ear and upper respiratory tracts – a complication occurs in infants. Escherichia coli, staphylococci are often the cause of otitis media. They infect the follicles of the ear canal. This contributes to reduced immunity during primary disease.
5. Intussusception of intestines – type of obstruction, when one part is embedded in another. In 90% of cases occur in infants first year of life. Reasons – violation of peristalsis and the presence of inflammatory process. Acute attacks interspersed with the sudden disappearance of the symptoms. Addressing complications of both surgical and medical.

The most threatening complication for a child is infectious-toxic shock. Often develops in salmonellosis. Cause of mass death and decay of pathogenic bacteria, which is accompanied by release of huge amounts of toxins.

The child is in a state of shock. There is a strong fever, blood pressure falls, heartbeat slows down. The child appears short of breath. The condition with each minute worsens.

Then agitation is replaced by stupor. Appears confusion. Body temperature starts to decrease, the skin becomes bluish. Sharply decreases the amount of urine (stop kidneys). Under the skin is clearly visible hemorrhage.

Signs of progressing shock:

• hypothermia;
• total cyanosis;
• the absence of a pulse;
• pressure below 70 mm Hg. article, or is not defined.

In the absence of resuscitation shock goes into a coma.

Differential diagnosis of the OKA

In order to properly identify the infectious agent, it is important to gather medical history and determine the history: when were the first symptoms, slowly or acutely developed the disease, were treatment at home and how it affected the health of the child.

Then move to the collection epidemiologicheskogo history: find out a potential source of infection, what was the transmission mechanism, establish the path of infection.

Objective examination – visual inspection, definition of symptoms and syndromes. These data put the preliminary diagnosis. In order to confirm it, conduct laboratory testing of stool, urine, blood, vomit.

Laboratory methods of diagnostics:

1. Microscopic or microscopy method under a microscope to see biological material taken from the patient. Smear-imprint stained with special dye, which gives the possibility to determine the causative agent. Advantage of the speed, the result is ready in a few hours.
2. Immunofluorescence method – the use of specific serums containing antibodies to the alleged causative agent. Refers to early diagnosis.
3. Bacteriological method – selection of (growing) a pure culture, followed by study of the characteristics and properties of pathogenic microorganisms. The average duration of study is 4 days. The result of the seeding was accurate, the material must be delivered to the laboratory immediately (within 2 hours).
4. Serological method – detection of antibodies in the serum of the child. The study is reliable and accurate.

According to testimony carried instrumental diagnosis – ultrasound of abdomen, colonoscopy, sigmoidoscopy, laparoscopy.

Methods of treatment of intestinal infection in children

Modern diagnosis and treatment of acute intestinal infections includes complex interventions. Clinical guide that reglamentary the work of a doctor, three directions in the treatment of the OKA.

In the first place is etiotropic therapy is the use of specific drugs aimed at the destruction of the pathogen. Based on the antibiotics of natural origin and chemotherapeutic drugs – substances derived by chemicalsynthesis.

Used group of drugs:

• Penicillins;
• Cephalosporins;
• Macrolides;
• Tetracycline;
• Chloramphenicol;
• Aminoglycosides;
• The sulfonamides.

In second place – pathogenetic therapy. It is aimed at elimination of violations and malfunctions of the internal organs. Also this treatment strengthens the protective mechanisms of the child's body – detoxification, rehydration, anti-inflammatory therapy.

Last is a symptomatic treatment. But to eliminate the infectious process has no effect. Its main task is to facilitate the well-being of the child.

Tactics of therapy of acute intestinal infections includes not only the use of drugs, but also organizational and security measures, child care during the rehabilitation period.

Intestinal infection in a child treated without difficulties. This is due to the malleability of the child's body and the instability of bacteria to antibiotics. With proper and timely treatment of the favorable outcome of the disease. In a quarter of cases can form functional disorders of the pancreas, bile ducts, dyspepsia. These conditions are easily corrected with drugs (enzymes), and with the growth and maturity of the child are.

Prevention OKI

Prevention of acute intestinal infections includes the following measures:

• compliance with sanitary and hygienic norms as a child and the parents;
• compliance with the technological rules of food processing and cooking;
• the correct implementation and storage of food.

Guidelines to prevent the spread of the outbreak – detection of the disease in the early stages, isolation of the child with an intestinal infection, hospitalization. In epidemiological need for the patient to provide a separate box (the special chamber).

In order to prevent and prevent relapse after discharge, the first month the child should be actively observed in the clinic (medical examination).

Treatment of acute intestinal infections in children, even if the boy's condition is satisfactory should not be undertaken at home. The lack of professional control by doctors over health may lead to negative consequences.