Acute enteric infections:

etiology, clinical features,

principles of treatment

Lecture for the V year foreign students

Assistant professor T. Sirotchenko
Chair of pediatrics and children’s infection
disease
• Acute enteric infections are
infections poly-etiological
diseases (virus, bacterial,
fungal, parasitical) with fecal
– oral mechanism of the
transmissions and with
morbid affection on the
different parts of the
intestines.
• According the international
classification all diarrheal
diseases may be dividing on
two groups: infection and
non-infection. The infection
diarrhea may be dividing on
invasive group (inflammatory,
bleeding) and secretory
(non-inflammatory, watery).
• Rotavirus, Adenovirus, Coronavirus,
Reovirus, Vibrio Cholerae, Escherichia
coli (some types), pathogenic fungi,
protozoa cause the secretory diarrheas.
• Shigella, Salmonella, Escherichia coli
(some types), Yersenia enterocolitica,
Campylobacter, Clostridium,
Staphylococcus, lamblias, entmoebas
cause the invasive diarrheas.

• Pathogenesis of diarrhea of AEI have

such mechanisms as: osmotic,
secretory, inflammatory
Osmotic mechanism of diarrhea
(under virus AEI).
epithelium
damages of the intestines
Virus

increases
the level
of the disaccharidases
(lactase, maltase, sucrase).

Disaccharides
accumulate
in the cavity of intestines,
decrease the osmotic pressure,
hinder absorption of the water
Secretory mechanism
(AEI with the enterotoxin
ferment
Enterotoxin activates (adenylatcyclase)

increases the synthesis

of the cyclic nucleotides

stimulates the penetration of the cell’s

membranes and increases
he secretion of the water and electrolytes
 Inflammatory mechanism
(invasive diarrheas). synthesis
of the inflammation’s
mediator
(prostaglandins,
Invasion the pathogen histamine,
mati on
in the wall inflam serotonin
of the intestine and cytokines)

cell’s membranes are damaged,

the microcirculation is broken,
intestinal motility is intensified.

exudates (with the blood, protein, mucus)

are in the cavity of intestines,
dimension enteric contents
are increased,
quantity of the fluid is increased too.
 Echerichiosis
Echerichia coli,
gram - negative colibaccilius,
non spore - forming bacteria,

Enteropathogenic
(O111, O55, O25, O44, O127)

Enterohaemorrhagic
Enteroinvasive (O159, O121, O126, O145
(O28, O124, O151, O143);
Enterotoxigenic
(O1, O2, O6, O9);
Echerichiosis
• The sources of infection are ill person
and bacteriocarries.
• Mechanism of the transmissions is fecal
– oral.
• The ways of the transmissions are
alimentary, watery, contact and
domestic.
• Incubation period - 3 - 6 days.
 Clinical algorithm:
Echerichiosis
• intoxication
• vomiting, regurgitation
• faeces – watering, canary with the
glassy mucous admixtures
• pain in stomach, haemorrhagic
colitis
 Echerichiosis ( clinic course)
• Beginning of disease is increase of temperature
(37,5-380C), intoxication, disorders of the
function of the intestines (remiss faeces,
vomiting, regurgitation, increasing of the
appetite) during first 5 days.
• Next faze ( 2-5 days) watering, canary faeces
with the glassy mucous or blood’s admixtures;
vomiting 1-2 times during day, prolonged and
persistent bloating of stomach and palpatory
tenderness, dehydration, decreasing of body’s
mass.
• Next faze- decreasing of the temperature and
intoxication, normal faeces, recovery
Laboratory tests:
• epidemiological anamnesis
• blood ad urinal tests
• coprocytogramm ( microscopy of faeces)
– presence of the mucus, leucocytes,
epithelial cells
• haemoagglutination reaction (HGA) – on
the 2-3- days and on the 10-12 days of
disease
• express – test ( method of the
luminescence) – detection of the
Escherichia
 Shigellosis
Pathogen –
Shigellae, gram - negative colibaccilius,
aerobe

A (Sh. Dysenteriae)

B (Sh. Flexnery) D (Sh. Sonnei)

C (Sh. Boydi)
 Shigellosis
• The sources of infection are ill person and
bacteriocarries.
• Mechanism of the transmissions is fecal –
oral.
• The ways of the transmissions are
alimentary (Sh.Sonnei), watery (Sh.
Flexnery), contact and domestic,
“alimentary line” take place – from
beginning to end
• Incubation period – 0 (some hours) - 6 days.
Shigellosis: Children of the
preschool and school age
• acute beginning of disease ( increasing the
temperature – 38-40C, regurgitation,
vomiting, decreasing of the appetite, head
ache, toxic encephalopathy)
• periodical pain in the stomach
• spasm and pain in the sigmoid colon
• faeces – green, frequent, remiss,
nonplentiful, with mucous, blood and
purulent admixtures, “dysenteric or rectal
spit” -
• relaxation of the external sphincter muscle
of anus or incompletely closed anus
Shigellosis: Children of the
early age
• acute beginning of disease, severe
toxicosis, affections of the nervous
and cardiovascular system
• toxic encephalopathy - disorders of
the consciousness, convulsions,
disorders of microcirculation
• enterocolitis
• prolonged clinical course
 Rectoromanoscopic picture of
shigellosis.
Clinic classification of the
dysentery
Type Severity Clinical
course
Typical form slight Acute ( under
1 month)
Atypical moderate
forms: Prolonged
severe: ( under 3
low-grade month)
with the toxic
dyspeptic symptoms
Bacterio-
subclinic with the local carrier
process
hypertoxic
Laboratory tests:
• epidemiological anamnesis
• blood ad urinal tests
• coprocytogramm ( microscopy of faeces) –
presence of the mucus, leucocytes,
epithelial cells
• bacteriologic tests – until beginning the
treatment – inoculation of the some
mediums (agar and so on)
• haemoagglutination reaction (HGA) – on the
2-3- days and on the 8-10 days of disease
(uninformative)
• express – test ( method of the luminescence)
– detection of the Shigella
•
 Salmonellosis
Pathogen –
Salmonellae ,
gram - negative facultative colibaccilius,

A
(Salm. typhimurium)
D
C
(Salm.
B (Salm. infantis
London
(Salm. virchov)

E F
(Salm. anatum) ( Salm. enteritidis)
Salmonellosis
• The sources of infection are ill person
and bacteriocarries, animals.
• Mechanism of the transmissions is
fecal – oral.
• The ways of the transmissions are
alimentary, watery, contact and
domestic. Factors of transmissions
are pork, meat of poultry, beef, eggs
and egg’s dishes.
Salmonellosis
TypClinic Severity Clinic course
classification
of the typhoid
fevere
Typical forms: slight Acute ( under
a. localized 1 month)
(gastritis moderate
entheritis Prolonged
gastroenteritis and severe ( under 3
so on)
month)
b. generalized
( such a typhus,
Chronic
septic) ( more than 3
Atypical forms:
month)
Salmonellosis: Children of the
preschool and school age
• prolonged fever, vomiting
• coated tongue abdominal
swelling morbidity and
borborygmus in the right iliac
part
• faeces have green mucus, blood
and stinking odor
• heratosplenomegaly
Faeces of patient with
salmonellosis.
Salmonellosis: Children of the
early age:
• - gradual clinical course
• - severe toxicosis and exycosis
• - heamocolitis, heratosplenomegaly
• - septic form of disease
• - mixed – infections, complications
• - incidence of the forming of the
bacteriocarrier
Laboratory tests:
• epidemiological anamnesis
• blood ad urinal tests
• coprocytogramm ( microscopy of
faeces) – presence of the mucus,
leucocytes, epithelial cells
• bacteriologic tests of faeces, blood
and vomit masses, foodstuff– in first
days, inoculation of the some
mediums (bile salt agar and so on)
Typhoid fever
• Pathogen is Salmonella typhi, gram - negative
facultative colibaccilius from D group.
• The sources of infection are ill person and
bacteriocarries.
• Mechanism of the transmissions is fecal –
oral.
• The ways of the transmissions are alimentary,
watery, contact and domestic. Factors of
transmissions are use of the water or
swimming in the indoor reservoir
Typhoid fever
Type Severity Clinic course
Typical forms slight Without the
complications
moderate
Atypical With the
forms: severe: complications:
toxic, early, late, allergic,
septic heamorrhagic, with
the nervus purulent
with the syndrome
With the acute
separated with the etnteric condition
affections syndrome
With the relapse
with
rudimentary cardiovascular
syndrom
 Typhoid fever: Children of the
preschool and school age
• acute beginning with the high temperature
• head ache with the disturbances of the sleep,
dizziness, status typhosus
• pale skin, nonplentiful pink maculopapular rush,
which disappears after thumb pressure
• coated dry reinforced tongue with the imprint of
the teeth
• hepatosplenomegaly
• bradicardia, dry and bubbling rales in the lungs
• constipation
 Typhoid fever: Children of the
early age:
• - acute clinical course with high fever
• - bad appetite, dyssomnia, nervoness
• - vomiting, spasms, mental confusion
• - severe toxicosis and exycosis, diarrhea – 10-15
time during day, green mucus
• - hepatosplenomegaly, enteroparesis
• - maculopapular rush is very pale or is absent
• - taxicardia, bacterial complications – otitis,
pneumonia, stomatitis
. Roseoles ("rose spots") in
patient with typhoid fever
Laboratory tests:
• epidemiological anamnesis ( village stay-
пребывание в деревне, swimming in the
reservoir, use the milk or milk’s product)

• blood ad urinal tests

• bacteriologic tests of blood ( three times
during first days on the height of the fever),
faeces ( during second week of the disease),
and urine (during third week of the disease)
• serological tests – reaction of the indirect
haemagglutination (RIG) with the
erythrocytic antigen– after 6-7-days of
disease, Vidal ‘s reaction – after 2 weeks of
disease, RIG with the Vi- antigen – after 3
weeks of disease – for the diagnostic of
bacteriocarries.
Paratyphoid A,B and C
• Pathogen is Salmonella paratyphii, gram –
negative, anaerobe colibaccilius from A,B
and C group.
• The sources of infection are ill person and
bacteriocarries.
• Mechanism of the transmissions is fecal –
oral.
• The ways of the transmissions are
alimentary (paratyphoid B), watery
(paratyphoid A), contact and domestic.
• Factors of transmissions are foods (milk,
salads, ice-cream, berries and vegetables),
water, household goods
Main clinical sings of the
paratyphoid A
• children of the preschool and school age
• incubation period – 5-20 days
• - acute beginning, fever, head ache, pain in the
stomach
• - diarrhea - abdominal swelling, morbidity
along the full length and borborygmus
• - catarrhal inflammation on the fauces, herpes,
conjunctivitis
• - enteric bleeding, necrosis of intestine, enteric
perforation
Main clinical sings of the
paratyphoid B
• children of the early age
• incubation period – 1-14 days
• specific intoxication with the
gastroenterocolitis or enterocolitis
• acute beginning, fever, head ache, vomiting,
diarrhea
• pale skin, maculopapular rush after 3-5-
days of disease
• hepatosplenomegaly
Laboratory tests:
• epidemiological anamnesis use the milk or
milk’s product or some another products)

• blood ad urinal tests

• bacteriologic tests of blood ( three times
during first days on the height of the fever),
faeces ( during second week of the disease),
and urine (during third week of the disease)
• serological tests – reaction of the indirect
haemagglutination (RIG) with the erythrocytic
antigen– after 6-7-days of disease, Vidal ‘s
reaction – after 2 weeks of disease, RIG with
the Vi- antigen – after 3 weeks of disease – for
the diagnostic of bacteriocarries.
Cholera
• Pathogens are Vibrio choleare and Vibrio El
-Tor , gram – negative, aerobe vibrions.
• The sources of infection are ill person and
bacteriocarries.
• Mechanism of the transmissions is fecal –
oral.
• The ways of the transmissions are
alimentary, watery, contact and domestic.
Factors of transmissions are fruits, berries
and vegetables, infection water, fish,
shrimp, crabs, clams
Clinic classification of cholera
Type Severity Clinic course

Typical forms slight Acute

Atypical moderate Without
forms: complications
severe
low- grow With the
complications:
subclinic
pneumonia, shock
fulminant
dry
 Cholera : Children of the
preschool and school age

• acute beginning with the severe diarrhea,

vomiting, without pain in the stomach and
spasms
• vomit masses are rice – water or lactoserum
• subnormal temperature
• acrocyanosis, laundress’s hands
• aphonia, husky voice, tachypnea, tachycardia,
anuria
Cholera :Children of the early
age
• severe clinic course with the
complications
• beginning of disease with the high
temperature and intoxication
• quickly developing of the hypotonic
exicosis
• affects of the CNS
• hypocaliemia, hypoglycemia
 Laboratory tests: Cholera
• epidemiological anamnesis (use the fish, shrimp,
crabs, clams or some another products)
• blood ad urinal tests
• biochemical tests: level of the Na and K, creatinine,
urea, general protein
• microscopy of the native smears of the feces ( may
be find of the morphological virions)
• bacteriologic tests of blood, faeces under
beginning the treatment
• express – diagnostic ( method of the luminescent
antibodies) - after 3-5 hours
• – method of the immobilization and micro
agglutination with the specific anticholera 01 –
serum) - answer after some minutes
Yersinia’s infections
• Pathogens are Yersenia enterocolitica and
Yersenia pseudotuberculosis, gram –
negative, aerobe.
• The sources of infection are ill person and
mouse, rat, dog, cat, pig, caw, sheep
• Mechanism of the transmissions is fecal –
oral.
• The ways of the transmissions are
alimentary, watery, contact and aerogenic.
Yersenia enterocolitica: main
clinical sings
• acute beginning with the pain in the stomach, pain
and borborygmus in the iliac parts, sickness
• general intoxication – head ache, pain in the joints,
chill
• exanthema ( punctulated, in the axillary region and on
the chest, around the joints, may be with hemorrhagic
character
• icteritiousness of the skin, hepatomegaly, hepatitis
• hyperemia of the plants and palms
• fever
• diarrhea – with the green mucus, 10-15 time in day
• lymphadenopatia
 Yersenia pseudotuberculosis:
main clinical sings
• Incubation period – 3-18 days
• acute beginning with the general symptoms of
intoxication ( head ache, fever, pain in the muscles and
joints, pain in swallowing, scratch in the throat
• exanthema – little maculas on the skin of the throat,
axillary and inguinal regions, white dermographism
• hyperemia of the conjunctivas, scleritis, catarrh of the
respiratory tracts, cough, hyperemia and edema of the
face ( symptoms of the “ hood” and “ glasses”
hyperemia and edema of the plants and palms
( symptoms of the “ gloves” and “ socks”)
• pain and borborygmus in the iliac parts, pain in the
stomach, sickness, vomiting
• diarrhea – 2-3- time in day
• hepatitis, arthritis, splenomegaly, lymphadenopatia
Pseudotuberculosis
Pseudotuberculosis
Laboratory tests:
• epidemiological anamnesis (use the dirty
fruits and vegetables, milk’s and meat’s
products without the thermal treatment)

• blood (leucocytosis, neuthrophylosis,

lymphopenia, eosinophilia) ad urinal tests
• bacteriologic tests of blood, urine, mucus,
pus and faeces ( three times during first
days on the height of the fever)
• serological tests – RHA during dynamic of
disease
Rotavirus infection
• Rotavirus infection is acute infection disease it is
caused by viruses from family of REOVIRUS, it is
characterized by disorders from digestive tract and
respiratory tracts.
• The sources of infection are ill person or virus
carrier.
• Mechanism of transmission is fecal - oral
• Ways of transmission is contact-domestic – by food,
water.
• Entry of infection is peptic (digestive) tract.
• Epidemiology’s features – winter - spring
seasonality, high contagiously, early age of the
children, especially – babies
 Clinic classification
TYPE Severity Clinic course
Typical: Slight Acute
Prolonged
Gastroenteritis Middle weight
Without
Gastritis Severe complications

Enteritis With

complications
Atypical:
Low – grow
Sub clinical
 BASIC CLINICAL SINGS OF
TYPICAL FORM:
• Acute beginning with the febrile temperature and
vomiting during 1-2
days.
• Urges to defecate arrear suddenly, is accompanied
by grumbling in the intestine, meteorism. Faeces
are liquid, watery and foamy with light color,
without pathological admixtures or with the mucus,
with heavy smell, from 5 до20 times per days.
• Signs of exicosis.
• Respiratory syndrome is beginning from the 2-З
days of illness without tendency
to growth.
FEATURES OF CLINIC COURSE
(children of the early age):
• Beginning from the severe symptoms of
intoxication (languor, adinamia, mottled skin ),
cyanosis, cramps, and cardiovascular
disorders.
• On 2-3 days of illness child has maximum of
the exicosis of 2-3 degrees.
• Rotaviral infection can be connected with the
bacterial affects of intestine. In this case
pathological admixtures appear in the faeces
(mucus, blood, and pus).
• Duration of illness may be to10-14 days.
SPECIFIC METHODS OF
LABORATORY DIAGNOSTIC

Rotatest – RHA with erythrocytes,

accumulated with the rotaviral
antibodies. Express method- result
during 2- 4 hours.
• Serological method – diagnostically
titers is more then 1: 16
• IFA( IgM)