Features of infectious diarrhea and methods of its treatment. All about infectious diarrhea

For quotation: Ivashkin V.T., Sheptulin A.A. Infectious diarrhea in the practice of a general practitioner // RMZh. 2000. No. 2. P. 47

Diarrhea of ​​an infectious nature is currently one of the most common diseases and ranks second in frequency after acute inflammatory diseases of the upper respiratory tract. For example, in the countries of Africa, Asia (excluding China) and Latin America, every year in children under

Literature
1. Speelman P. Acute gastrointestinal infections and their complications. Current topics in gastroenterology and hepatology (Ed. G.N.J.Tytgat, M. van Blankenstein). Stuttgart-New York, 1990; 81-7.
2. Ivashkin V.T. Infectious diarrhea in the practice of a gastroenterologist. Ross. magazine gastroenterology, hepatology, coloproctology. 1997; 5; 51-7.
3. Slutsker L., Ries A.A., Greene K.D. et al. Escherichia coli 0157: H7 diarrhea in the United States: clinical and epidemiologic features. Ann. Intern Med. 1997; 126:505-13.
4. Bogomolov B.P. Diarrhea in the differential diagnosis of infectious diseases. Wedge. honey. 1997; 7: 8-12.
5. McQuaid K.R. Diarrhea. Current medical diagnosis & treatment (Ed.L.M.Tierney, S.J.McPhee, M.A.Papadakis). 38th Ed. Appleton & Lange. Stamford, 1999; 546-52.

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Diarrhea of ​​infectious origin

Diarrhea is one of the most common symptoms in the practice of gastroenterologists. The reasons for its appearance are varied and may indicate many diseases that are not directly related to the gastrointestinal tract.

Very often, the painful condition occurs unexpectedly and is accompanied by vomiting. Diarrhea of ​​infectious origin, observed with dysentery, is accompanied by increased frequency of stools and the transformation of feces into watery formations. The liquid has a green or yellow color. In more rare cases feces reminiscent of rice broth. Sometimes they are mixed with mucus and blood. As a result of infectious diarrhea, which occurs against the background of the onset of vomiting, dehydration of the patient’s body occurs, as a result of which his appearance undergoes certain changes: facial features become sharper, additional folds appear on the skin that were not there before, and in general, the skin acquires a bluish tint. Heart sounds become muffled and decrease arterial pressure, urine output decreases. There is not always an increase in body temperature; palpation of the abdomen does not cause any unpleasant sensations.

• fever-like condition;
• a lot of sweating;
• abdominal pain, which is cramping in nature;
• depressed state, drowsiness, lethargy;
• feeling of dehydration, feeling of constant thirst.

Subject to change clinical picture diseases depending on the pathogen causing the process. If it is caused by campylobacter, the disease has symptoms similar to appendicitis. If there has been infection with salmonella, meningitis, pneumonia, and purulent pathologies may occur internal organs. Manifestations of anemia and kidney failure are very common after exposure to E. coli, which causes a painful condition

In acute form infectious diarrhea more severe symptoms are observed. It is characterized by the presence of an infectious period in the development of the disease, which lasts from six hours to three days. In this case, vomiting may occur, body temperature may rise, abdominal pain and fever may increase.

Infectious diarrhea in children

Infectious diarrhea in adults

Almost always, the occurrence of infectious diarrhea indicates the onset of diseases of the gastrointestinal tract. Adults often suffer from diarrhea due to poor diet and other factors. If diarrhea is not treated on time, it easily develops into a chronic form.

Recurrences of infectious diarrhea are possible, lasting for several weeks. In these cases we can talk about chronic forms diarrhea due to ulcerative colitis, oncology of the rectum, disruptions in the absorption processes in the body.

Infectious diarrhea treatment

The attending physician should have in his arsenal the means and methods of treating the most various forms acute diarrheal infections. Perhaps the manifestation is not too severe forms course of infectious diarrhea, which may well be curable at home. Gastroenteric variant acute form infectious diarrhea requires medical care which involves gastric lavage with water or sodium bicarbonate solution, concentration 0.5%. At the same time, it is quite ordinary tap water to ensure that the washing is carried out efficiently. To lavage the stomach, a special probe is used, with a funnel at the lower end, which rises and falls like a siphon. If, by all means, use it for washing only boiled water, pre-cooled before the procedure, this will delay the washing process. The process itself is carried out before clean rinsing water in a volume of at least six liters has left. Washing without using a probe is possible only in case of group poisoning, in cases where it is not possible to use the probe on all patients.

Once the stomach has been sufficiently rinsed, oral hydration should be administered. Not every liquid is suitable for this. The task is to replenish not so much the lost fluid itself, but electrolytes, such as potassium and sodium electrolytes. Absorption of electrolytes does not occur in cases where there is a lack of glucose in rinsing solutions. In addition, if the solutions do not contain carbohydrates, they begin to act as a strong laxative and diarrhea only intensifies. Failure to understand this principle can be classified as gross medical errors. This does not solve the problem of treating infectious diarrhea; only a complication of rehydration is possible.

Diarrhea due to infectious diseases

Diarrhea having infectious nature, is one of the most common diseases today and is in second place after acute inflammatory diseases of the upper respiratory tract. Only in one tenth of all cases, the causative agents of infectious diarrhea are viruses, and the cause of this disease is often difficult to establish even in a specially equipped laboratory.

In case of diarrhea resulting from an infectious disease, it is the properties of the infectious agent that determine the course of the disease. Decreased stomach acidity can also cause diarrhea when infectious disease. Besides, a large number of entering gastrointestinal tract microorganisms also contributes to the development of infection, along with the resistance of the pathogen to acidic environment. In an adult, the development of infectious diarrhea rarely causes complications that seriously threaten his health.

Symptoms of diarrhea with infectious lesion the body can be varied, ranging from diarrhea with blood, accompanied by attacks of severe pain, to the onset of dehydration. In the latter case, it may occur light form diarrhea accompanied watery discharge. Such symptoms may not last long, on average up to a week.

Acute diarrhea is watery, loose stools with a frequency of more than 3 times a day, more than 200 r/orbital, or loose stool with blood more than 1 time per day. The duration of acute diarrhea does not exceed 14 days.

Surgical diseases of the abdominal organs,

Acute infectious diarrhea,

Nosocomial infections

Non-surgical diseases

Functional disorders of the gastrointestinal tract.

To the acute surgical diseases include - appendicitis, inflammation of the appendages, diverticulosis, intestinal perforation, nonspecific inflammatory diseases intestines. Non-surgical diseases include systemic infection, malaria, typhus, nonspecific inflammatory bowel diseases, ischemic enterocolitis, drug intoxication, irritable bowel syndrome, endocrinopathies, radiation therapy.

Acute infectious diarrhea combines about 20 bacterial, viral, protozoal or helminthic diseases and is the most common cause of acute diarrhea.

In bacterial infections, diarrhea is associated with the production of enterotoxins, which, through the activation of natural intracellular mechanisms, increase the secretion of fluid and electrolytes into the intestinal lumen, which leads to the development of dehydration.

Enterotoxins do not cause structural changes in the intestinal mucosa.

If the pathogens produce only enterotoxin, then the disease occurs in gastroenteric and gastric variants, characteristic of foodborne toxic infection, purpose antimicrobials in these patients is inappropriate. Some infectious diarrhea pathogens produce cytotoxins that damage epithelial cells and cause inflammation.

The invasiveness of bacteria leads to inflammation in the submucosal layer of the intestine, the formation of ulcers and erosions on the mucous membrane. Bacteria are able to penetrate the cytoplasm epithelial cells, destroying them.

Traveler's diarrhea

Traveler's diarrhea (TD) - considered a form of acute infectious diarrhea. Infection with it when traveling to the countries of Latin America, Africa, Asia and the Middle East is 30–54%, to the countries of Southern Europe - 10–20%, Canada, countries of Northern Europe - less than 8%. Transmitted through raw fruits, vegetables, water, seafood, ice cream, unpasteurized milk; development is facilitated by changes in nutritional patterns, climatic features of the country and stress... In 25–60% of cases of DP, the causative agent of the disease is toxigenic Escherichia coli.

Also distinguished:

Salmonella spp.

Shigella spp.

Klebsiella enterocolitica.

Staphylococcae cause acute infectious diarrhea by producing toxins in food that cause food poisoning.

Viruses cause acute infectious diarrhea in 10% of cases. It is quite difficult to determine the cause of acute infectious diarrhea even in a well-equipped laboratory.

The pathogenicity and virulence of the pathogen and the immunological reactivity of patients determine the severity of the symptoms of acute infectious diarrhea. The occurrence of acute infectious diarrhea is facilitated by the reduced acidity of the stomach contents, a large number of microbial cells massively entering the gastrointestinal tract, and the resistance of the pathogen to hydrochloric acid. In adults, acute infectious diarrhea rarely leads to the development of severe, life-threatening complications.

The severity of the disease in travelers' diarrhea is determined to a large extent by emotional experiences due to the disruption of the traveler's plans. The prognosis is serious in patients in the high-risk group, which include children under 5 years of age, people over 60 years of age, people with inadequate immunity: alcohol abusers, taking corticosteroids, undergoing chemotherapy or radiation therapy, suffering systemic diseases, acquired immunodeficiency syndrome.

Symptoms of acute infectious diarrhea can range from frequent bloody diarrhea with severe abdominal pain and dehydration to relatively mild, watery diarrhea. Most sporadic cases of acute infectious diarrhea last no more than 3–6 days.

Symptoms of acute infectious diarrhea

Symptoms of acute infectious diarrhea, depending on the severity, are divided into: acute profuse diarrhea: watery, bloody, bloody; dehydration: mild, moderate, severe; intoxication: medium degree, severe, shock; abdominal pain: tenesmus, cramping pain, acute stomach; fever: low-grade (37.5 °C), febrile (38 °C); nausea/vomiting: mild, severe.

Acute infectious diarrhea of ​​bacterial origin is more severe and more unfavorable than viral diarrhea due to damage to the mucous membrane by enterotoxins. The incubation period of acute infectious diarrhea ranges from 6–8 hours to 3 days.

Coccal infections and salmonellosis are characterized by a shorter incubation period. Bacterial acute infectious diarrhea is accompanied by severe intoxication, significant deterioration general condition patient, dehydration, headache, fever up to 38–39 °C, nausea, vomiting. With widespread infection, symptoms of irritation of the muscle membranes, muscle and osteoarticular pain may appear.

Bacterial acute diarrhea always accompanied by painful tenesmus (the urge to defecate) and cramping severe pain in the stomach, and in dysentery it leads to bloody stools. Men may develop Reiter's syndrome: arthritis - inflammation of the joints, conjunctivitis - inflammation of the conjunctiva of the eyes, urethritis - inflammation of the urethra.

Based on the characteristics of the course, several of the most typical variants of viral or bacterial acute infectious diarrhea are distinguished. Infection with E. cole leads to watery diarrhea without clinically significant dehydration (dehydration): watery stools 4–8 times a day, low-grade fever no more than 2 days, unexpressed abdominal pain and vomiting last no more than 2 days, palpation of the abdomen is painless.

Bloody stools are often caused by salmonella, E. coli, and Shigella dysentery. At the beginning of the disease - watery diarrhea, after 1–2 days frequent stool(10–30 times a day) small volume, consisting of blood, mucus and pus; abdominal pain, tenesmus - false urge to defecate, febrile - heat body, fever, slight dehydration (dehydration), pain on palpation of the abdomen, hemolytic-uremic syndrome - blood breakdown and increased urea levels in the blood, sepsis.

Watery OID with clinically significant dehydration requires the first exclusion of cholera. It has a sudden onset, is profuse, is accompanied by severe dehydration, absence of fever and abdominal pain, palpation of the abdomen does not cause pain, and convulsions may develop.

For diagnostic purposes, carry out microbiological examination and dark field microscopy of feces. Travelers' diarrhea occurs 2-3 days after the start of the trip. In 80% of patients, the frequency of stools is 3–5 times a day, in 20% - six or more times. In 50–60% of cases, fever and abdominal pain occur; blood in the stool is observed in only 10% of patients.

The duration of the disease does not exceed 4–5 days. Algorithm for managing such patients: in cases where a patient with diarrhea has “alarm symptoms” - temperature above 38.5 °C, feces mixed with blood, severe vomiting, symptoms of dehydration - the patient is prescribed bacteriological examination stool, determination of the toxin (if diarrhea occurred while taking antibiotics), sigmoidoscopy and specific therapy, depending on the changes detected. In the absence of such symptoms, therapy includes symptomatic remedies, if there is no improvement within 48 hours, an examination is necessary.

Gastroenteritis

Gastroenteritis is one of the most common variants of acute infectious diarrhea. Complexity differential diagnosis This variant of the course of the disease is that in some cases it develops in conditions not associated with infection - acute appendicitis.

From the group of acute infectious diarrhea, the gastroenteric variant most often develops with foodborne toxic infections (PTI), bacterial OIDs with a secretory mechanism for the development of diarrheal syndrome, viral gastroenteritis, cryptosporidiosis and giardiasis (giardiasis).

The article uses materials from open sources:

Acute infectious diarrhea is one of the leading causes of death in the world. More than 4 million children under 5 years of age die from acute infectious diarrhea. In developed countries (USA) there are certain groups of the population that have increased risk diseases intestinal infections(Table 5-5). Most cases of acute diarrhea are caused by bacteria or viruses, but the cause is often unknown. Some bacterial infections sometimes they go away on their own, without treatment and therefore are not recognized. Comparative characteristics The reasons that most often contribute to diarrhea are given in table. 5-6.

Table 5-4.

(From: KellyW. N.. ed. Textbook of Internal Medicine. Philadelphia: J. B. Lippincott, 1989: 672.)

Diarrhea due to bacterial infections is accompanied by many symptoms, but based on their totality they can be fundamentally divided into two groups: inflammatory and non-inflammatory (Table 5-7). In noninflammatory diarrhea, microorganisms multiply in the intestines and/or produce toxins that cause “watery” diarrhea without bleeding. These enterotoxins stimulate secretion without damaging mucosal cells. In inflammatory diarrhea, microbes and/or their toxins damage the cells of the intestinal lining and cause inflammation. In this case, the stool can be bloody, for example with dysentery, and patients complain of general disorders, such as fever and abdominal pain.

Table 5-5. GROUPS high RISK INFECTIOUS DIARRHEA DISEASES

Recent travel

Returnees from developing countries

Peace Corps workers

Users of water from natural sources

"Unusual" food

Seafood and shellfish, especially raw

Eating in restaurants, especially fast food

Banquets and picnics

Homosexuals, prostitutes, drug addicts

"Gay Gut Syndrome"

Nannies, housewives

Contact with children (more often suffer from intestinal infections)

Secondary contact with sick family members

Institution related

Patients psychiatric clinics

Home call nurses

Patients in hospitals

(From: Yamada T, Alpers D. H., Owyang S., Powell D. yv., Silverstein F. E., eds. Textbook of Gastroenterology, 2nd ed. Philadelphia: J. B. Lippincott, 1995: 825.)

Table 5-6.

(% OF TOTAL CASES)

A high percentage is observed in adults and children hospitalized for diarrhea in winter ( total percentage for the entire human population: 12.5% ​​in the USA; 5-19% in developing countries.)

(no: Yamada T., Alpers D. H., Owyang C., Powell D. W., Silverstein F. E., eds. Textbook of Gastroenterology, 1sted. Philadelphia: J. B. Lippincott, 1991: 1448.)

Health

Viral infections

Viral infections are one of the most common causes that can cause short-term diarrhea. These infections usually go away on their own. For example, the so-called rotavirus ( rotavirus infection or stomach flu caused by rotaviruses) leads to damage to the intestinal mucosal membrane, disrupting the process of fluid absorption. Rotavirus is very common cause diarrhea in children under two years of age. Cause of quickly passing chronic diarrhea In adults, the so-called norovirus more often occurs, which enters the body along with contaminated water or food.

Bacteria

Bacteria that live in contaminated water or food produce toxins that cause intestinal cells begin to secrete salt and water which causes diarrhea. This is one of the types food poisoning. The most common bacterial infections are caused by bacteria such as salmonella and campylobacter. Usually we're talking about about very serious pathological conditions who require urgent medical attention. The so-called traveler's diarrhea, caused by coli. This disease is very common among people visiting countries where the conditions of their stay are characterized low level sanitation. For example, to such a common disease as cholera (acute diarrhea is one of the most typical symptoms This disease) can also result from consumption of contaminated water.