OVERVIEW
Escherichia coli invasive bacteria (EIEC) was first reported in Japan in 1967 in older children and adults with dysentery-like diarrhea, often mistaken for bacillary dysentery. Laboratory tests are positive for E. enterica serovar agglutination, and stool cultures are also positive for E. enterica in the guinea pig corneal test.
Etiology
Enteroinvasive Escherichia coli is a group of diarrhea-causing Escherichia coli isolated from the stools of patients with dysentery in 1967. It has similar biochemical characteristics with Shigella, is non-powered, does not ferment lactose or ferments slowly, has a common antigen, and is an invasive causative agent, also known as dysentery-like Escherichia coli, which invades the epithelium and grows and multiplies therein, causing diarrhea. They are invasive pathogens, also known as dysentery-like Escherichia coli, which can invade epithelial cells and grow and multiply in them, causing an inflammatory response.
Pathogenesis
Enteric invasive Escherichia coli invades the epithelial cells of the intestinal mucosa, and the bacteria release endotoxin after death, destroying the cells to form inflammation and ulceration, causing diarrhea. It is rare clinically and mainly affects older children and adults. Clinical manifestations are similar to those of bacillary dysentery.
Symptoms
Patients mainly present with fever, abdominal pain, diarrhea, acute and severe diarrhea, and pus and blood stools. Symptoms are not easy to distinguish from bacillary dysentery.
Tests
1. Serum agglutination test
A positive serum agglutination test for entero-invasive Escherichia coli (EIEC) is necessary to establish the diagnosis.
2. Laboratory tests
Fecal culture of Escherichia coli is positive in guinea pig corneal test.
Diagnosis
Diagnosis must be based on a positive serum agglutination test for E. coli and a positive guinea pig corneal test for E. coli from a stool culture.
Treatment
1. General treatment
Patients with obvious symptoms should be put on bed rest, and sterilized and isolated according to the intestinal infectious diseases. Diet should be mainly fluid. When the condition improves, change to thin rice, noodles and so on. Avoid eating cold, greasy and stimulating food. Those with water loss should be rehydrated as appropriate. For infants with water loss in the range of 5% to 10% of body weight, oral rehydration salt solution (ORS) recommended by the World Health Organization can be used. For repeated vomiting or severe dehydration, intravenous rehydration can be considered first, and then changed to oral rehydration solution as soon as possible.
2. Antimicrobial treatment
In recent years, the resistance of enteroinvasive Escherichia coli to various drugs and antibiotics has been increasing year by year, and most of the commonly used antimicrobial drugs such as sulfa, streptomycin, chloramphenicol and tetracycline are resistant to these drugs, and the clinical efficacy is reduced accordingly. Bacteria can be multi-drug resistant. Therefore, the choice of antibiotics for enteroinvasive Escherichia coli should be based on the results of local drug sensitivity testing of prevalent strains or patient stool specimen cultures, to avoid the abuse of non-targeted. Attention should be paid to the rotation of drugs within a certain area. The assessment of the efficacy of antimicrobial drugs should be based on the fecal culture negative rate, and the negative rate should be more than 90% at the end of treatment. Commonly used drugs include the following:
(1) Quinolones have the advantages of wide antimicrobial spectrum and easy absorption by oral intake, etc. In recent years, the number of resistant strains has gradually increased, and the resistance can also be mediated by plasmid. Ciprofloxacin is commonly used orally for Shigella infections, with a course of treatment of 3 to 5 days. Other newer quinolones are also effective against Shigella infections.
(2) Sulfamethoxazole/metronidazole (compound sulfamethoxazole) Treatment for 7 days. According to the results of our use, the cure rate can be more than 95%. In recent years, drug resistance has been growing gradually, and the efficacy has a tendency to decline. It is contraindicated for those with sulfa allergy, decreased white blood cell count and liver and kidney insufficiency.
(3) Traditional Chinese medicine treatment Berberine, 7 days for a course of treatment. Or use raw garlic to take orally, or horse amaranth decoction to take orally, or use whitehead weng soup decoction to take orally, all of which have certain effect.