Overview.
Enteropathogenic Escherichia coli infections are enteric infections caused by enteropathogenic Escherichia coli (EPEC), a group of diarrhea-causing Escherichia coli bacteria recognized as early as in the 1940s, and a major etiologic agent of epidemic infantile diarrhea in the 1950s and 1960s. The main symptom is diarrhea, stools 3 to 5 times a day, yellow egg-shaped with milk petals, and large amount.
Etiology
The relatively certain pathogenicity of EPEC is their ability to adhere to intestinal surfaces. Pathogenic bacteria enter the small intestine through the mouth, grow and multiply in the duodenum, jejunum, upper ileum, adhere closely to the surface of the intestinal epithelial cells, or embedded in the surface of the intestinal epithelial cells in the depression, so that the mucous membrane is characterized by damage, local microvilli atrophy, intestinal dysfunction, and even lead to intestinal necrosis of the intestinal mucosa, ulceration, diarrhea. In addition, EPEC can also produce African green monkey cytotoxin (VT), causing intestinal epithelial cells to secrete fluid into the intestinal lumen. Non-specific congestion and edema can be seen in all organs of the body, which is more obvious in the heart, liver, kidney, and central nervous system.
Symptoms
1. Incubation period
Usually 2 to 5 days.
2. Symptoms and signs
The onset of disease is usually slow, but may be acute. There are triggers such as dietary disorders and improper addition of complementary foods. In mild cases, there is no fever, and the main symptom is diarrhea, which occurs 3 to 5 times a day in the form of yellow egg-shaped stools with milk petals, and in large quantities. If the disease continues to develop, fever, vomiting, lack of appetite, abdominal distension and toxic intestinal paralysis will occur. Diarrhea worsens before intestinal paralysis occurs, and mucous bloody stools may appear. Adults often have an acute onset, with vague pain around the umbilicus, abdominal ringing, and occasionally a “dysentery-like” presentation.
Examination
The peripheral blood picture is normal or the white blood cell count is a little high, stool microscopy can see a few red and white blood cells, occasionally can see a full field of vision, there are a large number of fat globules.
Diagnosis
The diagnosis cannot be confirmed on the basis of positive stool culture for Escherichia coli and positive serotyping, but must be supported by both clinical manifestations and epidemiology to diagnose enteropathogenic Escherichia coli infection.
Differential diagnosis
Dysentery, salmonella enteritis, Campylobacter jejuni enteritis, viral enteritis, and infantile rash are the most important differentials.
Complications
There are severe isotonic dehydration, metabolic acidosis, hypokalemia, hypocalcemia, pneumonia, cardiac, hepatic and renal dysfunction, sepsis.
Treatment
1. Traditional Chinese medicine treatment
Closure of foot-sanli acupoints with scopolamine can reduce the frequency of stool. Pepsin, pancreatic enzyme, ellagic acid protein, traditional Chinese medicine, such as fat children’s powder, can promote the improvement of stool properties and increase the digestive function. For severe and malnourished children, blood transfusion and human albumin can be given in small amounts to improve the general condition.
2. Western medical treatment
(1) Dietary therapy is basically the same as rotavirus enteritis. Breastfeeding is an effective measure to prevent and control E. coli enteritis in infants and young children.
(2) Antimicrobial therapy Mild cases can be treated without antimicrobial drugs. It can be cured by adjusting the normal intestinal flora. For severe infants and those with sepsis, antimicrobial treatment is still needed.
Prognosis
Adults have a better prognosis, while infants have a higher mortality rate, mainly dying from dehydration, acidosis, malnutrition and pneumonia.