Intestinal infections in young children - Kharchenko G.A. Causes and development of acute intestinal infection in childhood Differential diagnosis of acute intestinal infections

Acute intestinal infections are the second most common after ARVI and influenza. Children are at particular risk.

This fairly large group of diseases is caused by various microbes, the most common pathogens being E. coli, worms, salmonella, dysentery bacillus, typhoid bacillus, staphylococci and streptococci. Intestinal infections are often called “diseases of dirty hands” - this is how they enter the body most often. But they can also get into the gastrointestinal tract with food and water contaminated with bacteria, if hygiene rules are not followed, and flies that spread the infection are often the culprits.

It has been noted that in socially disadvantaged families, where hygiene is not a priority, children more often suffer from intestinal infections, and the consequences after an illness can be quite serious, because the immunity of such children is weaker. In general, intestinal infections are especially popular among children under 7 years of age, but if a child is accustomed to the rules of hygiene from childhood, and the cult of cleanliness is observed in the family, then it is likely that the child will grow up without knowing what kind of “beast” this is - intestinal infection.

Signs of an intestinal infection

Most viruses, having penetrated the intestines, begin to actively multiply there. The result of their activity is inflammation of the cells of the intestinal mucosa and disruption of the digestive process, as a result of which the main symptom of intestinal infection appears - diarrhea. But there are exceptions, for example, Botkin’s disease (viral hepatitis A) - in the case of this disease, the liver is affected, and, as a rule, there is no diarrhea.

In most cases (but not always), other signs also appear: high fever, abdominal pain, nausea, vomiting and general weakness. Let's talk about some of the most common intestinal infections in more detail.

Giardiasis

The main symptom here is loose, watery stools, and bowel movements can occur up to 6-7 times a day. Moreover, the younger the child, the more often this happens to him. And the danger is that diarrhea leads to a large loss of fluid, which makes the disease more severe. A large loss of fluid is indicated by a dirty gray coating on the tongue, dry mouth, and sunken eyes. Other signs include decreased appetite and nausea. It is recommended to treat giardiasis in a hospital, where dehydration will be quickly eliminated, appropriate antibiotics and biological drugs will be prescribed, and a special diet will be prescribed.

Dysentery

The dysentery bacillus primarily affects the large intestine. The body’s reaction is frequent (up to 10 times a day) stools mixed with blood and mucus. In no case should the disease be ignored - the active activity of bacteria can lead to the development of inflammatory changes in the intestine, with the formation of erosions on it. And if decay products of bacterial activity enter the bloodstream, as they accumulate there, damage to the cardiovascular and central nervous systems may occur.

It is characteristic that with dysentery the body temperature can remain normal, and the disease does not affect the general condition. During treatment, antibiotics, enzyme preparations, plenty of fluids, and diet are prescribed.

Botkin's disease

This disease, colloquially referred to as jaundice, can leave behind a lifelong scar: a diseased liver. The disease also affects metabolic disorders, because the liver is directly involved in this process. Where does the name “jaundice” come from? With this disease, bile acids and pigments enter the blood in large quantities, which is why human skin acquires a characteristic rich yellow color.

In general, the symptoms of jaundice are very similar to the flu: headache, chills, runny nose, general weakness, sore throat, joint pain.

Patients with Botkin's disease must be hospitalized. This is important, since jaundice that is not completely cured can lead to the most serious complications, for example, causing hepatic coma. Diet plays an important role in the treatment of this disease; if it is not followed, no antibiotics will help.

Botulism

The anaerobic bacterium enters the body with contaminated foods: canned vegetables, meat, fish and mushrooms, sausage, ham. Getting into the gastrointestinal tract with contaminated food, bacteria and their poisons are absorbed into the intestinal walls and penetrate into the blood. Intoxication is manifested by damage to the muscles of the pharynx, nerve nodes of the heart, respiratory muscles and the central nervous system.

Therapy for this disease includes antibiotics, cardiovascular and diuretic drugs, vitamins B and C, drugs to strengthen the immune system and, of course, diet. There is no specific prevention against this disease, just don’t give your children canned food, and buy only fresh sausages.

Prevention methods

They are as old as time and known to everyone. Wash your hands more often, and especially before eating and after visiting the toilet, do not drink raw water, be sure to heat-treat food, do not buy food in dubious stores, and demand a quality certificate at the market. When there are small children in the house, these rules must be strictly observed, and a love of cleanliness must be instilled in children as early as possible, reminding them that unclean chimney sweeps will face not only shame and disgrace, but also a variety of bacteria.

In the structure of infectious pathology in children, acute intestinal infections (AI) occupy one of the leading places. According to WHO experts, more than 1 billion cases of diarrhea are registered annually in the world (60-70% are children under 5 years of age); About 3 million preschool children die.
The causative agents of intestinal infections belong to various taxonomic groups. Bacteria (Shigella, Salmonella, diarrheagenic Escherichia, Yersinia, Campylobacter, Staphylococcus, Klebsiella, etc.) act as etiological agents; viruses (roto-, adeno-, entero-, astro-, corono-, toro-, caliciviruses, etc.); protozoa (giardia, cryptosporidium, etc.).
Intestinal infections have a number of epidemiological patterns: widespread distribution, high contagiousness, fecal-oral mechanism of infection, and a tendency to develop epidemic outbreaks.
Depending on the etiology and pathogenesis, invasive, secretory and osmotic diarrhea are distinguished. With invasive intestinal infections, pathogens (Shigella, Salmonella, enteroinvasive Escherichia, Campylobacter) penetrate epithelial cells, causing inflammation of the mucous membrane of the small and large intestine. In secretory intestinal infections (enterotoxigenic and enteropathogenic escherichiosis, cholera), the occurrence of diarrhea syndrome is associated with activation of adenylate cyclase of cell membranes, followed by increased secretory activity of the small intestinal epithelium and impaired reabsorption of water and electrolytes. Osmotic diarrhea caused by rota-, adeno-, astroviruses, etc., develops as a result of dysfunction of the enzymatic systems of enterocytes that break down carbohydrates. However, it should be noted that it is rarely possible to distribute nosological forms accompanied by diarrhea syndrome, depending on one mechanism of diarrhea; More often than not, several pathogenetic mechanisms are important.
Intestinal infections are clinically manifested by the following syndromes: intoxication (acute infectious toxicosis), dehydration (dehydration, exicosis), fever and gastrointestinal (gastritis, enteritis, gastroenteritis, enterocolitis, gastroenterocolitis, colitis).
Gastritis syndrome is characterized by nausea, repeated vomiting, pain and a feeling of heaviness in the epigastric region.
Enteritis syndrome is manifested by frequent, profuse, loose, watery stools, flatulence, and abdominal pain, mainly in the umbilical region.
Gastroenteritis syndrome is characterized by a combination of signs of gastritis and enteritis.
Enterocolitis syndrome is characterized by frequent, profuse, loose stools mixed with mucus and sometimes blood; abdominal pain, tenderness on palpation and rumbling along the colon.
Gastroenterocolitis syndrome - a combination of signs of gastritis, enteritis and colitis is noted.
Distal colitis syndrome: retracted “scaphoid” abdomen, cramping abdominal pain with predominant localization in the left iliac region, spasmodic painful rumbling sigmoid colon, compliance of the anal sphincter, tenesmus; change in the frequency and nature of stool (frequent, scanty with mucus, blood - such as “rectal spitting”).

Acute intestinal infections

Intestinal infections are rightfully called “diseases of dirty hands,” emphasizing their close connection with failure to comply with basic hygiene rules. Pathogenic microorganisms enter the child’s gastrointestinal tract with poor-quality food, dirty hands, infected nipples, spoons and, rapidly multiplying in it, cause diseases, the main symptoms of which are abdominal pain, diarrhea and vomiting. The causative agents of intestinal infections are countless, as are their clinical manifestations, which exist under different names: dyspepsia, diarrhea, gastroenteritis, enterocolitis, gastroenterocolitis, etc.

Pathogenic E. coli, salmonella, dysentery microbes, staphylococci and various viruses (most often entero-, rota- and adenoviruses) can cause the most trouble to a child.

Often, adult family members experience erased forms of the disease or carriage of pathogenic pathogens, which contributes to the spread of infections.

The routes of transmission have been known for a long time: pathogens are excreted from the body with the feces of the patient and enter the healthy person through the mouth with food, water, household items (door handles, switches, dishes, linen, etc.).

A baby, whose living space is limited to a crib, receives intestinal infection pathogens from the mother’s hands with a pacifier, bottle, or toy contaminated with formula. Often, a mother “disinfects” a pacifier that has fallen on the floor by licking it with her tongue, adding her own from the nasopharynx to the microbes picked up from the floor. And if adult family members do not have the habit of washing their hands after using the toilet, the baby faces endless diarrhea.

The main symptoms of acute intestinal infectious disease(OKIZ) are known to everyone: abdominal pain, repeated vomiting, frequent loose stools, often accompanied by fever. Young children (under 3 years of age) are most often affected.

High morbidity at this age is facilitated by reduced body resistance and behavioral characteristics of the child: mobility and curiosity, the desire to get to know the world, trying it out, neglect of the rules of personal hygiene.

The period from the moment of infection to the onset of the disease can be short (30–40 minutes), then the cause of the disease can be confidently named, or long (up to 7 days), when errors in diet and behavior have already been erased from memory.

Often the disease progresses so rapidly that within a few hours dehydration can develop due to the loss of fluid and salts through vomit and loose stools.

Signs of dehydration It is not difficult to detect: the child is lethargic, the skin is dry, its elasticity is reduced, little saliva is secreted, the tongue and lips are dry, the eyes are sunken, the voice becomes less clear, urination is rare and scanty.

This is a serious condition, indicating a disruption in the functioning of all organs and systems of the body and requiring immediate medical attention.

In the first hours of the disease no matter what pathogen caused the digestive upset: dysentery or E. coli, salmonella or staphylococcus, Yersinia or viruses - the main thing is prevent dehydration of the body Therefore, the child must receive a sufficient amount of fluid to restore lost fluid.

With vomiting and diarrhea, not only fluid is lost, but also trace elements such as potassium, sodium, chlorine, the acid-base balance is disturbed, which further aggravates the condition, and convulsions often occur against the background of dehydration. Therefore, the child should receive not plain water, but glucose-salt solutions.

Mixtures of salts with glucose are freely sold in the pharmacy: “Glucosolan”, “Regidron”, “Citroglucosolan”, “Oralit”, etc. The contents of the package are dissolved in one liter of boiled and cooled water, and the medicine is ready.

Now you will need patience and perseverance to feed a sick child. During the first hour, give him 2 teaspoons of the solution every 2 minutes. Even if a child drinks greedily, you should not increase the dose, because a large amount of liquid can cause vomiting.

From the second hour, the dose can be increased and the child can be given 2 tablespoons every 10–15 minutes. During the day, the amount of fluid administered should be from 50 to 150 ml of solution per kilogram of weight, depending on the frequency of vomiting and diarrhea and the severity of the condition.

The glucose-saline solution should not be boiled and a fresh portion should be prepared after 12–24 hours.

In addition to glucose-saline solutions, the child can be given plain drinking water, tea, rosehip decoction, and still mineral water.

If your child drinks a lot and willingly, do not limit him. Healthy kidneys will cope with the load and remove excess water from the body along with toxic substances.

It is much worse if the patient refuses to drink, then you have to resort to various tricks to get the stubborn person to drink. An infant can instill the solution into the mouth from a pipette or inject it into the oral cavity using a syringe (without a needle) or a rubber bulb. For a two or three year old child, ask him to remember how he was little and sucked from a bottle. It’s okay that he’s been drinking from a cup for a long time, give him a bottle of medicinal solution and let him play “little one.”

According to the law of meanness, the disease occurs unexpectedly at the most inopportune time (at night) and in the most inappropriate place (at the dacha, in the village), when there is no medicine at hand, and to the nearest pharmacy, as they say, “seven miles to heaven and all through the forest.”

Ingenuity and intelligence will come to the rescue. After all, what is, for example, “Glucosolan”? This is a mixture of salts consisting of sodium chloride (salt) - 3.5 g, sodium bicarbonate (baking soda) - 2.5 g, potassium chloride - 1.5 g and glucose - 20 g.

Any home will have salt and soda, and we can get potassium and glucose (fructose) by boiling a handful of raisins or dried apricots in one liter of water. For 1 liter of raisin broth, add 1 teaspoon of salt (without top), half a teaspoon of soda, and here you have a glucose-saline solution.

If you don’t have raisins or dried apricots, take several large carrots as a source of potassium, cut them into pieces, after washing and peeling them, and boil them in the same amount of water. Then add 1 teaspoon of salt, half a teaspoon of baking soda and 4 teaspoons of sugar.

If you don’t have any raisins or carrots on hand, the solution will be based on simple boiled water, in one liter of which you will dilute 1 teaspoon of salt, half a teaspoon of soda and 8 teaspoons of sugar.

Very often, mothers complain that the baby does not want to drink “tasteless water.” And in this situation, you can, by showing ingenuity, turn the medicinal solution into a pleasant-tasting drink. Simply dilute a packet of “Regidron” not in ordinary water, but in raisin broth. We have already noted that raisin decoction is rich in potassium and glucose, so after dissolving a packet of Regidron in it, you will receive a glucose-saline solution enriched with an additional amount of mineral salts. And the baby will be grateful to you for the delicious medicine.

Despite its apparent simplicity, drinking water is one of the main points in the complex treatment of a child with an intestinal infection. Remember this and do not neglect drinking water, cherishing the hope of miracle antibiotics that should immediately stop the disease.

Vomiting and diarrhea are the body’s protective reaction to a foreign agent entering the stomach. With their help, the body is freed from microbes and their toxins. We need to help the body in this fight. This is what adsorbents are designed to do - substances that bind microbes, viruses, toxins and remove them from the body.

The most famous adsorbent is activated carbon. Before use, the charcoal tablet should be crushed to increase the adsorption surface, diluted with a small amount of boiled water and given to the child to drink. A single dose of activated carbon is one tablet per 10 kg of child’s weight.

Polyphepan– highly effective adsorbent of natural origin, brown powder. A single dose for a child under 3 years old is 1 teaspoon of powder (without top), diluted in a small amount of boiled water, from 4 to 7 years old - 2 teaspoons, from 8 to 14 years old - 1-2 tablespoons per dose.

Smecta– dilute one powder in 100 ml (half a glass) of boiled water and give the child from 2-4 teaspoons to 2-4 tablespoons per dose, depending on age.

Children are reluctant to take charcoal and polyphepane; apparently, they are scared off by the dark color and the presence of unpleasant grains in the aqueous suspension of the adsorbent, and prefer smecta, which is devoid of these disadvantages.

Enterodesis– dilute one sachet in 100 ml of boiled water and give the child a few sips per dose. Enterodesis is especially effective for frequent, loose, profuse stools.

Recently, a shelf of adsorbents has arrived: new effective drugs have appeared - enterosgel and polysorb.

Adsorbents should be taken 3-4 times a day. Do not despair if the adsorbent taken for the first time soon comes back with vomiting. During the few minutes that it was in the stomach, a significant part of the microbes managed to settle on it and leave the body. At the next dose, the adsorbent will remain in the stomach and, having passed into the intestines, will continue to serve as a “cleaner” there.

Not recommended for use an oral solution of potassium permanganate for the treatment of intestinal infections and food poisoning. After taking a pink solution of potassium permanganate, vomiting stops for some time. But this is an apparent and short-term improvement, after which the condition worsens and violent vomiting resumes. Why is this happening? The mucous membrane of the stomach reacts sensitively to the entry and proliferation of microbes, and when they reach a certain concentration, it removes the infectious agent from the body through vomiting.

A solution of potassium permanganate has a tanning effect on the mucous membrane and reduces its sensitivity to microbes, which allows them to multiply and accumulate in the stomach in larger quantities and for a longer time. Consequently, more toxins will be absorbed into the blood from the stomach, and more microbes will pass into the intestines.

A solution of potassium permanganate administered as an enema has the same negative effect. It causes the formation of a fecal plug, which prevents the removal of loose stools, which contain a large number of pathogenic microorganisms, and the rapid proliferation of the latter in the intestines contributes to the absorption of toxins into the blood and the development of severe inflammatory processes in the intestines.

No medications without a doctor's prescription! Especially do not try to give pills to a child who is vomiting repeatedly. Your efforts will not be rewarded, since any attempt to swallow the medicine will cause vomiting. Only glucose-salt solutions and adsorbents.

When giving your child medications prescribed by a doctor, do not combine them with taking adsorbents. The medicine, deposited on the sorbent, leaves the body without having any effect on it. There should be a break of at least 2 hours between doses of adsorbents and medications.

Do not force-feed a child who is experiencing nausea and vomiting. This will not lead to anything good, but will only cause vomiting.

Devote the first 4-6 hours from the moment of illness to taking glucose-saline solutions and other liquids that we have already discussed. But don’t delay fasting so that you don’t have to deal with its consequences later. If a child asks to eat, then you need to feed him, but often and in small portions, so as not to provoke vomiting.

The baby who receives mother's milk is lucky, because it is not only food, but also medicine, thanks to the presence of antibodies, lysozyme and enzymes in it. Attachments to the breast after a water-tea break should be short (3-5-7 minutes), but frequent - after 1.5-2 hours.

For the first meal, offer the “artificial” baby kefir, acidophilus “Malyutka”, “Bifidok” or any other fermented milk product. The lactobacteria and bifidobacteria they contain have a beneficial effect on the inflamed intestines. The single dose should be reduced by half, and the intervals between feedings should be halved. Then you can cook porridge, preferably oatmeal or rice, with diluted milk, pureed slimy soup, vegetable puree, omelet, cottage cheese soufflé, steamed cutlets or meatballs, boiled fish. For several days, exclude fruit and vegetable juices, meat and fish broths, and sweets from your diet.

It is advisable to accompany each meal with the use of enzyme preparations that facilitate the digestion of food and help the digestive tract cope with the disease.

If the disease is accompanied by an increase in temperature above 38 ° C, and the child continues to vomit, then taking antipyretic drugs by mouth will be useless, since the medicine will not be retained in the stomach and will immediately come out.

Start with physical methods of cooling: undress the patient, wipe him with a 1-2% solution of vinegar or a mixture of equal parts of water, vodka and 9% vinegar, create a “breeze” near him using a fan or fan. Use antipyretics in the form of suppositories with analgin, paracetamol for insertion into the rectum.

If there is a risk of seizures(trembling hands and chin against a background of rising temperature) call a children's emergency room or an ambulance, since the child's condition requires immediate medical attention, especially since the continued loss of salts with vomiting and diarrhea contributes to the development of convulsive syndrome.