Enteroinvasive E. coli infection

　　Enteroinvasive E. coli infection is an intestinal infectious disease caused by EIEC. EIEC is a group of enterotoxigenic Escherichia coli isolated from the feces of patients with dysentery in 1967. EIEC has similar biochemical characteristics to Shigella, is non-motile, does not ferment or ferments lactose slowly, has common antigens, and is an invasive pathogen, also known as dysentery-like Escherichia coli, which can invade epithelial cells and grow and reproduce within them, causing inflammatory reactions. It is important to differentiate between the two, and the differential culture media include citrate medium and sodium acetate medium. Common O serotypes include: O28, O29, O32, O112, O124, O136, O143, O144, O152, O164, O167, etc. EIEC does not produce enterotoxins, mainly invades the colon, and forms intestinal wall ulcers. It has a strong pathogenicity, and only 10 to 100 bacteria are needed to cause disease. Contaminated water and food can cause outbreaks, and it can also be transmitted by contact, forming sporadic cases. Both adults and children can be affected. In simple terms, the cause is EIEC invasion of the intestinal mucosal epithelial cells, the release of endotoxins after bacterial death, destruction of cells to form inflammation and ulcers, and causing diarrhea. It is relatively rare in clinical practice, mainly affecting older children and adults.

　　The main complications of enteroinvasive Escherichia coli infection are mainly three kinds:

　　The first is septicemia, which is mainly seen in children with malnutrition, sickle cell anemia, and low immune function. There have been more than 100 cases abroad, and there are also a few cases reported in China. The symptoms of those with concurrent septicemia are more severe, with a mortality rate as high as 46%. Septicemia is common within 1 to 2 days after onset, and antibiotic treatment is effective.

　　The second is hemolytic uremic syndrome, which is mainly seen in Shigella dysenteriae infection. Some cases initially have a leukemic reaction, followed by hemolytic anemia and DIC. Some cases show acute renal failure, with thrombosis in both the renal arteries and veins, renal cortex necrosis, fibrin deposition in glomeruli and arterial walls, about half of the cases are positive in the limulus test, and the majority of cases are positive for immune complexes in serum. Endotoxemia may be related to the onset, but the endotoxemia caused by other bacteria does not have similar manifestations. The prognosis of this disease is severe.

　　The third is arthritis, which often occurs within 2 weeks after dysentery and may be due to an allergic reaction, mainly affecting large joints and can cause redness and swelling of the knee and ankle joints, as well as effusion. The synovial fluid contains antibodies against Shigella agglutination, and the serum anti-O titer is normal. Hormonal therapy can quickly alleviate the symptoms. At the same time, due to the certain risk of enteroinvasive Escherichia coli infection, one must be more careful and cautious in dealing with different complications, and go to the hospital for consultation in a timely manner when necessary to ensure one's health.

　　Enteroinvasive Escherichia coli infection manifests as fever, abdominal pain, diarrhea, tenesmus, and purulent blood stools. The symptoms are indistinguishable from those of dysentery, and a positive EIEC agglutination test is required for diagnosis, along with a positive guinea pig corneal test of the Escherichia coli obtained from stool culture. Treatment is the same as for dysentery, and antibiotic treatment is necessary for severe cases. EIEC invades the intestinal mucosal epithelial cells, releases endotoxins after bacterial death, damages cells to form inflammation and ulcers, and causes diarrhea. It is relatively rare in clinical practice, mainly affecting older children and adults. The clinical manifestations are similar to those of dysentery. Of course, in any case, after these symptoms appear, one should seek medical attention immediately and cannot ignore them to prevent the aggravation of the condition.

　　Enteroinvasive Escherichia coli infection is mostly a self-limiting disease, which recovers within 1 to 2 weeks. Therefore, special attention needs to be paid to the prevention of several situations:

　　Old people, infants, children, and patients with low immune function have more complications, so they must be cautious and strengthen prevention.

　　The mortality rate of toxic Shigella dysentery is high, especially in respiratory failure type, and immediate medical treatment should be sought if there are related symptoms.

　　Type I Shigella dysentery causes more severe symptoms, while the Weyl strain is prone to chronic conditions, and drug-resistant strains affect efficacy, so it is necessary to be cautious in prevention.

　　The use of appropriate antibacterial drugs plays an important role in clearing the infection. Improper use of drugs, insufficient course of treatment, and untimely treatment all affect the efficacy. In summary, the most important thing is that people with low immunity can use antibacterial drugs for a long time to enhance immunity and maintain their own health.

　　The diagnosis of enteroinvasive Escherichia coli infection must be confirmed by fecal culture. The obtained Escherichia coli is also positive in the guinea pig corneal test. Therefore, it can also be judged whether the hospital has relevant authority in this disease according to the examination items. This disease cannot be pre-diagnosed, and it is necessary to have a positive EIEC serum agglutination test to confirm the diagnosis, so one should never be lazy and not go to the hospital personally. For health, one must be down-to-earth. Enteroinvasive Escherichia coli infection should mainly be differentiated from dysentery. These diseases are easy to be confused with the disease, although the symptoms are somewhat similar, but there are actually many differences. If the treatment method is incorrect, it may delay the treatment or even worsen the condition. Therefore, it is necessary to clarify and differentiate.

　　Patients with enteroinvasive Escherichia coli infection should pay attention to dietary adjustment. The early stage of the disease is a severe stage of intestinal acute congestion, edema, inflammation, and exudation. At this time, the intestinal peristalsis is active or in a spastic state, and the digestive and absorptive functions are relatively weak. Therefore, within 8 to 12 hours after the onset, patients can eat liquid foods such as rice porridge, egg paste, and thin noodles. If diarrhea is severe or sweating is excessive, some more soup and water should be given to the patient to supplement the body's water, vitamins, and electrolytes.

　　Patients in the convalescent stage can eat easily digestible and nutritious liquid or semi-liquid foods, such as thin wonton skin, steamed egg custard, and so on. It is advisable to adopt the method of eating small meals frequently, with 4 to 5 meals per day. It should be noted that milk and a large amount of sucrose should not be consumed at this time.

　　During the convalescence period, it is especially important to pay attention to dietary moderation. It is advisable to eat light, soft, and warm foods, and to avoid eating fatty meat, fried foods, cold and hard foods, and high-fiber foods such as celery, soybean sprouts, chives, garlic sprouts, and others too early. About 2-3 days after the convalescence period, one can resume normal meals.

　　In terms of Western medicine treatment, due to the increasing drug resistance of EIEC to various drugs and antibiotics in recent years, most commonly used antibacterial drugs such as sulfonamides, streptomycin, chloramphenicol, and tetracycline are mostly resistant, resulting in a decrease in clinical efficacy. Therefore, the selection of EIEC antibiotics should be based on the results of local drug sensitivity tests of the流行strains or the culture of patients' feces to avoid targeted misuse. In certain areas, attention should be paid to drug rotation. The evaluation of the efficacy of antibacterial drugs should mainly be based on the negative conversion rate of stool culture, and the negative conversion rate at the end of treatment should reach above 90%.

　　There are a total of three commonly used drugs, the first being quinolone drugs, which have the advantages of a wide spectrum of antibacterial activity and easy absorption after oral administration. In recent years, the number of drug-resistant strains has gradually increased, and drug resistance can also be mediated by plasmids. Ciprofloxacin 400-600mg/d is commonly used for Shigella infection, taken orally in two or three doses, and the course of treatment is 3-5 days. Other new quinolone drugs are also effective against Shigella infection.

　　The second is trimethoprim: the dose is 2 tablets per time, 2 times a day, and the course of treatment is 7 days. According to our results, the cure rate can reach above 95%. In recent years, drug resistance has gradually increased, and there is a trend of decreasing efficacy. It should be avoided in patients with sulfonamide allergy, leukopenia, and incomplete liver or kidney function.

　　The third is antibiotics: EIEC is mostly resistant to commonly used antibiotics such as chloramphenicol, streptomycin, and ampicillin. Some strains are still relatively sensitive to doxycycline. Most pathogenic bacteria are still relatively sensitive to kanamycin and gentamicin in vitro tests, but they can only be used by injection, and the immediate effect is better. Due to the low concentration of drugs in the intestinal wall tissue, they are not excreted into the intestinal cavity, making it difficult to clear bacteria, easy to relapse, and it is recommended to be used in combination with methotrexate. Studies outside of China have shown that cephalosporin antibiotics also have good efficacy against Shigella, and they can also be chosen if necessary.