Enteropathogenic Escherichia coli infection

　　1, Etiology

　　The morphology and biochemistry of EPEC are the same as those of ordinary Escherichia coli, and the main method of differentiation between the two is based on the difference in serotypes. EPEC has 13 common serotypes, with 0111 being the most common, accounting for 40% to 50% of the total number of cases.

　　2, Pathogenesis

　　EPEC is confirmed to have pathogenicity due to their adhesive ability to the intestinal surface. The pathogenic bacteria enter the small intestine through the mouth, grow and reproduce in the upper part of the duodenum, jejunum, and ileum, closely adhering to the surface of intestinal epithelial cells, or embedding in the indentations of the surface of intestinal epithelial cells, causing characteristic damage to the mucosa, local microvilli atrophy, intestinal dysfunction, and even leading to necrosis and ulceration of the intestinal mucosa, resulting in 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 occur in all organs of the body, with the heart, liver, kidneys, and central nervous system being more obvious.

　　It can lead to severe isotonic dehydration, metabolic acidosis, hypokalemia, hypocalcemia, pneumonia, dysfunction of the heart, liver, and kidneys, sepsis, etc. The lesion site is mainly located in the duodenum and jejunum, with epithelial cells becoming square or irregular, but most intestinal mucosal cells are still normal. The intestinal villus epithelial cells show vacuolar degeneration, and there are a large number of round-shaped virus particles in the endoplasmic reticulum. It is often accompanied by chills and fever, abdominal pain, abdominal distension, nausea, vomiting, diarrhea, watery stools with a foul smell, and early onset of bacteremia.

　　The incubation period is generally 2 to 5 days.

　　The onset of symptoms and signs is generally slow, but can also be acute, with causes such as maladjustment of diet, improper addition of complementary food, etc. Mild cases do not have fever, and the main symptoms are diarrhea, with stools 3 to 5 times a day,呈 yellow egg yolk-like with milk lumps, abundant in quantity. As the condition progresses, fever, vomiting, lack of appetite, abdominal distension, toxic enteroparesis may occur. Before the onset of enteroparesis, diarrhea may worsen, and may appear mucous and bloody stools. Adult patients often have an acute onset, with hidden pain around the umbilicus, abdominal rumbling, and occasionally tenesmus, presenting as 'dysentery-like'.

　　The infectious sources are mainly patients and carriers, including infants and adults who carry bacteria. It is highly contagious, mainly transmitted through direct contact, and can be spread through contaminated hands, food, or utensils; adults often spread through contaminated food and drinking water; it may also cause disease by inhaling contaminated dust into the intestines. The peak period for onset is from May to June. It can occur in all age groups, but is more common in children under 2 years old, and can also affect adults, with adult cases accounting for about half in some local areas. It can be sporadic or outbreak in kindergartens, or cause nosocomial cross-infection in hospitals, and can also cause food poisoning.

　　At the time of diagnosis, in addition to relying on its clinical manifestations, auxiliary examinations are also needed. The peripheral blood count of this disease is normal or slightly elevated, and the fecal microscopy shows a few red and white blood cells, occasionally full field, with a large number of fat globules.

　　1, Prognosis:The prognosis of adults is better, and the mortality rate of infants is higher, mainly due to dehydration, acidosis, malnutrition, pneumonia, etc.

　　2, Nursing:Keep the perianal skin clean and dry, prevent perianal erythema and perianal abscess. Use infrared radiation to dry locally for perianal erythema, and apply pine pollen, tannic acid ointment, etc. to the perianal area.

　　An intestinal infectious disease caused by enteropathogenic Escherichia coli (Enteropathogenic Escherichia coli, EPEC). EPEC is a group of diarrheal Escherichia coli that was recognized as early as the 1940s, and was the main pathogen of epidemic infantile diarrhea from the 1950s to the 1960s, and is clinically known as 'dyspepsia'. The National Symposium on Experience Exchange on Diarrhea in 1983 decided that diarrhea caused by EPEC should be called EPEC enteritis, not 'dyspepsia'.

　　Firstly,Traditional Chinese medicine treatment for Escherichia coli infection caused by intestinal pathogens:

　　Traditional Chinese medicine treatment:

　　Using anisodamine at the acupoint of Zusanli can reduce the frequency of defecation. Trypsin, pancreatin, tannic acid protein, traditional Chinese medicine Feier powder, etc., can promote the improvement of stool characteristics and increase digestive function. For severe and malnourished children, blood transfusion and human serum albumin (albumin) can be administered in small doses and multiple times to improve the overall condition.

　　Secondly,Western medicine treatment for Escherichia coli infection caused by intestinal pathogens

　　Medication treatment:

　　(1) Diet therapy is basically the same as rotavirus enteritis. IgA in human milk can prevent the growth of bacteria that require iron, such as Escherichia coli, so breastfeeding is an effective measure for preventing and treating Escherichia coli enteritis in infants and young children.

　　(2) Antibacterial treatment for mild cases may not require antibacterial drugs. It can be cured spontaneously by adjusting the normal intestinal flora. For severe infants and those with sepsis, antibacterial treatment is still needed. According to clinical observations, oral polymyxin B and polymyxin E are effective, but the drug source is difficult. In clinical practice, norfloxacin, ciprofloxacin (sparfloxacin) or berberine are often首选, and methoxazole (TMP) is also added. Gentamicin can also be taken orally or tobramycin can be injected intramuscularly. The course of treatment is 5 days.