Intestinal infections. Acute intestinal infection Children's intestinal infections general characteristics

19.07.2019

Acute intestinal infections are a group of infectious diseases caused by pathogenic enterobacteria, representatives of opportunistic flora (OPF), numerous viruses and characterized by damage to the gastrointestinal tract with the development of symptoms and dehydration (dehydration, exicosis).

Acute intestinal infections occupy 4th place in the structure of mortality, and acute intestinal infections occupy 2nd place in the structure of infectious diseases.

Acute intestinal infections are characterized not only by high morbidity and incidence, but also, unfortunately, by high mortality.

Classification of acute intestinal infections.

By etiology

  1. (shigellosis). Shigella Sonne and Flexner are mainly sown in RME.
  2. Salmonella. They occupy 2nd place in the structure of acute intestinal infections in terms of frequency. All age groups are affected.
  3. Coli infection ().
  4. Intestinal diseases caused by staphylococcus, yersinia, enterococcus, campylobacter, representatives of opportunistic flora (Proteus, Klebsiella), fungi of the genus Candida.
  5. Viral intestinal infections. According to American authors, the most important viruses are: rotavirus. Also important in the occurrence of intestinal syndrome: adenovirus is tropic to all mucous membranes - therefore, a number of symptoms can occur simultaneously: runny nose, cough, conjunctivitis, severe diarrhea, etc. Enterovirus is the causative agent of enteroviral diseases that can occur with meningitis, polio-like syndrome, including diarrhea syndrome and rash. Most infections with enterovirus occur when swimming in bodies of water into which municipal waste flows.

According to the clinical form of the disease (posyndromic diagnosis).

  1. Acute, when the disease is characterized only by vomiting syndrome, there are no intestinal disorders. This happens in older children with food poisoning.
  2. Acute: there is no vomiting syndrome, but there is diarrhea syndrome - frequent, liquid stools.
  3. Acute gastroenteritis occurs most often: there is a syndrome of vomiting, dehydration, and diarrhea.
  4. In some cases, when a person falls ill with a severe form of dysentery, the symptom complex is realized in the lower sections and is characterized by acute colitis: stool without stool mixed with blood.
  5. Acute enterocolitis - damage to the entire intestine

According to the severity of the disease:

Typical forms: light, medium, heavy.

Criteria for determining severity: by

  • temperature altitude
  • frequency of vomiting
  • stool frequency
  • severity of symptoms and dehydration

Atypical forms

  1. Erased forms: scanty symptom complex - pasty stool 1-2 times, low-grade single increase in temperature, absence of vomiting, satisfactory condition. The diagnosis is made by bacteriological and serological confirmation.
  2. Asymptomatic form: complete absence of any symptoms. The diagnosis is made by seeding.
  3. Bacterial carriage is a complete absence of clinical manifestations; there is only a transient, one-time release of the microbe. Making such a diagnosis is quite risky because there is no possibility of examination on an outpatient basis, and it is better to make a diagnosis of a mild form.
  4. Hypertoxic form. The disease develops very rapidly, acutely, sometimes with the development of infectious-toxic shock (grades 1-3), characterized by pronounced toxic symptoms and virtually no local changes (the intestines are intact since the changes do not have time to develop). For acute intestinal infections

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.

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– a group of infectious diseases of various etiologies, occurring with primary damage to the digestive tract, toxic reaction and dehydration of the body. In children, intestinal infection is manifested by increased body temperature, lethargy, lack of appetite, abdominal pain, vomiting, and diarrhea. Diagnosis of intestinal infection in children is based on clinical and laboratory data (history, symptoms, excretion of the pathogen in feces, detection of specific antibodies in the blood). For intestinal infections in children, antimicrobial drugs, bacteriophages, and enterosorbents are prescribed; During the treatment period, it is important to follow a diet and rehydrate.

General information

Intestinal infection in children is an acute bacterial and viral infectious disease accompanied by intestinal syndrome, intoxication and dehydration. In the structure of infectious morbidity in pediatrics, intestinal infections in children occupy second place after ARVI. Susceptibility to intestinal infections in children is 2.5-3 times higher than in adults. About half of the cases of intestinal infection in children occur at an early age (up to 3 years). Intestinal infection in a young child is more severe and may be accompanied by malnutrition, the development of dysbacteriosis and enzymatic deficiency, and decreased immunity. Frequent repetition of episodes of infection causes disruption of the physical and neuropsychic development of children.

Causes of intestinal infection in children

The range of pathogens causing intestinal infections in children is extremely wide. The most common pathogens are gram-negative enterobacteria (Shigella, Salmonella, Campylobacter, Escherichia, Yersinia) and opportunistic flora (Klebsiella, Clostridia, Proteus, Staphylococcus, etc.). In addition, there are intestinal infections caused by viral pathogens (rotaviruses, enteroviruses, adenoviruses), protozoa (giardia, amoebae, coccidia), and fungi. The common properties of all pathogens that cause the development of clinical manifestations are enteropathogenicity and the ability to synthesize endo- and exotoxins.

Infection of children with intestinal infections occurs through the fecal-oral mechanism through nutritional (through food), water, contact and household routes (through dishes, dirty hands, toys, household items, etc.). In weakened children with low immunological reactivity, endogenous infection with opportunistic bacteria is possible. The source of OKI can be a carrier, a patient with an erased or manifest form of the disease, or pets. In the development of intestinal infection in children, a major role is played by violation of the rules of preparation and storage of food, the admission into children's kitchens of persons who are carriers of the infection, patients with tonsillitis, furunculosis, streptoderma, etc.

Sporadic cases of intestinal infection in children are most often recorded, although group and even epidemic outbreaks are possible with food or waterborne infection. The increase in the incidence of some intestinal infections in children has a seasonal dependence: for example, dysentery occurs more often in summer and autumn, rotavirus infection - in winter.

The prevalence of intestinal infections among children is due to epidemiological characteristics (high prevalence and contagiousness of pathogens, their high resistance to environmental factors), anatomical and physiological characteristics of the child’s digestive system (low acidity of gastric juice), and imperfect defense mechanisms (low concentration of IgA). The incidence of acute intestinal infection in children is facilitated by disruption of the normal intestinal microbiota, non-compliance with personal hygiene rules, and poor sanitary and hygienic living conditions.

Classification

According to the clinical and etiological principle, among the intestinal infections most often recorded in the pediatric population, there are shigellosis (dysentery), salmonellosis, coli infection (escherichiosis), yersiniosis, campylobacteriosis, cryptosporidiosis, rotavirus infection, staphylococcal intestinal infection, etc.

According to the severity and characteristics of symptoms, the course of intestinal infection in children can be typical (mild, moderate, severe) and atypical (erased, hypertoxic). The severity of the clinic is assessed by the degree of damage to the gastrointestinal tract, dehydration and intoxication.

The nature of local manifestations of intestinal infection in children depends on the damage to one or another part of the gastrointestinal tract, and therefore gastritis, enteritis, colitis, gastroenteritis, gastroenterocolitis, enterocolitis are distinguished. In addition to localized forms, generalized forms of infection can develop in infants and weakened children with the spread of the pathogen beyond the digestive tract.

During an intestinal infection in children, acute (up to 1.5 months), protracted (over 1.5 months) and chronic (over 5-6 months) phases are distinguished.

Symptoms in children

Dysentery in children

After a short incubation period (1-7 days), the temperature rises sharply (up to 39-40° C), weakness and fatigue increase, appetite decreases, and vomiting is possible. Against the background of fever, there is a headache, chills, and sometimes delirium, convulsions, and loss of consciousness. Intestinal infection in children is accompanied by cramping abdominal pain localized in the left iliac region, symptoms of distal colitis (pain and spasm of the sigmoid colon, tenesmus with rectal prolapse), symptoms of sphincteritis. The frequency of bowel movements can vary from 4-6 to 15-20 times per day. With dysentery, the stool is liquid, containing impurities of cloudy mucus and blood. In severe forms of dysentery, hemorrhagic syndrome may develop, including intestinal bleeding.

In young children with intestinal infection, general intoxication prevails over colitis syndrome; disturbances in hemodynamics, electrolyte and protein metabolism occur more often. The most common intestinal infection in children is caused by Shigella Zona; heavier - Shigella Flexner and Grigoriez-Shig.

Salmonellosis in children

Most often (in 90% of cases) the gastrointestinal form of salmonellosis develops, occurring as gastritis, gastroenteritis, gastroenterocolitis. Characterized by subacute onset, febrile fever, adynamia, vomiting, hepatosplenomegaly. Stool with salmonellosis is liquid, copious, fecal, the color of “swamp mud”, with admixtures of mucus and blood. Typically, this form of intestinal infection ends in recovery, but in infants it can be fatal due to severe intestinal toxicosis.

Influenza-like (respiratory) form of intestinal infection occurs in 4-5% of children. In this form, Salmonella is detected in cultured material from the throat. Its course is characterized by febrile temperature, headache, arthralgia and myalgia, symptoms of rhinitis, pharyngitis, conjunctivitis. From the cardiovascular system, tachycardia and arterial hypotension are noted.

The typhus-like form of salmonellosis in children accounts for 2% of clinical cases. It occurs with a long period of fever (up to 3-4 weeks), severe intoxication, and dysfunction of the cardiovascular system (tachycardia, bradycardia).

The septic form of intestinal infection usually develops in children in the first months of life who have an unfavorable premorbid background. It accounts for about 2-3% of cases of salmonellosis in children. The disease is extremely severe, accompanied by septicemia or septicopyemia, disruption of all types of metabolism, and the development of severe complications (pneumonia, parenchymal hepatitis, otoanthritis, meningitis, osteomyelitis).

Escherichiosis in children

This group of intestinal infections in children is extremely extensive and includes coli infections caused by enteropathogenic, enterotoxigenic, enteroinvasive, and enterohemorrhagic Escherichia.

Intestinal infection in children caused by Escherichia, occurs with low-grade or febrile temperature, weakness, lethargy, decreased appetite, persistent vomiting or regurgitation, flatulence. Characterized by watery diarrhea (copious, splashing yellow stool mixed with mucus), quickly leading to dehydration and the development of exicosis. In Escherichiosis, caused by enterohemorrhagic Escherichia, the diarrhea is bloody.

Due to dehydration, the child develops dry skin and mucous membranes, tissue turgor and elasticity decreases, the large fontanel and eyeballs sink, and diuresis decreases such as oliguria or anuria.

Rotavirus infection in children

It usually occurs as acute gastroenteritis or enteritis. The incubation period lasts on average 1-3 days. All symptoms of intestinal infection in children develop within one day, while damage to the gastrointestinal tract is combined with catarrhal phenomena.

Respiratory syndrome is characterized by hyperemia of the pharynx, rhinitis, sore throat, and coughing. Simultaneously with damage to the nasopharynx, signs of gastroenteritis develop: loose (watery, foamy) stools with a frequency of bowel movements from 4-5 to 15 times a day, vomiting, temperature reaction, general intoxication. The duration of intestinal infection in children is 4-7 days.

Staphylococcal intestinal infection in children

A distinction is made between primary staphylococcal intestinal infection in children, associated with eating food contaminated with staphylococcus, and secondary, caused by the spread of the pathogen from other foci.

The course of intestinal infection in children is characterized by severe exicosis and toxicosis, vomiting, and increased bowel movements up to 10-15 times a day. The stool is liquid, watery, greenish in color, with a small admixture of mucus. With secondary staphylococcal infection in children, intestinal symptoms develop against the background of a leading disease: purulent otitis media, pneumonia, staphyloderma, tonsillitis, etc. In this case, the disease can take a long wave-like course.

Diagnostics

Based on an examination, epidemiological and clinical data, a pediatrician (pediatric infectious disease specialist) can only assume the likelihood of an intestinal infection in children, however, an etiological deciphering is possible only on the basis of laboratory data.

The main role in confirming the diagnosis of intestinal infection in children is played by bacteriological examination of stool, which should be carried out as early as possible, before the start of etiotropic therapy. In case of a generalized form of intestinal infection in children, blood cultures are performed for sterility, bacteriological examination of urine and cerebrospinal fluid.

Serological methods (RPGA, ELISA, RSK), which make it possible to detect the presence of antibodies to the pathogen in the patient’s blood from the 5th day from the onset of the disease, are of certain diagnostic value. The study of the coprogram allows us to clarify the localization of the process in the gastrointestinal tract.

In case of intestinal infection in children, it is necessary to exclude acute appendicitis, pancreatitis, lactase deficiency, biliary dyskinesia and other pathologies. For this purpose, consultations are held with a pediatric surgeon and a pediatric gastroenterologist.

Treatment of intestinal infection in children

Complex treatment of intestinal infections in children involves the organization of therapeutic nutrition; carrying out oral rehydration, etiotropic, pathogenetic and symptomatic therapy.

The diet of children with intestinal infection requires a decrease in the volume of food, an increase in the frequency of feedings, the use of mixtures enriched with protective factors, and the use of pureed, easily digestible food. An important component of the treatment of intestinal infections in children is oral rehydration with glucose-saline solutions and drinking plenty of fluids. It is carried out until fluid loss stops. If oral nutrition and fluid intake are impossible, infusion therapy is prescribed: solutions of glucose, Ringer, albumin, etc. are administered intravenously.

Etiotropic therapy of intestinal infections in children is carried out with antibiotics and intestinal antiseptics (kanamycin, gentamicin, polymyxin, furazolidone, nalidixic acid), enterosorbents. The use of specific bacteriophages and lactoglobulins (salmonella, dysentery, coliproteus, klebsiella, etc.), as well as immunoglobulins (antirotavirus, etc.) is indicated. Pathogenetic therapy involves the administration of enzymes and antihistamines; Symptomatic treatment includes taking antipyretics and antispasmodics. During the period of convalescence, it is necessary to correct dysbiosis, take vitamins and adaptogens.

Prognosis and prevention

Early detection and adequate therapy ensure full recovery of children after an intestinal infection. Immunity after ACI is unstable. In severe forms of intestinal infection in children, the development of hypovolemic shock, disseminated intravascular coagulation syndrome, pulmonary edema, acute renal failure, acute heart failure, and infectious-toxic shock is possible.

The basis for the prevention of intestinal infections in children is compliance with sanitary and hygienic standards: proper storage and heat treatment of products, protecting water from contamination, isolating patients, disinfecting toys and utensils in children's institutions, instilling personal hygiene skills in children. When caring for an infant, a mother should not neglect treating the mammary glands before feeding, treating nipples and bottles, washing hands after swaddling and washing the baby.

Children who have been in contact with a patient with an intestinal infection are subject to bacteriological examination and observation for 7 days.

Pediatrics. Lecture No. 2

TOPIC: ACUTE INTESTINAL INFECTIONS.

Relevance of the problem: acute intestinal infections occupy 4th place in the structure of child mortality; acute intestinal infections occupy 2nd place in the structure of childhood infectious diseases.

Acute intestinal infections are characterized not only by high morbidity and incidence, but also, unfortunately, by high mortality. Mortality is especially high in children under 1 year of age.

Acute intestinal infections are a group of infectious diseases caused by pathogenic enterobacteria, representatives of opportunistic flora (OPF), numerous viruses and characterized by damage to the gastrointestinal tract with the development of symptoms of toxicosis and dehydration (dehydration, exicosis).

Classification of acute intestinal infections in children.

By structure (etiology)

    Dysentery (shigellosis). It ranks first among diseases in children, especially preschool and school age.

    Salmonella. They occupy 2nd place in the structure of acute intestinal infections in terms of frequency. Children of all age groups are affected.

    Coli infections (escherichiosis).

    Intestinal diseases caused by staphylococcus (mainly the pathogenic strain of Staphilococcus aureus), Yersinia (in particular Yersinia enterocolitica), enterococcus, Campylobacter, representatives of opportunistic flora (Proteus, Klebsiella - absolutely insensitive to antibiotics, Citrobacter), fungi of the genus Candida (damage to all Gastrointestinal tract due to the fact that children have physiological immunodeficiency).

    Viral intestinal infections. According to American authors, the most important viruses are: rotavirus. Also important in the occurrence of intestinal syndrome: adenovirus is tropic to all mucous membranes - therefore, a number of symptoms can occur simultaneously: runny nose, cough, conjunctivitis, severe diarrhea, etc. Enterovirus is the causative agent of enteroviral diseases that can occur with meningitis, polio-like syndrome, including diarrhea syndrome and rash. Most infections with enterovirus occur when swimming in bodies of water into which municipal waste flows.

According to the clinical form of the disease (posyndromic diagnosis).

    Acute gastritis, when the disease is characterized only by vomiting syndrome, there are no intestinal disorders. This happens in older children with food poisoning.

    Acute enteritis: there is no vomiting syndrome, but there is diarrhea syndrome - frequent, liquid stools.

    Acute gastroenteritis occurs most often: there is a syndrome of vomiting, dehydration, and diarrhea.

    In some cases, when a child falls ill with a severe form of dysentery, the symptom complex is realized in the lower parts and is characterized by acute colitis: tenesmus, loose stools mixed with blood.

    Acute enterocolitis - damage to the entire intestine

ACCORDING TO THE SEVERITY OF THE DISEASE

Typical forms: light, medium, heavy.

Criteria for determining severity: severity is determined by:

    temperature altitude

    frequency of vomiting

    stool frequency

    severity of symptoms of intoxication and dehydration

Atypical forms

    Erased forms: scanty symptom complex - pasty stool 1-2 times, low-grade single increase in temperature, absence of vomiting, satisfactory condition. The diagnosis is made by bacteriological and serological confirmation.

    Asymptomatic form: complete absence of any symptoms. The diagnosis is made by seeding the child.

    Bacterial carriage. Many pediatricians, when they do not want to have trouble with the SES (with graduates of the Faculty of Sanitation), make a diagnosis of bacterial carriage. Therefore, this diagnosis must be approached with caution: bacterial carriage is a complete absence of clinical manifestations, there is only a transient, one-time isolation of the microbe. Making such a diagnosis is quite risky because there is no possibility of examination on an outpatient basis, and it is better to make a diagnosis of a mild form.

    Hypertoxic form. The disease develops very rapidly, acutely, sometimes with the development of infectious-toxic shock (grades 1-3), characterized by pronounced toxic symptoms and virtually no local changes (the intestines are intact since the changes do not have time to develop). In acute intestinal infections, infectious-toxic shock is rare.

DYSENTERY (SHIGELLOSIS). It is a very common disease in our country. From 1980 to 1990, the incidence rate declined; if children did get sick, it was in mild, monotonous forms; the only thing that was unpleasant was the seeding (carriage). But since 1991-92, including in St. Petersburg, the incidence of dysentery has increased catastrophically and the manifestations of the disease have become more severe. The mortality rate among adults is 200 per 100 thousand.

ETIOLOGY: dysentery is caused by:

Shigella Sonnei (mainly fermentative type 2) - this strain predominated in previous years. Shigella Flexneri (strains 2a and 4b. Strain 2a is more vicious and predominant.)

causes the most severe forms of dysentery.

FEATURES OF DYSENTERY IN CHILDREN IN THE FIRST YEAR OF LIFE.

    Children in the first year of life suffer from dysentery quite rarely, which is due to lack of contact, breastfeeding and antibody protection of the mother. Therefore, if an infant has diarrhea syndrome, then dysentery should be the last thing to think about.

    The disease occurs predominantly in a moderate or mild form, quite monotonously, the temperature is often subfebrile, vomiting is rare (in general, vomiting is not very characteristic of dysentery), the stool is enteritic in nature (high stool - liquid, with fine mucus, green, fecal in nature) - non-classical, with different frequencies.

    Young children do not have such a classic symptom of dysentery as tenesmus (the urge to go down). Instead of this symptom, the equivalent of tenesmus occurs: before the act of defecation, the child is sharply excited, knocks his legs, screams, facial flushing, severe sweating, tachycardia, sometimes a tense abdomen, and after the act of defecation all these phenomena disappear.

    Layering of intercurrent diseases: if a child falls ill with dysentery, then it is not the dysentery itself that depletes him, but the intercurrent diseases: purulent otitis media, ARVI, pneumonia, pustular skin lesions, urinary tract infection and so on.

    The course of dysentery is characterized by a slow (often protracted - over 1.5 months) monotonous course, due to the frequent development (up to 90% of cases) of dysbacteriosis, which leads to prolonged release of the microbe (months), which is difficult to treat (treatment should be variable).

FEATURES OF TOXIC DYSENTERY:

    It is most often caused by Shigella Flexneri and mainly in school-age children (since a small child, due to the underdevelopment of the immune system, cannot react to infection in this way). The onset is acute: a rise in temperature to 39-40 degrees (lightning fast), severe headache, sudden agitation in the first hours, accompanied by clonic-tonic convulsions. In some cases, loss of consciousness is possible, there may be vomiting, and an objective examination reveals positive meningeal symptoms. This is a typical clinical picture of serous or purulent meningitis, and it is better to hospitalize such a child. The difficulty of diagnosis lies in the later (after several hours or days) appearance of a characteristic intestinal syndrome - frequent characteristic stools, tenesmus, abdominal pain, which contributes to the incorrect hospitalization of the child. Helps in diagnosis:

    indication of contact with a patient with acute intestinal infection

    reference to the consumption of dairy products on the eve of illness. Since it is dairy products that take first place in the causes of infection, since the dairy environment is the best environment for the development of Shigella Flexneri.

    mandatory hospitalization of the child for a differential diagnosis with meningitis, and, if necessary, a lumbar puncture.

    carrying out a comprehensive laboratory examination:

coprogram

stool culture for disgroup, colipathogenic flora, typhoparatyphoid group. It is carried out 3 times in the first hours and days of illness before the start of antibacterial therapy. Bacteriological confirmation occurs in 30% of cases, so it needs to be examined at least three times.

On days 5-7 from the onset of the disease, a serological test should be carried out: RNGA with a dysentery diagnosticum, with a repeat study after 7-10 days.

The diagnostic titer for dysentery caused by Shigella Flexneri is 1/200, for dysentery caused by Shigella Sonnei - 1/100. Diagnostically important is the increase in antibody titer over time.

If necessary, sigmoidoscopy is performed, which is very important for dysentery.

SEVERE FORMS OF DYSENTERY with a predominance of local phenomena (colitic or hemocolytic syndrome). Modern dysentery usually occurs in this form. The onset is acute: complaints of cramping intense pain in the lower abdomen come to the fore. Mainly on the left in the projection of the sigmoid colon. The pain intensifies before defecation - tenesmus. Along with this pain syndrome, symptoms of intoxication appear and increase (temperature from low-grade to high, which determines the severity of the disease), vomiting is possible, including repeated vomiting, diarrhea syndrome may appear in the first hours - this is the main dominant syndrome - frequent, loose stools , containing an admixture of coarse stringy mucus, quite often mixed with blood, which is called hemocolitis. In the coprogram there is a greater amount of mucus, blood cells: leukocyte mass (30-40), an increase in red blood cells that cannot be counted. With the development of the erosive-ulcerative process, there is practically only scarlet blood in the stool (surgical pathology must be excluded).

SALMONELLOSIS.

They rank second in frequency, after dysentery, in the morbidity structure. There are more than 2,000 salmonellosis pathogens in nature. According to the Kaufman-White classification, pathogens belonging to group B (Salmonella typhimurium) predominate, group D (Salmonella typhi abdominalis), group C to a lesser extent, group E - almost isolated cases.

Salmonella infections occur more frequently in developed countries. Now very often the causative agent is Salmonella enteritidis.

Infection occurs in two ways:

1. Food route: when consuming infected products - most often these are meat products - minced meat, jellies, boiled sausages, eggs, chicken, goose, canned meat, fish). Salmonella is very stable in the external environment.

2. Contact and household path.

According to the clinical course and routes of infection, there are 2 clinical variants of the course of salmonellosis:

1. Salmonellosis, occurring as a toxic infection.

2. Contact (“hospital”) salmonellosis.

SALMONELLOSISES PROCESSING BY THE TYPE OF TOXIC INFECTION.

CLINIC: the disease mainly affects older children - schoolchildren. It is characterized by an acute, violent onset: the first symptom that appears is repeated, repeated vomiting, nausea, aversion to food, possibly an increase in temperature (from 38 and above), and in parallel with this onset, abdominal pain appears: mainly in the epigastrium, around the navel, in some cases without a specific localization, accompanied by rumbling, flatulence, the abdomen is sharply swollen and after a few hours liquid, mucous stool appears, quite foul-smelling, with a lot of gas. The mucus, unlike dysentery, is very small, mixed with feces (since the upper intestines are affected). A “swamp mud” type chair. The frequency of stool varies: perhaps up to 10 or more times a day. Dehydration develops quite quickly in the absence of treatment (gastric lavage must be done, fluids must be given) or in very severe forms.

The course of food poisoning varies: it can be very short, but it can be quite long with the release of the pathogen from the feces.

LABORATORY DIAGNOSTICS Unlike dysentery, with salmonellosis the pathogen breaks into the blood and bacteremia occurs, so the diagnosis consists of:

    At the height of fever, culture blood into bile broth. Blood from a vein in the amount of 3-5 ml is prescribed in the emergency room upon admission.

    Coprogram for the presence of an inflammatory process and enzymatic changes.

    Bacteriological culture of stool for typhoparatyphoid group.

    Urine culture (this must be done upon discharge, since Salmonella is often not cultured from stool, but is found in large quantities in urine). Do it during convalescence and upon discharge.

    Serological study: RNGA with Salmonella antigen.

    It is possible and necessary to culture vomit or gastric lavage. If you do it right away, the answer is often positive.

This variant of salmonellosis is treated quite easily.

HOSPITALIZED SALMONELLOSIS. It is registered in children mainly in the first year of life, who are often ill, weakened (that is, with a poor premorbid background), newborns, and premature infants. It occurs in the form of an outbreak in children's departments, including maternity hospitals, intensive care units, and surgical departments. The source of infection is a patient or a bacteria carrier among staff or caring mothers. When the pathogen reaches the child through contact and household contact. The outbreak affects up to 80-90% of the children in the department, and therefore the department should be closed and final disinfection carried out.

THE CLINIC is developing gradually, gradually. The incubation period can extend to 5-10 days. Regurgitation appears, the child refuses to breastfeed, drink, lethargy, adynamia, weight loss, first mushy stool appears, and then liquid stool is absorbed into the diaper, with a frequency of up to 10-20 times a day. Dehydration develops. Due to the ineffectiveness of antibiotic therapy (the microbe is often resistant), the process generalizes with the emergence of multiple foci of infection:

Urinary tract infection

Purulent meningitis

Pneumonia

The most important focus is enterocolitis.

The peculiarity of this salmonellosis, in contrast to dysentery, is:

    prolonged fever (days to weeks)

    duration of intoxication

    enlarged liver and spleen (hepatolienal syndrome)

A fatal outcome may occur from the septic dystrophic condition of the child.

PREVENTION

    Mandatory examination of all personnel

    Mandatory examination of all caring mothers

    Immediate isolation of the child from the department to a separate box

    Surveillance during an outbreak

    For the purpose of prevention during an outbreak, phaging with a polyvalent liquid Salmonella bacteriophage of personnel, caring mothers, and children is effective. Course 3-5 days.

Escherichiosis (if INFECTION)

Caused by a group of pathogens called EPEC (enteropathogenic Escherichia coli). Next to the name of E.Coli is the serotype variant (by O-antigen).

O-111, O-119, O-20, O-18

This group causes severe intestinal disorders with the development of toxicosis and dehydration.

O-151 (“Crimea”), O-124

These pathogens are called “dysentery-like” because the clinical course of the disease is similar to dysentery.

They cause intestinal diseases in young children, clinically resembling cholera.

The SOURCE OF INFECTION is most often the adult mother, father, and personnel for whom this pathogen is not pathogenic.

ROUTES OF INFECTION: contact and household, possible food (with technological contamination, Escherichia can persist in products for years).

CLINIC: incubation period from 1-2 to 7 days. The onset of the disease can be different: acute, violent: repeated vomiting, gushing vomiting is especially characteristic, along with intestinal dysfunction. The appearance of liquid orange stool with white lumps, absorbed into the diaper, mixed with mucus (unlike dysentery, blood is not typical). Very often, severe flatulence is observed, which causes anxiety in the child, a categorical refusal to eat and drink, and due to the loss of fluid, dehydration occurs with pronounced electrolyte disturbances (first loss of sodium, then potassium). In this regard, pronounced hemodynamic disorders appear in the form of: cold extremities, pale marbled skin, often with a grayish tint, muscle hypotonia, pointed facial features, and sharply reduced skin turgor. Retraction of the large fontanelle, dry mucous membranes: sometimes the spatula sticks to the tongue.

A serious symptom of dehydration is a decrease in diuresis up to anuria, a drop in blood pressure, tachycardia turning into bradycardia, and an abnormal pulse.

Summary

The article is devoted to one of the most serious problems in pediatrics - acute intestinal infections. Treatment issues are discussed in detail - rehydration, antibacterial therapy, auxiliary therapy. Recommendations on the diet of children with infectious diarrhea are given.

The article is devoted to one of the most serious problems in pediatrics - acute intestinal infections. Nutritional treatment - rehydration, antibacterial therapy, and additional therapy are examined in detail. Recommendations have been made for the care of children with infectious diarrhea.

The article deals with one of the most serious problems in pediatrics - acute intestinal infections. The issues of treatment - rehydration, antibiotic therapy, adjuvant therapy are considered in detail. The recommendations on the diet of children with infectious diarrhea had been given.


Keywords

acute intestinal infections, diarrhea, rehydration, antibacterial therapy.

acute intestinal infections, diarrhea, rehydration, antibacterial therapy.

acute intestinal infections, diarrhea, rehydration, antibiotic therapy.

One of the serious problems of pediatrics in the world is the incidence of acute intestinal infections (AEI) among children. According to the World Health Organization (WHO), between 68.4 and 275 million diarrheal diseases are reported annually worldwide. According to the World Bank, half of all deaths of children under 5 years of age are caused by infectious diseases (respiratory diseases, acute intestinal infections, measles, malaria, HIV infection).

Acute intestinal infections are a widespread pathology, ranking second (after acute respiratory infections) among all infectious diseases in childhood. Children account for about 60-70% of all cases registered in different age groups. According to WHO, in developing countries, about 1 billion episodes of diarrhea occur annually in children under 5 years of age (an average of 3-4 episodes of diarrhea per year per child). Diarrhea kills 3 million children every year (about 80% of them are children under 2 years of age). ACI ranks third in these countries in the structure of child mortality, accounting for 15% of all cases.

According to official statistics, 50-60 thousand cases of infectious diarrhea in children are registered annually in Ukraine. 20-30 children die from acute intestinal infections in the country every year.

Infectious diarrhea

Secretory- diarrhea, caused mainly by viruses or bacteria that secrete enterotoxin and are characterized by predominantly damage to the small intestine (enteritis).

Invasive- diarrhea, caused mainly by bacteria and characterized by primary damage to the large intestine (colitis).

Etiology of infectious diarrhea

Secretory diarrhea:

— rotaviruses;

— adenoviruses;

— astroviruses;

— coronaviruses;

- norovirus;

- reoviruses;

— caliciviruses;

- Vibrio cholera;

— enteropathogenic, enterotoxigenic and enteroaggregative Escherichia;

— cryptosporidium;

- microsporidia;

- balantidia;

- isospores;

- lamblia giardia.

Invasive diarrhea:

— shigella;

— salmonella;

— enteroinvasive and enterohemorrhagic Escherichia;

- intestinal yersinia;

- campylobacter;

- clostridia;

- staphylococcus;

- proteus;

- klebsiella;

— other enterobacteria;

- amoeba histolytica.

Treatment of acute intestinal infections in children

The complex of treatment measures for OCI consists of 4 components:

1. Rehydration therapy.

2. Antibacterial therapy.

3. Auxiliary therapy.

4. Diet therapy.

Rehydration therapy

In 1978, the World Health Organization introduced oral rehydration solutions (ORS) into the treatment of dehydration in diarrheal diseases. The use of ORS as the main method of combating dehydration due to diarrhea has made it possible to reduce the global mortality rate among children under 5 years of age due to diarrheal diseases from 4.8 to 1.8 million annually.

— sodium — 75 mmol/l (sodium chloride 2.6 g/l);

— potassium — 20 mmol/l (potassium chloride 1.5 g/l);

— glucose — 75 mmol/l (glucose 13.5 g/l);

— sodium citrate — 10 mmol/l (2.9 g/l);

— osmolarity — 245 mOsm/l.

Timely and adequate rehydration therapy is the primary and most important link in the treatment of acute intestinal infections, both secretory and invasive. Early use of adequate rehydration therapy is the main condition for rapid and successful treatment. Rehydration therapy is carried out taking into account the severity of dehydration of the child’s body (Table 1).

If a child with diarrhea does not have signs of dehydration, the main goal of rehydration therapy is to prevent it. To do this, from the first hours of illness, the child is given more liquid to drink: children under 2 years old - 50-100 ml after each stool; children from 2 to 10 years old - 100-200 ml after each stool; children over 10 years old - as much liquid as they want to drink.

Methodology for oral rehydration in the presence of signs of dehydration. The amount of fluid required during dehydration is calculated depending on its severity. For mild dehydration, rehydration is carried out on an outpatient basis in two stages.

1st stage: in the first 4-6 hours, the water-salt deficiency that arose during the illness is eliminated (Table 2). At this stage of rehydration, it is necessary to use special oral rehydration solutions. No food other than breast milk should be given during the initial rehydration period.

A guideline amount of fluid at the initial stage of rehydration may be 20 ml/kg/hour for young children and 750 ml per hour for children over 12 years of age and adults.

When administering oral rehydration in an outpatient setting, a healthcare professional should visit the patient 4-6 hours after the start of treatment, assess the effect of therapy and choose one of the following options:

1) if signs of dehydration disappear or significantly decrease, switch to maintenance therapy (2nd stage);

2) if signs of dehydration remain at the same level, treatment is repeated over the next 4-6 hours in the same mode. At this stage, feeding is resumed;

3) if the severity of dehydration increases, hospitalization is indicated.

2nd stage: maintenance rehydration, carried out depending on the current fluid losses, which continue with vomiting and stool. The approximate volume of solution for maintenance rehydration is 50-100 ml or 10 ml/kg body weight after each stool. At this stage, glucose-saline solutions can alternate with salt-free solutions - fruit and vegetable decoctions, tea, especially green tea, without sugar.

Antibacterial therapy of acute intestinal infections in children

Indications for antibiotics for infectious diarrhea:

- severe forms of invasive diarrhea (hemocolitis, neutrophils in coprogram);

- children under 3 months of age;

— children with immunodeficiency conditions, HIV-infected children; children who are on immunosuppressive (chemo-, radiation), long-term corticosteroid therapy; children with hemolytic anemia, hemoglobinopathies, asplenia, chronic intestinal diseases, oncological and hematological diseases;

- hemocolitis, shigellosis, campylobacteriosis, cholera, amebiasis (even if these diseases are suspected).

When providing care for infectious diarrhea in an outpatient setting, antibacterial drugs are administered orally (Table 3). Their parenteral administration is indicated only in a hospital setting.

Today in Ukraine, nitrofuran derivatives, in particular nifuroxazide, are widely used as empirical therapy for acute intestinal infections (the most successful pharmaceutical drug from this group in terms of price/quality/efficacy ratio is the drug Lecor produced by the Spanish-Ukrainian joint venture Sperko Ukraine). Nifuroxazide (Lecor), unlike other drugs of the nitrofuran series, is not absorbed into the blood in the gastrointestinal tract, its dosage forms do not have a systemic effect on the macroorganism, and the spectrum of its antimicrobial action covers most bacterial pathogens of acute intestinal infections.

According to the classification of active medicinal ingredients by dispensing categories in some countries of the European Union (Belgium, France), dosage forms of nifuroxazide (Lecor) for oral use in a single dose of 200 mg are available without a prescription; in other countries, including Ukraine, the drug is classified as a prescription drug.

The effectiveness and safety of nifuroxazide (suspension, tablets) was studied in 2004 at the Clinic of Children's Infectious Diseases of the A.A. National Medical University. Bogomolets. The study involved 400 children aged 2 months and older. up to 14 years old. The dose of the drug corresponded to the instructions. The course of treatment was 7 days.

The results of a study of the effectiveness of nifuroxazide (suspension, tablets) for acute intestinal infections of bacterial etiology in children are presented in table. 4.

As can be seen from table. 4, on the first day of treatment, symptoms from the nervous system and loss of appetite were observed in all patients. On the last day of taking the drug, these symptoms disappeared. At the end of the course of therapy with nifuroxazide, abdominal pain also disappeared and body temperature normalized.

In addition to the general symptoms of DCI, the dynamics of the severity of local symptoms from the gastrointestinal tract were analyzed. By the 7th day of treatment, the frequency of bowel movements was within the physiological norm, and pathological impurities disappeared from the stool.

In order to determine the safety profile of nifuroxazide, all patients underwent a general blood test and the level of ALT in the blood was determined. The examinations were carried out twice: at the beginning of therapy and after its discontinuation.

When analyzing the indicators of a general blood test at the beginning of treatment, disturbances characteristic of the acute period of ACI were noted - moderate leukocytosis in most patients, a shift in the blood count to the left, increased ESR. When examined over time, in almost all children, the general blood test indicators returned to normal. ALT activity was within the age norm in all patients before and after treatment.

As a result of the study, it was concluded that nifuroxazide (suspension, tablets) is a safe and effective antibacterial drug for the treatment of acute intestinal infections in children. Thus, nifuroxazide (Lecor) can be recommended in treatment regimens for acute intestinal infections in children as an antibacterial drug.

Adjuvant therapy

The use of adequate rehydration therapy, diet therapy, and, if necessary, antibacterial therapy almost always ensures the patient’s recovery. Along with this, a number of drugs can have a positive effect on the child’s body during illness, help reduce the duration of its symptoms, and alleviate the patient’s condition, although they are not decisive for recovery from the disease. Among these drugs, probiotics are widely used. They contribute to the normalization of intestinal biocenosis and can act as antagonists of pathogenic bacteria due to their competitive action. For invasive diarrhea, the effectiveness of therapy increases with the parallel use of probiotics and antibiotics. For secretory diarrhea, probiotics can act as independent treatments. The course of probiotic therapy should be 5-10 days.

Enterosorbents can reduce the duration of intoxication during infectious diarrhea and speed up recovery. The basis for the use of enterosorbents in children is that they are able to fix on their surface not only toxic products, but also pathogens of infectious diarrhea (viruses, bacteria). Sorbents inhibit the adhesion of microorganisms on the surface of the intestinal mucosa, reduce the translocation of microflora from the intestine into the internal environment of the body and, thus, prevent the generalization of the infectious process.

Silicon sorbents, whose activity exceeds that of other enterosorbents, are promising for the treatment of diarrhea in children. Unlike coal sorbents, achieving the goal does not require the introduction of a large volume of silicon sorbents, which are significantly superior to carbon sorbents in organoleptic properties. The presence of micropores in enterosorbents prevents the sorption of high molecular weight protein toxins that are present in microbial pathogens. Carbon sorbents penetrate the submucosal layer of the intestine and can damage it, causing inflammation.

Diet therapy

Feeding with human milk should be maintained during acute intestinal infections in the mode that was before the disease. This is because the lactose in human milk is well tolerated by children with diarrhea. In addition, human milk contains epithelial, transformed and insulin-like growth factors. These substances contribute to faster restoration of the intestinal mucosa of children. Human milk also contains anti-infective factors such as lactoferrin, lysozyme, IgA, and bifidus factor.

For bottle-fed children in the acute period of the disease, it is recommended to reduce the daily amount of food by 1/2-1/3, in the acute period of colitis - by 1/2-1/4. It is possible to increase the frequency of feedings up to 8-10 times a day for infants and up to 5-6 times for older children, especially with the urge to vomit. At this time, the most physiological is considered to be an early gradual resumption of nutrition. The restoration of the qualitative and quantitative composition of food, characteristic of the child’s given age, is carried out as soon as possible after rehydration and the disappearance of signs of dehydration. Early resumption of normal diet along with oral rehydration is thought to reduce diarrhea and promote faster bowel repair.

For children receiving complementary feeding, it is recommended to introduce porridge with water into the diet, and earlier administration of meat puree. You can give baked apples and fermented milk products. It is recommended to introduce into the diet foods rich in pectin substances (baked apple, bananas, apple and carrot puree). The latter is especially indicated for acute intestinal infections, which are accompanied by colitis syndrome.

In some children, at the height of the disease (usually with salmonellosis), the exocrine function of the pancreas is disrupted, as evidenced by flatulence, profuse foul-smelling gray-green stools with an increased content of neutral fat and free fatty acids in the coprogram. In such cases, formula-fed children are prescribed adapted formulas that contain medium-chain triglycerides, which are easily absorbed in the body of a sick child without the participation of pancreatic lipase and bile acids.

In older children with mild forms of diarrhea without toxicosis, in the first days of the disease it is necessary to reduce the amount of food by 15-20%, it should be pureed. Insufficient food is supplemented with liquid: tea, glucose-salt solutions, decoctions of cereals, vegetables and fruits. Gradually, from the 3-5th day, the child is transferred to a nutritious diet according to age. In moderate forms, the amount of food is reduced by 20-30% during the first 2-3 days with a gradual, over 4-6 days, return to an age-appropriate diet.

In older children, it is advisable to exclude from the diet foods that cause excessive osmotic load on the intestines:

- sweets;

- concentrated meat broths;

- juices, sweet drinks, whole milk.

- baked apples;

- bananas;

- boiled vegetables.

Food should be well cooked, mashed or pureed.


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