PEDBASE.org - The Pediatric Database - Detailed information of ENTEROINVASIVE COLITIS

ENTEROINVASIVE COLITIS

DEFINITION:

A bacterial infection of the colon caused by Enteroinvasive E. coli (EIEC) resulting in a dysenteric diarrhea.

EPIDEMIOLOGY:

incidence: ?
risk factors:
- age: any age
- season: unknown
- route: indirect: food (cheese) (large inoculum needed)
- environ: epidemics and sporadic
incubation period: ?

PATHOGENESIS:

1. Background

Enteroinvasive E. coli is a gram negative rod
- serotypes 028ac, 029, 0112, 0124, 0136, 0143, 0144, 0147,
- 0152, 0164, 0167
- Shigella-like clinical picture due to the presence of a large virulence plasmid closely related to the virulence plasmid within Shigella -> able to invade gut epithelium and produce a dysentery-like illness
- EIEC adhere then invade the intestinal epithelium causing cell death and an inflammatory response (colitis)

CLINICAL FEATURES:

1. Diarrhea

indistinguishable from clasic bacillary dysentery
watery or bloody diarrhea
small volume with RBC's and WBC's
duration is variable
associated symptoms: crampy abdo pain, tenesmus, urgency, fever, systemic toxicity

INVESTIGATIONS:

1. Stool

culture, WBC+, DNA probes
guinea pig eye test (Sereny Test) - presence of purulent keratoconjunctivits after inoculation into the conjunctival sac

2. Biopsy

cause colonic lesions similar to those of bacillary dysentery: ulcerations, hemorrhagic infiltration of PMN with mucosal and submucosal edema

MANAGEMENT:

1. Supportive

oral rehydration fluid (ORF) or intravenous rehydration
Ampicillin or Colistin

Pediatric Database - ENTEROINVASIVE COLITIS

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