PEDBASE.org - The Pediatric Database - Detailed information of ENTEROPATHOGENIC ENTERITIS

ENTEROPATHOGENIC ENTERITIS

DEFINITION:

A bacterial infection of the intestines caused by Enteropathogenic pathogenic E. coli (EPEC) resulting in a secretory diarrhea.

EPIDEMIOLOGY:

incidence: up to 30% of diarrhea in developing countries
risk factors:
- age: < 1 year
- season: warm season peaks
- route: direct: fecal-oral
- indirect: food, formula
- environ: sporadic, endemic (developing countries)
intubation period: ?

PATHOGENESIS:

1. Background

Enteropathogeneic E. coli is a gram negative rod

1. Class I EPEC

serotypes 055, 086, 0111, 0119, 0125, 0126, 0127,
0128ab, and 0142
EAF probe + and localized adherence

2. Class II EPEC

serotypes 018, 044, 0112, 0114
EAF probe - and diffusely adherent
known to produce diarrhea exclusively as a result of their enteroadhesiveness for they do not produce enterotoxins or invade epithelial cells

CLINICAL FEATURES:

1. Diarrhea

nonbloody with watery diarrhea and mucous
RBC's and WBC's present in stool
can last longer than 7 days
associated symptoms: malaise

2. Complications

chronic persistent diarrhea

INVESTIGATIONS:

1. Stool

culture, DNA probes (class I EPEC only)
RBC's and WBC's present
duodenal fluid cultures for long-standing diarrhea

2. Biopsy

1. Light Microscopy

normal or blunting of the villi with inflammatory changes and sloughing of superficial mucosal cells

2. Electron Microscopy

distinctive adherence pattern of EPEC to intestinal mucosa (from duodenum to colon):
- "close attaching and effacing" or "pedestal-forming" adherence pattern
- lesion characterized by the loss of microvilli with a cup or pedestal on the membrane in which the bacteria can be seen

MANAGEMENT:

1. Supportive

oral rehydration fluid (ORF) or intravenous rehydration

2. Medications

TMP-SMX
Colistin

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