Thermophilic Campylobacter DNA in feces. Treatment of campylobacteriosis. Promotions and special offers

Campylobacteriosis (Vibriosis) is an acute zoonotic (infection occurs from animals) bacterial disease, with a predominantly fecal-oral transmission mechanism, characterized by damage to the gastrointestinal tract and occurring against the background of a feverish-intoxication syndrome.

Campylobacter

The causative agent belongs to the genus Compylobacter and is represented by 3 species - C.jejuni, C.coli, C.lari, etc., causing acute respiratory disease (acute intestinal disease) with similar clinical course. These are gram-negative spirally curved rods with specific features buildings responsible for symptoms:

It does not form spores or capsules, but there is a capsule-like shell that determines resistance in the external environment and to the action of phagocytosis.
There are flagella, their number reaches 5, this ensures their high mobility with corkscrew/helical/forward movements and, as a result, rapid generalization of the infection.
Energy is obtained from amino acids, and this can play a role in the formation of intoxication, since such a competitive method of energy consumption leads to disruption of protein metabolism.
Long-term growth on nutrient media makes diagnosis difficult, since the pathogen forms colonies within 2-4 days.
The ability to form hydrogen sulfide – this contributes to the formation of flatulence.
Cytotoxin damages the intestinal mucosa.
Enterotoxin causes diarrhea syndrome (diarrhea).
Lipopolysaccharide of the cell wall is an endotoxin that becomes harmful only after the death of bacteria, and this component contributes to intoxication.

Campylobacter resistance:

In the environment, when room temperature, persists for 1-5 weeks, the same periods of stability when the pathogen is found in food products, water supplies and wastewater, milk, and also in biological waste. At sub-zero temperatures it persists for several months.

Have a destructive effect high temperatures(50°C), direct UV and air, drying, high and low pH values, disinfectants in working concentration. Sensitive to macrolide antibiotics, metronidazole, nalidixic acid.

High susceptibility to campylobacteriosis in persons with weakened resistance, immunodeficiency, severe concomitant pathology, after gastrectomy and treatment with immunosuppressants. Also under high risk there are people working in the agricultural industry. The prevalence is geographically very high and occurs on all continents, which is associated with the intensification of livestock production, increased international trade in animal feed and increasing urbanization. The seasonality of the disease is recorded throughout the year, but the maximum increase in incidence is in June-August, and the minimum in the winter months.

Causes of infection with campylobacteriosis

The source is farm and domestic animals (rabbits, pigs, cows, sheep, ducks, etc.), and rodents and wild animals complete this list.

Mechanism of transmission: fecal-oral due to the nutritional route, i.e. by consuming contaminated products - infected milk and dairy products from sick animals, vegetables and fruits (by contaminating the soil in which these fruits grow); Transplacental; Contact-household and blood transfusion are not excluded.

Symptoms of campylobacteriosis

The incubation period is the period of time from the beginning of the introduction of the pathogen to the first signs of the disease, lasts 2-11 days, but on average 1-5. During this period, the pathogen penetrates through the gastrointestinal tract and adheres (attachment) to enterocytes (intestinal cells), mainly thin section intestines, after which the pathogen begins to multiply, colonizing the remaining parts of the intestine and, upon reaching a certain concentration of the pathogen, the next period occurs - clinical manifestations.

Period clinical manifestations is characterized by either gastroenteritis, or enterot, or enterocolitis, but other clinical forms are also possible - this depends on the amount of the infectious dose, on the premorbid background (the presence of aggravating factors on the part of the body), on the state of resistance. Thus, under unfavorable circumstances (younger age, imperfect immune system, concomitant pathology - malformations or diseases), bacteremia can develop with dissemination of the pathogen into various organs and tissues - that is, sepsis occurs, with the formation of secondary bacterial foci in the heart, central nervous system , lungs, liver and other organs.

When the clinical period begins, there are some age-related features:

In newborns, general intoxication symptoms with decompensation come to the fore: fever, development of RDS (respiratory disorder syndrome), diarrhea is characterized by stool with mucus and streaks of blood. Sometimes there may be no intoxication, and the intestines are affected in isolation.

In children early age Enterocolitis is more often observed (i.e., damage to both the small and large intestines), characterized by an acute onset of the disease, ITS I and II degrees (infectious-toxic shock), fever up to 38 ° C for 5 days. The stool is initially watery, after 2-3 days the stool becomes colitic in nature - that is, scanty, with a large amount of mucus and scarlet blood, abdominal pain is cramping and is often localized in the lower sections, possible peritoneal symptoms (Shchetkin-Blumbirg, shirt sign and etc). The duration of this disease is about 8 days.

In older children and adults, campylobacteriosis occurs with damage to the upper gastrointestinal tract - a gastrointestinal form characterized by an acute onset with a flu-like prodromal period, i.e. within 1-2 days patients complain of general weakness, headache, myalgia and arthralgia (muscle and joint pain), nausea and vomiting up to 15 times per day, pain in the epigastrium and mesogastrium as a result of the formed inflammatory reaction, fever appears on the 2-3rd day of the disease and persists for 3 days. The stool is initially copious, liquid, foamy, foul-smelling, then watery up to 10 times a day - this can lead to dehydration and acidosis, skin turgor decreases, dry skin appears, muscle cramps and decreased diuresis. This condition lasts about 5 days. Regardless of age, a generalized form may occur - bacteremia with dissemination to various organs.

Diagnosis of campylobacteriosis

Diagnosis is often impossible due to diverse and nonspecific symptoms, therefore, if suspected, laboratory methods are used:

Bacteriological and bacterioscopic - using these methods, the pathogen is determined in feces, blood, CSF (cerebrospinal fluid) and others biological materials.
Serological methods: RIF (immunofluorescence reaction), RSK (complement fixation reaction), ELISA (enzyme-linked immunosorbent assay), RPGA. Using these methods, the quality and quantitation antigens and antibodies.

Treatment of campylobacteriosis

Etiotropic therapy is aimed at the use of antibiotics, the most effective are gentamicin and erythromycin, and the least effective are kanamycin, levomycin, and semisynthetic antibiotics.

Symptomatic therapy is determined by clinical manifestations: antipyretics, administration of pre- and probiotics, enzyme therapy, immunomodulators and immunostimulants under the control of an immunogram, etc.

Complications of campylobacteriosis:

Peritonitis, intestinal bleeding, reactive arthritis, in pregnant women can lead to miscarriages.

Prevention of campylobacteriosis

Specific prevention has not been developed, but nonspecific prevention consists of compliance with processing and storage standards food products, compliance with personal hygiene rules and protection of water bodies from wastewater pollution.

The doctor's consultation

Question: Is immunity preserved after an illness?
Answer: post-infectious immunity has been little studied, but after an illness, bacteria can be excreted in feces for 2-5 weeks (this period may be shorter when treated with antibiotics).

Question: Is a sick person dangerous?
Answer: officially no, but a potential threat remains.

General practitioner Shabanova I.E.

Among acute intestinal infections (AEI), diseases caused by pathogens whose role in the pathogenesis of AEI in humans have been established relatively recently are currently attracting increasing attention. Among them, campylobacteriosis occupies an important place due to its widespread prevalence, the constant tendency to increase incidence and the significant socio-economic damage it causes.

Campylobacteriosis is an acute zooanthroponotic infectious disease, caused by pathogenic species of bacteria of the genus Campylobacter for humans, characterized by symptoms of intoxication, predominantly affecting the gastrointestinal tract (GIT), and in young children and weakened people it often occurs in the form of a generalized (septic) process.

Although Campylobacters were identified at the beginning of the century by McFadien and Stockman, their connection with human pathology was first established only in 1947 by R. Vincent, and the connection with ACI in humans was confirmed only in the 70s (J.P. Butzler, M. Skirrow and others). The reasons for this were unusual conditions for the growth of Campylobacter (microaerophilic atmosphere and temperature of +42°C), as well as the imperfection of selective media. Currently, the genus Campylobacter includes more than 14 species and subspecies isolated from animals and humans, and this number is constantly growing, the potential capabilities of these microorganisms in the etiology and pathogenesis of the disease in humans are being clarified. Highest value today they have C.jejuni, C.coli, C.laridis, C.fetus. The latter, however, more often affects people weakened by intercurrent diseases with the development of hematogenously disseminated forms of the disease. Most cases of campylobacteriosis, which occur as a diarrheal disease, are caused by C. jejuny and C. coli.

Campylobacters are small, non-spore forming, gram-negative bacteria with a spiral, S-shaped, or curved shape. Their length is 0.5-0.8 µm, width 0.2-0.5 µm, they have one or two flagella in polarity (Fig. 1). In older cultures they may take spherical or coccal forms. For optimal growth of Campylobacter, microaerophilic conditions are required with a gas composition containing 5% O2, 10% CO2 and 85% N2 at a temperature of 37 to 42°C. C.fetus also grows well under anaerobic conditions. Campylobacters have heat-stable and heat-labile antigens. O- and H-antigens in C.jejuni were studied. A protein flagellar antigen common to all serotypes of Campylobacter has been established.

To isolate Campylobacter, selective media have been developed that inhibit the growth of other enteropathogens. These are agar media with the addition of 5-10% blood of a sheep, rabbit or horse, as well as antibiotics to which Campylobacter is resistant. Commercial selective media have been created, in particular Skirrow's medium, Butzler's medium, Preston's medium, etc. There are also a number of enrichment and transport media.

It has been established that campylobacteriosis is widespread. However, its full identification is hampered by difficulties laboratory diagnostics. In many countries where testing for campylobacteriosis is widely carried out, the share of the latter among ACIs is 3-15%, but in some regions it can reach 44-73% and exceed the incidence of salmonellosis and shigellosis combined. In our country, similar studies have been carried out since the 80s. According to published last years According to the data, campylobacteriosis was detected in 5-22% of examined patients with acute intestinal infections.

Campylobacter is found in the intestinal flora of many wild and domestic animals and birds and can be transmitted to humans through contaminated food, milk and water. In this case, children, pregnant women, and weakened people get sick more often. Occupational diseases of persons constantly in contact with animals are observed. Infection from humans is possible, for example, when newborns are infected (transplacentally or during childbirth), adults can become infected from their children, and family outbreaks associated with bacterial carriage are also common. An autumn-summer seasonality of diseases has been noted.

It has been established that the pathogen enters the body mainly through the gastrointestinal tract through the nutritional route. Penetration through damaged skin (contact with animals, bites) is also possible. Inflammation (usually diarrhea) occurs in the area of ​​the entrance gate. In some cases it may be accompanied by transient bacteremia, but this does not appear to be a common occurrence in individuals with good immunological status. Possessing adhesive and invasive activity, Campylobacter causes destruction of the mucous membrane (MU) of both the small and large intestines, therefore mucus, pus and often an admixture of blood are usually detected in feces.

During endoscopy of the large intestine at the height of the disease, a picture of catarrhal-hemorrhagic or erosive-hemorrhagic colitis is determined with an abundance of light or pinkish mucus in the intestinal lumen, often tightly fixed to the CO epithelium. According to our data, the focality of the lesion along the entire length of the colonic mucosa is important, although the greatest changes are observed mainly in its distal parts.

At histological examination biopsies in the colon, as a rule, reveal a picture of erosive-hemorrhagic colitis with multiple microerosions in the surface epithelium and deep damage to the lamina propria with a predominance of exudative and proliferative components and maximum (compared to other colitis) tissue eosinophilia (Fig. 2, 3). The latter indicates a pronounced allergic component in the pathogenesis of intestinal lesions in campylobacteriosis.

Extraintestinal lesions in campylobacteriosis are a consequence of the progression of transient bacteremia into a septic process with the development of secondary purulent foci in various organs and tissues (endocarditis, meningitis, encephalitis, peritonitis, pleurisy, arthritis, etc.). This usually occurs in individuals belonging to the so-called risk groups due to factors that weaken the body’s defenses, such as diabetes, cachexia, tuberculosis, alcoholism, liver cirrhosis, systemic diseases, malignant neoplasms, HIV infection, etc.

On the contrary, in individuals with a full-fledged immunological background, the disease may not be accompanied by pronounced manifestations (subclinical form, bacterial carriage).

The incubation period ranges from six hours to 11 days (average two to five days). Most authors consider it appropriate to distinguish the following clinical forms of campylobacteriosis: 1) gastrointestinal (intestinal campylobacteriosis) with the predominant involvement of various parts of the gastrointestinal tract in the form of enteritis (4-12%), enterocolitis, gastroenterocolitis and colitis (81-93%); 2) generalized (septic); 3) chronic; 4) subclinical (bacteria carriage) - up to 1%.

The gastrointestinal form is often caused by C. jejuni (85%) and C. coli (15%). Mostly children (83%) and young people under 35 years of age are affected. In targeted studies in patients with campylobacteriosis, it is found high percent(66%) concomitant diseases of the digestive system (gastritis, gastroduodenitis, peptic ulcer stomach and duodenum, hepatocholecystitis, biliary dyskinesia, etc.).

In clinically severe cases, the disease begins acutely with fever, intoxication and the development of diarrhea syndrome. In approximately 40% of patients, diarrhea develops a day or more after its onset initial symptoms, which is characterized by a number of authors as a prodromal period.

In mild cases, the clinical manifestations of the disease persist for no more than a day, and in nature they are practically indistinguishable from other diarrheas, in particular viral ones. We observed a similar course in 5.7% of cases, although it is quite obvious that most of these patients do not seek treatment. medical care and therefore cannot be fully taken into account.

In cases of moderate severity, which, according to our data, among hospitalized patients is 91%, upon admission to the hospital, as a rule, there is a fever with an increase in temperature to 38-40 ° C, accompanied on the first day by chills (60%), sweating ( 40%), as well as intoxication, the most characteristic features which are general weakness (85.7%), dizziness (75%), headaches (48.5%), aches in bones and joints (36%), malaise (36%), and less commonly, myalgia (8%).

Damage to the gastrointestinal tract is characterized by the development of diarrhea with a stool frequency of up to five to six, less than ten or more times a day. The stool is copious, watery, colored with bile. In 45.7%, there is visually an admixture of mucus in the stool, and in 8.5% - blood. However, during scatological examination, inflammatory exudate, leukocytes and erythrocytes are usually found in stool. Vomiting and nausea occur in only 23% of patients. In 88.5%, diarrhea is accompanied by abdominal pain, in 76% - cramping. The pain syndrome can last from several hours to ten or more days and sometimes precedes the development of diarrhea.

On palpation of the abdomen, pain is noted in the peri-umbilical region, as well as along the intestine (51%), sometimes widespread moderate tension of the abdominal muscles, which is not, however, accompanied by symptoms of peritoneal irritation. Spasm and soreness sigmoid colon, as well as false urges are not typical and occur only in 8% of patients.

Changes in the hemogram and urine analysis are not typical and mainly reflect the phase of the disease and the degree of intoxication. Indicators water-salt metabolism in adult patients, as a rule, remain within physiological fluctuations. In 7.7% of children with a moderate course, there may be disturbances in water-salt balance that require correction.

In severe cases (3-4%), significant intoxication is observed, at the height of which delirium, meningism or convulsions (in young children) can develop. Severe enterocolitis occurs with profuse mucous or bloody diarrhea, as well as severe pain in the abdomen, requiring the exclusion of surgical pathology or ulcerative colitis. In clinical and laboratory research a complex of signs of dehydration, as well as dysfunction of cardio-vascular system, liver, pancreas and kidneys.

In an uncomplicated course of the disease, the duration of fever and intoxication is usually three to five days, clinical recovery in most cases occurs by the sixth to ninth day. Campylobacters in repeated bacteriological studies are more often detected before the sixth day of illness, in patients with concomitant pathology of the gastrointestinal tract - up to two weeks.

The generalized (septic) form of campylobacteriosis is usually caused by C. fetus. Such cases of diseases caused by C.jejuni/coli are reported infrequently (less than 2%). However, the role of the latter in the development of extraintestinal forms of infection is currently being reconsidered. It is believed that targeted studies of febrile patients, especially with diarrhea, for campylobacteriosis will clarify the true frequency and participation of C.jejuni/coli in the development of generalized forms of infection.

The development of a generalized process is more often observed in children in the first months of life (53%), in elderly people (24%) and in weakened adults (23%). The disease ranges from transient bacteremia and localized infection to fulminant sepsis with various organ involvement. A constant symptom is severe persistent fever (up to 40°C and above) with large daily ranges, repeated chills, profuse sweats, exhaustion, anemia. This is often accompanied by severe dyspeptic symptoms, diarrhea, and hepatosplenomegaly. At the same time, intestinal manifestations can only precede the development of a generalized infection and are not leading in the future, and the clinic of organ lesions (meningitis, endocarditis, hepatitis, pleurisy, etc.) comes to the fore. Therefore, in diagnostically difficult cases, especially in the absence of an adequate response to therapy, bacteriological studies are advisable to detect campylobacters as possible reason diseases.

Chronic forms of campylobacteriosis, associated with the persistence of Campylobacter bacteria in the body, have become increasingly described in immunosuppressive conditions, in particular in combination with HIV infection. The course of these forms is usually sluggish, without an acute phase, and in many ways resembles chronic sepsis. In some cases, this is accompanied by periodic dyspeptic disorders, unstable stools, and keratitis and conjunctivitis. During exacerbations, organ damage may develop, as with the generalized form. In women, the genital organs are often involved in the process, which leads to miscarriages and infertility.

The subclinical (asymptomatic) form of campylobacteriosis is usually detected in foci of infection during targeted studies. The pathogen is detected clinically in feces healthy people. At the same time, an increase in specific antibodies is determined in the blood serum.

Complications occur more often in cases of more severe disease and among people at risk.

In 20-25%, relapses of the disease are possible. More often they occur in elderly people, young children, and untreated patients.

Seizures have also been described severe pain in the abdomen, causing suspicion of acute appendicitis, cholecystitis, peritonitis. In most of these patients (as confirmed by laparotomy), inflammation of the jejunum and ileum is detected in combination with mesadenitis, which is similar to typhoid.

In the presence of severe concomitant diseases, life-threatening complications may develop, such as massive intestinal bleeding, peritonitis, pseudomembranous colitis, toxic megacolon.

Rarer complications include reactive arthritis, pancreatic lesions, Guillain-Barre syndrome, erythema nodosum, and Reiter's syndrome.

The variety of clinical manifestations significantly complicates the diagnosis of campylobacteriosis, especially in sporadic cases, since there are still no descriptions of symptoms strictly specific to of this disease, and requires mandatory laboratory confirmation. However, it is quite possible to suspect campylobacteriosis with careful consideration of the epidemiological history (contact with animals, the group nature of the disease, seasonality with a predominance in the summer-autumn period), when comparing the nature, severity, sequence and duration of individual symptoms, as well as with sufficient alertness of the doctor regarding the likelihood of this diseases.

To confirm the diagnosis, the most reliable method is the bacteriological research method. Depending on the form of the disease, samples include feces, blood, cerebrospinal fluid, pus from abscesses, amniotic fluid, etc. The likelihood of isolating a pathogen increases with examination in more early dates illness (preferably before prescribing etiotropic therapy).

For retrospective diagnosis, a serological research method is used (RA, RSK, RNGA, ELISA, immunoelectrophoresis, latex agglutination, etc.). Paired sera taken with an interval of 14 days are examined. The use of modern express methods for determining microbial antigens in material taken from patients, in particular the coagglutination reaction for detecting O-antigens of campylobacter, seems promising.

The gastrointestinal form of campylobacteriosis must be differentiated from other acute infections, primarily from shigellosis and salmonellosis, due to the significant similarity of these diseases. Campylobacteriosis, unlike other acute intestinal infections, is characterized by the onset of the disease with signs of intoxication and the later (up to two to three days) occurrence of diarrhea and abdominal pain; nausea and vomiting are observed relatively rarely. Severe pain in the abdominal area is also characteristic, which makes it necessary to differentiate the disease from acute surgical pathology.

In addition, with campylobacteriosis, unlike shigellosis, intoxication and chills are less pronounced, and stools in the form of “ rectal spitting", sigma spasm, false urges.

Unlike salmonellosis, campylobacteriosis also causes less severe intoxication, the disease progresses less violently, there is no epigastric pain typical of salmonellosis, and symptoms of dehydration rarely develop.

Endoscopic examinations have important differential diagnostic significance. In patients with campylobacteriosis in acute period diseases, as a rule, catarrhal-hemorrhagic or erosive-hemorrhagic focal lesions of the colon are found throughout its entire length, as well as significant deposits of mucus tightly fixed on the surface of the epithelium, which is usually not observed with other acute intestinal infections.

With severe intestinal damage, it may be necessary to exclude Crohn's disease and nonspecific ulcerative colitis(by biopsy method). If a sudden pain syndrome from the stomach differential diagnosis carried out with acute appendicitis, in children - with intussusception.

The generalized form of campylobacteriosis is differentiated from generalized forms of salmonellosis, yersiniosis and sepsis of other etiologies. In all these cases, to definitively confirm the diagnosis, it is necessary to isolate the pathogen from the blood and other lesions.

The chronic form of campylobacteriosis sometimes has to be distinguished from some similar chronic forms. infectious diseases(brucellosis, toxoplasmosis, etc.).

The prognosis is usually favorable. The prognosis is more serious for generalized forms in children, pregnant women, as well as in cases with severe concomitant diseases, when mortality can reach 29%. Mortality rates are especially high in cases with meningitis and endocarditis.

The choice of treatment for campylobacteriosis is determined primarily by the form and severity of the disease. In the case of the gastrointestinal form, in cases of mild and partially moderate course, etiotropic therapy is not indicated, and treatment is carried out according to the generally accepted principles of treatment of patients with ACI (diet, oral rehydration, enzyme preparations, antispasmodics, restoratives, etc.). However, taking into account the phenomena of intestinal dysbiosis in most patients, it seems to us advisable to supplement treatment with biological bacterial preparations (bificol, lactobacterin, bifidum- or colibacterin) depending on age, phase of the disease, and the presence of concomitant diseases. In this case, you can use shortened courses of treatment (five doses twice a day for 7-10 days).

In severe cases, especially when the process is generalized, in people at risk and when there is a threat of complications, the use of antibacterial drugs. It has been established that Campylobacter is sensitive to erythromycin, tetracyclines, aminoglycosides, chloramphenicol, clindamycin, fluoroquinolones, and furazolidone. Almost all campylobacters are resistant to penicillins, some cephalosporins, trimethoprim, polymyxin, and sulfamethoxazole.

It is generally accepted that for the gastrointestinal form, erythromycin is most indicated (especially in the first days of the disease) at a dose of 500 mg twice a day in adults and 40 mg/kg of body weight per day in children for five days. However, cases caused by erythromycin-resistant strains of Campylobacter are becoming increasingly common in the clinic.

The use of tetracyclines, including doxycycline, is also recommended, but they have a fairly wide range of contraindications for children and a relatively frequent (up to 20%) development of campylobacter resistance to them has been noted.

In generalized forms, especially in patients with septicemia, severe organ damage and complications, the most effective means Gentamicin and chloramphenicol succinate, often prescribed parenterally, are considered. Gentamicin sulfate is recommended at 0.8-1.0 mg/kg body weight two to three times a day; chloramphenicol-succinate (drug of choice in cases of campylobacteriosis meningitis) - 50-100 mg/kg body weight three to four times a day.

In chronic forms, there is a need for repeated courses of treatment with various bacterial agents, as well as their combinations in combination with restorative and immunotherapy.

In recent years in complex therapy fluoroquinolones, in particular ciprofloxacin, have been successfully used to treat various infectious diseases, including campylobacteriosis. Conducted by us comparative analysis effectiveness of using various antibacterial agents and ciprofloxacin in patients with campylobacteriosis allows us to give preference to ciprofloxacin - as it has wide range antibacterial activity, high tissue penetration and bactericidal effect, as well as the absence today of forms of microbes resistant to it.

Preventive measures for campylobacteriosis are carried out to the same extent as for other diarrheal diseases.

Literature

Campylobacteriosis in children- these are diseases that are caused by Campylobacter - opportunistic microorganisms, and which manifest themselves mainly by damage to the gastrointestinal tract. Campylobacter infections are called campylobacter infections in the scientific literature.

Campylobacteriosis affects mainly weakened adults and children who suffer from tuberculosis, diabetes, hematological malignancies and other oncological diseases. Pregnant women and children are at particular risk younger age.

Epidemiology

Campylobacters are quite widespread in nature. They often cause diarrheal diseases in humans of different ages. The infection is spread by domestic and wild animals, birds and sick people (children and adults). Campylobacters are isolated from healthy carriers in very rare cases (less than 1%). The main routes of transmission of infection: fecal-oral and contact-household. The pathogen is often recorded in developing regions, but in some cases - in developed countries.

Children under 2 years of age are at risk. Newborns are at risk of infection from sick mothers during childbirth. Outbreaks of campylobacteriosis occur at all times of the year, but the largest number of them occurs in the summer, when food products are most susceptible to contamination and contamination. The incidence is sporadic and epidemic. Epidemics are provoked by the intake of contaminated milk (unboiled) and unprocessed drinking water. Nosocomial outbreaks occur due to infection from patients with various forms stoneslobacteriosis.

What provokes / Causes of Campylobacteriosis in children:

Campylobacter belongs to the genus Campylobacter. They are gram-negative, non-spore-forming, spirally curved, motile rods measuring 0.2-0.5x0.5-0.8 µm. They belong to microaerophilic microorganisms. Pathogenic for humans (capable of causing disease) WITH.fetus jejuni(WITH.jejuni) And WITH.fetus intestinalis (WITH.intestinalis) .

Campylobacters “feel” most comfortable at a temperature of 4 °C. Their viability deteriorates slightly at room temperature, and they completely die when the temperature environment reaches 42 ˚С. Some strains of S. jejuni produce enterotoxin and cytolytic toxins.

Pathogenesis (what happens?) During Campylobacteriosis in children:

Campylobacters enter the gastrointestinal tract through the fecal-oral or household contact route, attach to the cells of the epithelial layer of the intestine, and colonize the mucous layer. Bacteria can pass through the intestinal mucosa and move along the epithelial cells. They can penetrate through the damaged membrane of enterocytes and the intercellular spaces of the epithelium. In the submucosal layer small intestine Infiltrates are usually found, which consist of lymphocytes, polynuclear cells and plasma cells. Around blood vessels An acute inflammatory reaction is localized in the glandular epithelium and crypts.

Endotoxin is released after the death of bacterial cells and leads to hemorrhagic and necrotic skin changes in rabbits infected with Campylobacter for research purposes. Enterotoxin, which is produced by Campylobacter, leads to the development of secretory diarrhea.

After surviving the disease, immunity is formed.

The pathogenicity of different campylobacters is not the same. WITH. intestinalis It is dangerous mainly for premature newborns and weakened adults; it causes hematogenously disseminated infection with the formation of purulent septic foci. WITH. jejuni induces localized pathological process only in the gastrointestinal tract.

Symptoms of Campylobacteriosis in children:

Among all clinical forms Campylobacter intestinal infection is the most studied. Lasts from 3 to 5 days incubation period. The average value is 3-5 days. The disease begins acutely, the body temperature rises to febrile. Muscle pain and general weakness appear. Half of the young children experience intense pain in the abdomen around the navel and in the right iliac region.

In the first days, vomiting may occur, even repeated. The main symptom of the disease is diarrhea. They appear in most cases immediately after the onset of the disease. The gastrointestinal tract can have lesions ranging from gastritis to enterocolitis. Often this is enterocolitis and gastroenteritis. More rare cases are gastroenterocolitis, gastritis and enteritis.

Stool occurs from 4 to 20 times during the day and night. The stools are copious, watery, and bile-colored. There is a small amount of mucus, an unpleasant odor emanates from the stool, blood streaks are often visible, and less often - fresh blood. Hemocolitis is very often diagnosed in young children.

In some cases, with intestinal campylobacter infection, measles-like, scarlet-like and urticarial exanthemas appear. Microscopic examination methods show inflammatory exudate and leukocytes in the feces. The temperature remains elevated only for up to 3 days. Symptoms general intoxication in most cases they are weakly expressed and do not last long - from 2 to 5 days. Neurotoxicosis is recorded only in rare cases. Diarrhea lasts 3-14 days. In less than 15% of sick children, stool returns to normal in the 3-4th week. The disease occurs in mild and non-severe forms.

Features of the disease in newborns

Perinatal campylobacteriosis is most often caused by C. intestinalis. In pregnant women, when infected with Campylobacter, the following symptoms appear: bacteremia, prolonged fever, necrotizing focal placentitis. Placentitis means infectious inflammation placenta. In 40 cases out of 100, pregnancy is resolved by stillbirth or miscarriage, in 60 cases out of 100 the child is born premature. Campylobacteriosis in newborns manifests itself 12-20 hours after birth - fever, vomiting, diarrhea, and respiratory distress syndrome appear.

Damage to the central nervous system manifests itself as meningitis or meningoencephalitis. Morphological changes include cystic degeneration and hemorrhagic necrosis of the brain. Newborns recover in rare cases, but gross residual pathology is formed.

Newborns may develop isolated campylobacter intestinal infection. In this case, no vomiting is observed, body temperature remains within normal limits. Diarrhea often occurs (moderately expressed) - the stool is frequent and liquefied, and there is a slight inclusion of mucus and bloody streaks in the stool. Signs of dehydration with isolated campylobacter intestinal infection There is no observed, as well as flatulence, abdominal pain syndrome.

In very rare cases it is recorded generalized form of the disease, which manifests itself with the following symptoms:

• chills
• fever
• weight loss
• the appearance of purulent foci various localizations
• diarrhea
• stomach ache
• exanthema.

Pericarditis, endocarditis, arthritis, meningitis, and lung damage in the form of pneumonia or abscess may occur. Hematogenously disseminated forms of campylobacteriosis are severe, and deaths are common.

Diagnosis of Campylobacteriosis in children:

To diagnose campylobacteriosis in children, pathogens are isolated from feces. If the form of the disease is generalized, the pathogen is also found in the blood and purulent-inflammatory foci. Campylobacters are isolated on nutrient media that are used for growing Brucella, creating microaerophilic conditions. Rapid identification of causative agents of campylobacteriosis is carried out using phase-contrast microscopy.

Serological methods are used to detect anti-Campylobacter antibodies in RA or in RSC with a reference culture or autostrain. On days 4-7, antibody titers begin to increase and in RA are 1:160-1:640 and higher. Using an indirect immunofluorescence reaction, antibodies of the IgM and IgG classes are determined separately. For a primary infection, antibodies belonging to IgM and IgG are typical in high titers; with repeated infection, there are high titers of only IgG antibodies.

Treatment of Campylobacteriosis in children:

The course of campylobacteriosis is usually favorable. Antibacterial therapy is not required in all cases. Etiotropic drugs are used to treat sick children with a burdened premorbid background, with moderate and severe forms, especially with generalized forms.

Campylobacters are highly sensitive to nitrofuran derivatives (solafur, furazolidone), macrolides (azithromycin, erythromycin), aminoglycosides (gentamicin, amikacin), and chloramphenicol (chloramphenicol). These antibiotics reduce symptoms and help prevent relapses and complications.

Most campylobacteriosis in children ends with recovery. The prognosis is unfavorable for generalized forms of the disease, when the disease sometimes ends in death.

Prevention of Campylobacteriosis in children:

Veterinary and sanitary control is important.

– an acute zoonotic infection caused by enterobacteria Campylobacter and occurring with primary damage to the digestive tract. The localized form of campylobacteriosis in most cases occurs as gastroenteritis or gastroenterocolitis; the generalized form is accompanied by the development of septicemia or septicopyemia. The diagnosis of campylobacteriosis is confirmed by bacteriological culture of stool and blood; serological reactions, intestinal endoscopy. Specific etiotropic therapy for campylobacteriosis is carried out with antimicrobial drugs (metronidazole, tetracycline antibiotics, macrolides or fluoroquinolones, etc.).

General information

The incubation period lasts from several hours to 10 days (on average 2-5 days). The onset of campylobacteriosis is acute - with chills, fever (38-39°C), sweating, myalgia, arthralgia, headache. At the same time or after a few hours, diarrhea occurs with a stool frequency of up to 5-10 times a day. The stools are watery, foul-smelling, and often contain impurities of bile, mucus and blood. Nausea and vomiting are not a mandatory symptom of campylobacteriosis and occur in only a quarter of patients. The most constant symptom is cramping pain in the abdomen. With a benign course, the disease resolves after 3-9 days.

In severe cases of campylobacteriosis, profuse mucous or bloody diarrhea and severe dehydration may develop; in children - convulsive syndrome or meningism. Less commonly, localized forms of campylobacteriosis occur in the form of acute mesadenitis, catarrhal or phlegmonous appendicitis. Complications of the localized form of campylobacteriosis can include serous peritonitis, reactive arthritis, toxic megacolon, intestinal bleeding, and infectious-toxic shock. There are reports of a connection between previous campylobacteriosis and the development of Guillain-Barré syndrome.

The development of generalized forms of campylobacteriosis is observed in individuals with unfavorable concomitant background: cachexia, liver cirrhosis, diabetes mellitus, tuberculosis, systemic diseases, malignant tumors, HIV infection, as well as in children in the first months of life. Clinical symptoms include persistent fever (up to 40°C and above), profuse sweats, chills, exhaustion, dyspeptic symptoms, hepatosplenomegaly, anemia. In some cases, transient bacteremia can progress into a septic process, causing the development of purulent metastatic foci in various organs in the form of arthritis, micropolylymphadenitis, peritonitis, endocarditis, myocarditis, pleurisy, pneumonia, meningitis, encephalitis, etc. The course of the generalized form of campylobacteriosis is severe, often fatal Exodus.

Chronic campylobacteriosis is usually associated with immunosuppressive conditions, including HIV infection. Patients are concerned about low-grade fever, unstable stools, mesogastric pain, loss of appetite, and weight loss. Signs of conjunctivitis, keratitis, and pharyngitis are often detected; Women experience recurrent vaginitis or vulvovaginitis, miscarriages. During periods of exacerbation of campylobacteriosis, organ lesions characteristic of the generalized form may develop.

Diagnosis of campylobacteriosis

Grounds for suspicion of campylobacteriosis may include epidemiological history (contact with animals, tourist trips, etc.), characteristic symptoms. When examining the coprogram, inflammatory exudate, leukocytes, and red blood cells are found in the stool. Sigmoidoscopy or colonoscopy at the height of the disease reveals a picture of catarrhal, catarrhal-hemorrhagic, erosive-ulcerative proctosigmoiditis or colitis.

The most accurate confirmation of campylobacteriosis is a bacteriological examination of stool. Sometimes the material for cultural examination is blood, pus from abscesses, cerebrospinal fluid, and amniotic fluid. Serological diagnostics are also carried out using the methods of RA, RNGA, RSK, ELISA, immunoelectrophoresis, latex agglutination, etc.

The gastrointestinal form of campylobacteriosis requires differentiation from other acute intestinal infections, primarily dysentery and salmonellosis, as well as mesadenitis and appendicitis of other etiologies. Endoscopic intestinal biopsy can rule out ulcerative colitis and Crohn's disease. The generalized form of campylobacteriosis must be distinguished from sepsis caused by another pathogen; chronic form– from toxoplasmosis, brucellosis, yersiniosis and other chronic infectious diseases.

Treatment and prevention of campylobacteriosis

Volume therapeutic measures for campylobacteriosis depends on the form and severity of the infection. At mild degree For localized forms of campylobacteriosis, etiotropic therapy is not carried out: in this case, they are limited to the prescription of diet, oral rehydration, antispasmodics, enzymes, and biological bacterial preparations for the correction of intestinal dysbiosis. In case of moderate and severe gastrointestinal forms of campylobacteriosis, as well as in the generalization of infection, the use of antibacterial drugs to which campylobacter is sensitive (erythromycin, tetracycline, doxycycline, chloramphenicol, clindamycin, fluoroquinolones, aminoglycosides, macrolides, metronidazole, furazolidone, etc.) is indicated in a course of 7- 14 days. Pathogenetic therapy for campylobacteriosis involves the infusion of glucose-electrolyte and polyionic solutions and the administration of desensitizing agents. Persons who have had campylobacteriosis are monitored by an infectious disease specialist for 1 month and are subject to double bacteriological examination.

With localized forms of campylobacteriosis, the prognosis is favorable. Complications are possible only in severe cases of the disease and among persons with aggravated concomitant background. In generalized forms that develop in children, pregnant women, and weakened patients, mortality can reach 25-30%. Prevention of campylobacteriosis should be aimed at preventing infection of domestic animals and birds; sanitary supervision of water supply, storage conditions and food processing technology; training the population in personal hygiene standards and food preparation rules.

Campylobacteriosis is one of the enteroviral infections.

The inflammatory process can be accompanied not only by the main signs of infection of the child’s body, but also by the manifestation of concomitant diseases of the gastrointestinal tract.

Treatment of campylobacteriosis in children is carried out according to a specific scheme and in most cases depends on the individual characteristics of the child’s body. The earlier an infection is detected, the faster and more effective the therapy will be.

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Concept and features

Campylobacteriosis is an acute zoonotic infection, the causative agent of which is a certain type of enterobacteria.

The inflammatory process mainly affects negative impact on the child's digestive system.

The disease can be diagnosed at any age, but to a special risk group children enter preschool age. Particular activity of bacteria is recorded in countries with warm climates or in the summer.

Peculiarities diseases:

• the incubation period can reach fourteen days;
• bacteria are killed by boiling.

Causes

The route of infection with the causative agent of campylobacteriosis is through the human intestines. In the digestive organ, bacteria actively penetrate the mucous membranes and provoke the development inflammatory process.

At the same time, they spread throughout lymphatic system towards the large intestine. Active growth of bacteria occurs in this section. The consequence of their vital activity is the appearance of symptoms characteristic of the disease.

Causes of the disease in humans are the following factors:

Children at risk of contracting campylobacteriosis under two years of age(the reason for the tendency to enteroviral infections is low level protective functions of the body and the process of formation immune system).

In some cases, a child may become infected with bacteria from mother if the woman was infected during pregnancy.

Pathogen

Bacteria that become the causative agent of campylobacteriosis belong to the family Enterobacteriaceae. There are fourteen types, but infection with some of them in medical practice occurs in isolated cases.

The symptoms of the infectious process depend on the type of bacteria that got into the digestive tract child. According to ICD 10 the disease is assigned number A 04.5(enteritis caused by Campylobacter).

Features of bacteria causing campylobacteriosis:

Symptoms and signs

In most cases, campylobacteriosis develops in a localized form. Against the background of infection, the child may develop additional diseases of the gastrointestinal tract.

These include cholecystitis, gastric ulcer or duodenum And .

The first symptoms of the infectious process resemble feverish condition. The child suddenly develops a fever, chills and excessive sweating.

The further course of the disease depends on general condition the health of the baby and his immune system.

Symptoms campylobacteriosis in children are the following conditions:

Forms of the disease

According to the severity, campylobacteriosis can develop in mild, moderate and severe forms.

In some cases, the development of the disease in children may be asymptomatic. The level of the baby’s immune system plays a key role.

The disease can develop in acute, chronic and residual form. In the first case, the duration of development of the infection is less than three months, in the second - more than three months.

Forms of the disease:

• generalized type (septicopyemia, septicemia);
• localized type (enteritis, enterocolitis, gastroenterocolitis).

How dangerous is the pathology?

Lack of treatment or improper therapy for campylobacteriosis can become cause of life-threatening diseases.

The waste products of bacteria, which are the causative agent of the inflammatory process, have an extremely negative effect not only on gastrointestinal tract the child, but also his entire body.

Suppuration may occur at the site of damage to the mucous membranes, and the progression of the disease may result in death of a young patient.

Complications The following conditions can become an infectious disease:

• intestinal bleeding;
• peritonitis;
• pleurisy;
• pneumonia;
• reactive arthritis;
• death;
• infectious-toxic shock.

Diagnostics and tests

Symptoms of campylobacteriosis similar to other enteroviral diseases.

The task of diagnosis is not only to identify the disease, but also to exclude the presence of nonspecific ulcerative, salmonellosis or.

The most effective way confirmation of the diagnosis is considered bacteriological culture feces . Pus from an abscess, blood or other biological materials can be used to conduct research.

Methods diagnostics campylobacteriosis include the following procedures:

• general blood and urine analysis;
• bacteriological culture of stool;
• biochemical analysis of blood and urine;
• study of serological reactions;
• intestinal endoscopy;
• RA and RSK;

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Treatment methods

The treatment regimen for campylobacteriosis depends on the intensity of the existing symptoms and the individual characteristics of the child’s body.

Antibacterial drugs are prescribed only for moderate and severe forms of the disease.

If it is mild or asymptomatic, therapy is carried out in accordance with the existing symptoms. Additionally, when treating children, infusion is used glucose-electrolyte solutions to speed up the recovery process of a small patient.

Therapy for campylobacteriosis includes the use of the following drugs and procedures:

Prevention measures

The main measure to prevent campylobacteriosis is to exclude factors that are considered sources of bacterial infection. The child's diet should contain only high-quality meats, thoroughly washed vegetables and fruits.

If the baby has a negative reaction to an insect bite, then the examination should be carried out before the symptoms intensify.

Experts note that children with good immunity are at risk of infection enteroviral infections is minimal.

Prevention measures campylobacteriosis include the following recommendations:

After treatment of campylobacteriosis, it is necessary to carry out re-examination child in a medical facility.

If within a short period of time the baby develops alarming symptoms, then you should not postpone your visit to the doctor.

If you start treatment for campylobacteriosis on early stages, then the risk of complications will be minimal. Otherwise, the infection will endanger the child's life.

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