Diarrhea with water in an adult: treatment. Tablets for diarrhea in adults. Symptoms, causes and pathogens of infectious diarrhea (bacterial origin) in adults

Diarrhea is loose, watery stools frequent urges, accompanied by painful sensations in the abdomen, sometimes vomiting, elevated temperature. Infectious diarrhea in adults (ICD code: A09) is caused either by viruses or bacterial (microbial) pathogens.

fall bacterial pathogens(salmonella, staphylococci, E. coli, etc.) most often through poorly cleaned drinking water, poor quality food, dirty hands. But the virus can be infected by airborne droplets like SARS. The risk of contracting viral diarrhea often depends on the person's age and immune status.

The course, nature and treatment of infectious viral diarrhea in adults directly depends on the definition of the etiology (origin) of a microbial or viral pathogen. It is possible to detect a specific pathogen only in laboratory conditions.

Viral

Diarrhea of ​​viral origin manifests itself in different variations, but medicine classifies three main groups.

Accurate diagnosis in modern medicine carried out clinically by fecal analysis or by immunological examination. Viral diarrhea mostly does not require treatment, except for the prevention of dehydration, replenishment of the body's water and electrolyte balance in case of frequent diarrhea and vomiting.

Bacterial origin

Many bacteria, germs can cause diarrhea bacterial nature. Some types of bacterial diarrhea are longer, more difficult, more acute than viral. Bacterial has a longer incubation period, it lasts from 8-10 hours (staphylococci, salmonella) to 10 days.

Infectionists identify the most common pathogenic bacteria in the following classification:

1. Food poisoning (enterotoxicogens) causing "traveler's diarrhea". Sources - food, milk, water.
2. Staphylococcus is a dangerous bacterium that multiplies quickly and is infectious. Source - stale foods, thermally insufficiently processed food.
3. Bacillus is a bacterium living in rice, often found in China, Southeast Asia.
4. Clostridia. The source of infection is meat products.
5. Cholera - enters the intestines from water, food, most often in Asia and Africa.
6. Shigella - can cause severe disorders, up to dysentery.
7. Campylobacter. The source is raw milk. The disease is accompanied by vomiting, diarrhea, fever, in some cases up to 4 weeks.
8. Salmonella. Source - food of animal origin, insufficiently thermally processed.
9. Chlamydia, mycobacteria, gonococci, Yersinia and others.

Non-infectious is caused by a violation of eating habits, taking medicines, a large amount of liquid drunk (5-6 liters), eating foods with high content fiber, allergic manifestation diarrhea.

Disease symptoms

General symptoms infectious diarrhea bacterial and viral origin the same:

• increase in body temperature;
• intoxication of the body, deterioration of the general condition, weakness;
• loose stools with frequent, sometimes false urges;
• dehydration, with the appearance of cyanosis, pallor of the skin;
• pain, cramps in the abdomen;
• headache, pain in muscles, joints;
• vomiting, nausea;
• with acute bacterial infections there may be impurities of blood, pus in the feces.

May be asymptomatic rotavirus infection in 30-40% of cases among adults and children. The chair with rotavirus has a light color. There may not be diarrhea (about 40% of cases), but only vomiting, nausea can be observed in case of an illness caused by the Norfolk virus.

Abundantly vilify with watery stools, you can experience vomiting with bacterial diarrhea caused by shigella, salmonella (with salmonellosis green stools), cholera, rotavirus. Nausea, vomiting, severe fever can be with staphylococcus aureus, gonococcus, caliciviruses. Cytomegalovirus usually infects people with AIDS, except for diarrhea, it is manifested by an increase lymph nodes(not to be confused with mononucleosis).

Treatment for infectious diarrhea

If symptoms appear, a doctor should be consulted. Selection medicines and therapy is carried out after determining the pathogen that caused infectious diarrhea. If the pathogen is not identified, doctors can make a diagnosis: an intestinal infection of unknown etiology with a predominant syndrome of colitis, enteritis (diarrhea), gastritis (vomiting).

Infectious diarrhea of ​​a viral nature will not require long treatment in addition to replenishing the fluid lost by the body and taking antiviral, antipyretic drugs. But getting rid of bacterial diarrhea has to take prescribed antibiotics. Medicines, complex medical measures appointed after the research, taking into account individual characteristics patient and are reduced to the following measures:

• the appointment of a diet;
• rehydration therapy;
• adsorbent preparations;
• antiviral drugs;
• antidiarrheals;
• antibacterial drugs;
• probiotics - to restore microflora;
• in some cases, gastric lavage is prescribed with special probes and solutions.

Without waiting for the arrival of an ambulance, you can begin to be treated for dehydration with the loss of vital electrolytes with special preparations (Regidron) or ordinary non-carbonated mineral water. Liquid should be given in small portions every 10-15 minutes. In order to avoid fluid loss through sweat, the patient should be laid in a cool place, provide him with peace.

Do not eat milk, fruits, vegetables, spicy dishes until the cure.

How long does diarrhea last with an intestinal infection

Diarrhea of ​​infectious origin is one of the most common diseases after colds and respiratory diseases of the upper respiratory tract. Diarrhea caused by a viral infection accounts for about 10%.

Mild indigestion, usually resolving after 3-4 episodes of diarrhea, is easily distinguished from an acute infection, which is accompanied by a deterioration in well-being and can last from 48 hours to 10-12 days. At the same time, diarrhea lasts for everyone in different ways, but on average, its duration should not exceed 14 days. With a viral infection, diarrhea can occur from 2 to 4-5 days. At bacterial infection diarrhea lasts longer, depending on the type of bacteria that caused it.

Symptoms associated with infection intestinal disorder, at proper treatment pass on their own, do not cause complications, health threatening or chronic relapses.

It must be remembered that diarrhea is a manifestation protective function organism, with its help it is excreted pathogenic microflora, toxins, bacteria. With diarrhea that lasts 1-2 days with a gradual decrease in intensity, it is better to do nothing.

It is important to follow a diet, exclude fatty, fried, spicy food. You can take enterosorbents ( Activated carbon), rehydron. If the symptoms do not go away within a few days, the state of health does not improve, you will need to consult a doctor.

With relapses intestinal infection that do not go away within a few weeks, be sure to contact medical professionals. After all, we can talk about chronic diarrhea because of ulcerative colitis, malabsorption, oncological disease intestines.

Possible Complications

Doctors talk about a favorable outcome of an intestinal infection in almost 100% of cases, provided proper treatment.

The main complication of long-term diarrhea is dehydration, especially in newborns, the elderly, and unconscious patients. Dehydration and a large loss of minerals (electrolytes) can cause following states patient:

• hypotension, orthostatic collapse weakness, dizziness when changing body position);
• renal failure;
• acidosis - an increase in the level of toxins in the blood due to a decrease in urination;
• hypokalemia, causing heart failure;
• possible irritation in the area anus, hemorrhoidal inflammation.

For citation: Ivashkin V.T., Sheptulin A.A. Infectious diarrhea in the practice of a general practitioner // BC. 2000. No. 2. S. 47

Diarrhea of ​​an infectious nature is currently one of the most common diseases and ranks second in frequency after acute inflammatory diseases upper respiratory tract. For example, in Africa, Asia (excluding China) and Latin America, children younger than

Literature
1. Speelman P. Acute gastrointestinal infections and their complications. Current topics in gastroenterology and hepatology (Ed. G.N.J. Tytgat, M. van Blankenstein). Stuttgart-New York, 1990; 81-7.
2. Ivashkin V.T. Infectious diarrhea in the practice of a gastroenterologist. Ross. magazine gastroenterology, hepatology, coloproctology. 1997; 5; 51-7.
3. Slutsker L., Ries A.A., Greene K.D. et al. Escherichia coli 0157: H7 diarrhea in the United States: clinical and epidemiologic features. Ann. Intern Med. 1997; 126:505-13.
4. Bogomolov B.P. diarrhea in differential diagnosis infectious diseases. Wedge. honey. 1997; 7:8-12.
5. McQuaid K.R. Diarrhea. Current medical diagnosis & treatment (Ed.L.M.Tierney, S.J.McPhee, M.A.Papadakis). 38th Ed. Appleton & Lange. Stamford, 1999; 546-52.

Loperamide -
Imodium (trade name)
(JANSSEN-CILAG)

Diarrhea of ​​infectious origin

Diarrhea is one of the most common symptoms from the practice of gastroenterologists. The reasons for its appearance are varied and may indicate many diseases that are directly and not related to gastrointestinal tract.

Often disease state comes on suddenly and is accompanied by vomiting. Diarrhea of ​​infectious origin, observed in dysentery, is accompanied by an increase in stool and the transformation of feces into watery formations. The liquid is green or yellow in color. In more rare cases, fecal masses resemble rice decoction. Sometimes they are mixed with mucus and blood. As a result of infectious diarrhea that occurs against the background of vomiting, dehydration of the patient's body occurs, as a result of which his appearance undergoes certain changes: facial features become sharper, additional folds appear on the skin that were not there before, and in general, the skin acquires a bluish tint. The heart sounds are muffled, arterial pressure, decreased urine output. Not always there is an increase in body temperature, with palpation of the abdomen there are no unpleasant sensations.

• fever-like condition;
• a lot of sweat;
• pain in the abdomen, which is cramping in nature;
• depression, drowsiness, lethargy;
• feeling of dehydration of the body, a feeling of constant thirst.

Changes in the clinical picture of the disease are possible depending on the pathogen causing the course of the process. If it is caused by campylobacter, the disease has symptoms similar to appendicitis. If there has been a salmonella infection, meningitis, pneumonia, purulent pathologies may occur internal organs. Very common are manifestations of anemia and kidney failure after exposure to E. coli, which caused a painful condition.

In the acute form of infectious diarrhea, there are more severe symptoms. It is characterized by the presence of an infectious period of the development of the disease, which has a length of six hours to three days. At the same time, vomiting may occur, body temperature may rise, abdominal pain and fever may increase.

Infectious diarrhea in children

Infectious diarrhea in adults

Almost always, the occurrence of infectious diarrhea indicates the onset of diseases of the gastrointestinal tract. Adults often suffer from diarrhea due to eating disorders and other factors. In the event that diarrhea is not treated on time, it easily develops into a chronic form.

Relapses of infectious diarrhea lasting for several weeks are possible. In these cases, one can speak of chronic forms diarrhea occurring due to ulcerative colitis, oncology of the rectum, failures in the course of absorption processes in the body.

Infectious diarrhea treatment

In the arsenal of the attending physician should be the means and methods for the treatment of various forms of acute diarrheal infections. Perhaps the manifestation is not too severe forms course of infectious diarrhea, which may well be curable at home. Gastroenteric variant acute form infectious diarrhea requires medical care, involving gastric lavage with water or a solution of sodium bicarbonate, a concentration of 0.5%. At the same time, the usual tap water to ensure that the washing is carried out efficiently. For gastric lavage, a special probe is used, with a funnel at the lower end, which rises and falls like a siphon. If, by all means, only boiled water, previously cooled before the procedure, is used for washing, this will delay the washing process. The process itself is carried out before clean wash water in a volume of at least six liters departs. Washing without using a probe is possible only in case of group poisoning, in the case when it is not possible to use the probe in relation to all patients.

After the stomach has already been sufficiently flushed, oral hydration should be carried out. Not every liquid is suitable for this. The task is to replenish not so much the lost fluid itself, but rather electrolytes, such as electrolytes of potassium and sodium. Absorption of electrolytes does not occur when there is no glucose in the flush solutions. In addition, if the solutions do not contain carbohydrates in their composition, they begin to act as a strong laxative and the diarrhea only intensifies. Failure to understand this principle can be attributed to the grossest medical errors. The problem of treating infectious diarrhea is not solved, only a complication of rehydration is possible.

Diarrhea in infectious diseases

Diarrhea, which has an infectious nature, is today one of the most common diseases and is in second place after acute inflammatory diseases of the upper respiratory tract. Only one tenth of all cases of infectious diarrhea are caused by viruses, and the cause of this disease is often difficult to establish even in a specially equipped laboratory.

With diarrhea resulting from an infectious disease, it is the properties of the infectious agent that determine the course of the disease. A decrease in the acidity of the contents of the stomach can also cause diarrhea in an infectious disease. Besides, a large number of microorganisms entering the gastrointestinal tract also contributes to the development of infection, along with the resistance of the pathogen to an acidic environment. In an adult, the development of infectious diarrhea rarely causes complications that seriously threaten his health.

Symptoms of diarrhea infectious lesion body can be varied, ranging from diarrhea with blood, accompanied by seizures severe pain before the onset of dehydration. In the latter case, there may be mild form diarrhea accompanied by watery secretions. Such symptoms can be observed for a short time, on average up to a week.

Ivashkin V.T., Sheptulin A.A.

Diarrhea infectious nature is currently one of the most common diseases and ranks second in frequency after acute inflammatory diseases of the upper respiratory tract. For example, in Africa, Asia (excluding China) and Latin America, children younger than

5 years more than 750 million cases of acute infectious diarrhea are registered, which in more than 4.5 million children leads to lethal outcome.

The causative agents of infectious diarrhea can be various agents that can determine the originality of the clinical picture of the disease, the features of diagnosis and treatment. The seriousness of the problem is also due to the fact that the diagnosis and treatment of infectious diarrhea is often carried out not by infectious disease specialists, but by general practitioners.

Bacterial diarrhea

Etiology and pathogenesis

Significant changes have now occurred in the structure of the etiological factors of bacterial diarrhea. The frequency of infectious diarrhea caused by common pathogens (Shigella, Salmonella) has decreased, and the number of cases of diseases caused by enteropathogenic strains of Escherichia coli and Campylobacter infection has increased.

Pathophysiological mechanisms bacterial diarrhea include the production of enterotoxin, which increases the activity of adenylate cyclase and thus stimulates the secretion of water and electrolytes by enterocytes (for example, in infections caused by vibrio cholerae, clostridia, enterotoxin-forming strains of Escherichia coli), or direct invasion of bacteria into the epithelial cells of the intestinal mucosa with their subsequent damage and development inflammatory response(with shigellosis infection, infection caused by enteroinvasive strains of Escherichia coli, yersiniosis, salmonellosis).

Clinical picture

The incubation period for bacterial diarrhea can last from several hours (for salmonellosis or staph infection) up to 10 days (with yersiniosis). Leading clinical symptoms bacterial diarrhea in addition to loose stools are fever and cramping abdominal pain. There may be some features clinical manifestations, due to the etiological factor. For example, the clinical picture of campylobacter ileitis may resemble acute appendicitis, and the surgeon, who decided to operate in this situation, finds an unchanged appendix and signs of mesenteric lymphadenitis. Yersinia infection sometimes occurs with the development nodular erythema and joint damage. Salmonella infection can be complicated by bacteremia with the occurrence of pneumonia, meningitis, abscesses of internal organs. Infectious diarrhea caused by enterohemolytic strains of Escherichia coli (0157:H7) can lead to the development of hemolytic uremic syndrome, manifested by acute kidney failure, hemolytic anemia and thrombocytopenic purpura.

Diagnostics

Diagnosis of bacterial diarrhea involves clinical analysis blood (leukocytosis is detected with a shift of the formula to the left) and sigmoidoscopy (a picture of acute proctosigmoiditis with shigellosis infection), as well as the search for the etiological factor that caused its development. Stool culture followed by microbiological research gives positive result Approximately 40-60% of patients with acute diarrhea flowing with fever and the appearance of leukocytes in the feces. With negative results of crops, immunological diagnostic methods are used. Thus, the use of enzyme immunoassay methods makes it possible to detect antibodies to Campylobacter and Salmonella. Enterotoxins of pathogenic strains of Escherichia coli can be detected using polymerase chain reaction and latex agglutination. With shigellosis, already in the first days of the disease, using the hemagglutination method, antibodies to antigen 0 can be determined.

Treatment

Fighting dehydration

Treatment of acute infectious diarrhea should primarily include (especially in children) control of dehydration. In mild cases of the disease, rehydration therapy is reduced to sufficient fluid intake (tea, mineral water, etc.) containing glucose and electrolytes. The simplest rehydration solution is prepared as follows: in 1 glass orange juice(it contains 1.5 g of potassium chloride) add 1/2 teaspoon table salt(3.5 g of sodium chloride) and 1 teaspoon of soda (2.5 g of sodium bicarbonate), after which the total volume of the solution is brought to 1 liter with boiled water.

With more pronounced dehydration, special rehydration solutions are shown that have an electrolyte composition recommended by WHO (Na + - 90 mmol / l, K + - 20 mmol / l, CI- - 80 mmol / l, HCO-3 - 30 mmol / l, glucose - 110 mmol/l). In pediatric practice, in order to combat dehydration with diarrhea, the drug rehydron is used, containing 3.5 g of sodium chloride, 2.9 g of sodium citrate, 2.5 g of potassium chloride and 10 g of dextrose in 1 sachet. After dissolving the contents of the sachet in 1 liter of warm boiled water the patient is allowed to drink the resulting solution, based on the expected loss of body weight (with a loss of 5-7.5% of body weight, the volume of fluid administered is 40-50 ml / kg of body weight for 4 hours or up to 150 ml / kg of body weight per day) . The total volume of oral fluid for adult patients should be at least 2-3 liters per day. In severe dehydration (loss of more than 10% of body weight within 24 hours), additionally resort to intravenous administration water and electrolyte solutions. Patients with acute infectious diarrhea are recommended light diet for a period of 2-3 days with the inclusion of such products as mucous soups, rice, dried bread, salted crackers, baked potatoes, eggs, etc. Foods rich in vegetable fiber, dairy products, coffee and alcohol should be avoided.

Antibacterial therapy

Antibacterial drugs, previously widely used in the treatment of bacterial diarrhea, are now prescribed differentially, taking into account the type of pathogen and the severity of the course of the disease. It should be borne in mind that many forms of infectious diarrhea end in self-healing within 5 days against the background of rehydration therapy.

In uncomplicated cases of salmonellosis, antibiotics are not indicated, since they do not reduce the duration of the disease and lengthen the period of isolation of the pathogen. Antibiotic therapy is resorted to in cases where the disease occurs with high fever, signs of severe intoxication, bacteremia and damage to other organs. The drugs of choice in this case are ampicillin (at a dose of 4-6 g per day) or chloramphenicol (1 g 3 times a day), which are used for 2 weeks. With severe intoxication, co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole 2 times a day for 1-2 weeks) can be considered an alternative.

Antibiotic therapy, carried out in patients with shigellosis, helps to reduce the duration of fever and shorten the period of carriage of microorganisms. The drug of choice is co-trimoxazole, administered at a dose of 960 mg 2 times a day for 5 days. Taking into account the possible resistance to this drug instead, you can also use nalidixic acid (1 g 4 times a day), norfloxacin (400 mg 2 times a day) or ciprofloxacin (500 mg 2 times a day). Ampicillin and doxycycline are used only when the susceptibility of cultured bacterial strains to them is confirmed. The use of ceftriaxone (1 g per day intravenously for 5 days) is considered as a backup method of treatment.

In the treatment of uncomplicated campylobacteriosis, antibiotics usually do not play a significant role, since the clinical manifestations of this disease often subside completely in such cases even before the pathogen is identified. Antibacterial agents usually used for severe course diseases, severe intoxication, the presence of blood in the stool. The main drug for the treatment of campylobacteriosis is erythromycin, which is prescribed at a dose of 1 g per day (in 2 or 4 doses) for 5-7 days. Tetracyclines (eg, doxycycline 200 mg on day 1 and then 100 mg daily) and fluoroquinolones are also effective. With campylobacter septicemia, gentamicin (at a dose of 4-5 mg per 1 kg of body weight), ceftriaxone (1 g per day) or chloramphenicol (3 g per day) is used.

With yersiniosis, antibiotic treatment is carried out only in severe cases of the disease. In this case, gentamicin (5 mg per 1 kg of body weight per day intravenously) or chloramphenicol (50 mg per 1 kg of body weight per day intravenously or orally) should be considered as the drugs of choice. The duration of treatment should be at least 2 weeks.

The use of antibiotics in cholera contributes to the rapid disappearance of cholera vibrio from faeces and a decrease in the duration of diarrhea. Tetracycline (250 mg every 6 hours for 4 days) remains the drug of choice. You can also use furazolidone (at a dose of 5 mg per 1 kg of body weight per day, divided into 4 doses for 3 days), loramfenicol (500 mg 4 times a day for 7 days) and co-trimoxazole (960 mg 2 times per day for 1 week).

The use of symptomatic antidiarrheals in the treatment of infectious diarrhea caused by enteroinvasive bacteria (Shigella and Salmonella) is not indicated, as they slow down the elimination of microorganisms and prolong the duration of the disease. Their appointment should also be avoided in case of high fever, severe intoxication, as well as in the presence of leukocytes and blood in the feces, because of the risk of developing toxic dilatation of the colon (toxic megacolon).

Viral diarrhea

Among various options viral diarrhea most clinical significance have diarrhea of ​​rotavirus etiology (the most common form of infectious diarrhea in children), diarrhea caused by the Norfolk virus, as well as adeno- and astroviruses. In the clinical picture of viral diarrhea, attention is drawn to the frequent combination of diarrhea and fever with dyspeptic disorders, and often (with rotavirus diarrhea) with damage to the upper respiratory tract. The diagnosis is confirmed by detecting the virus in the feces using electron microscopy or by special immunological studies (for example, with monoclonal antibodies). The course of viral diarrhea is usually favorable. The duration of the disease does not exceed, as a rule, 3-5 days. Treatment is symptomatic and is reduced to the elimination of water and electrolyte disorders.

One of the most common infections that can cause acute or chronic diarrhea, is giardiasis. When Giardia enters the intestines, asymptomatic carriage develops in many cases. The picture of giardia enteritis occurs only in 25-50% of those infected, and the disease often takes chronic course. The diagnosis of giardiasis is confirmed by the detection of trophozoites or cysts of Giardia in feces, bile or duodenal contents. It is also possible to determine antibodies of classes IgA, IgM and IgG to G. lamblia. The drug of choice in the treatment of patients with giardiasis is metronidazole, used for 7 days at a dose of 0.25 g 3 times a day.

Special forms of diarrhea

currently allocated special forms infectious diarrhea:

traveler's diarrhea;

diarrhea in homosexual men;

diarrhea in AIDS patients;

antibiotic-associated diarrhea;

syndrome overgrowth bacteria.

The need for their separate consideration is dictated by various circumstances: widespread (traveler's diarrhea), originality of etiological factors (diarrhea in homosexual men, diarrhea in AIDS patients), often uncontrolled use of antibiotics (antibiotic-associated diarrhea).

The risk of developing traveler's diarrhea is highest (30-70%) when traveling to countries in Asia, Africa and Latin America. In most cases, this form of the disease is caused by enterotoxigenic strains of Escherichia coli (less commonly, Salmonella, Shigella and other microorganisms). Additional importance in its development is the change in the nature of nutrition, climatic features, nervous stress. Traveler's diarrhea usually starts suddenly cramping pains in the abdomen and slight fever. Signs of dehydration, as a rule, are not observed and the symptoms of the disease disappear spontaneously within 3-4 days. Most patients have enough symptomatic treatment. Loperamide (Imodium) has proven itself well. The antidiarrheal effect of the drug is associated with a decrease in peristalsis and an increase in the time it takes for the contents to pass through the intestines. The preparation increases the tone of the anal sphincter, contributing to a better retention of feces and reducing the imperative urge to defecate. In adults with acute diarrhea, the first dose of Imodium is 4 mg (in children 2 mg), then after each episode of loose stools - 2 mg. The appointment of antibacterial drugs (furazolidone, fluoroquinolones, co-trimoxazole) is resorted to only with high fever and symptoms of intoxication.

Infectious diarrhea in homosexual men is caused by specific pathogens (gonococci, chlamydia, herpes simplex virus). So, getting into the rectum of gonococci can cause sluggish gonorrheal proctitis with mucopurulent discharge. The diagnosis is confirmed by the detection of gram-negative diplococci in leukocytes obtained with a swab during sigmoidoscopy. Treatment in such cases is carried out with penicillins.

The combination of diarrheal syndrome with severe proctalgia, difficulty urinating, increased inguinal lymph nodes and characteristic vesicular rashes on the mucous membrane of the rectum in the anus may indicate that the patient has an infection caused by the herpes simplex virus. The diagnosis is confirmed by examining the contents of the vesicles (using the method of tissue culture), as well as determining the titer of the corresponding antibodies. Treatment is with acyclovir.

Diarrhea in AIDS patients is one of the leading syndromes in the clinical picture of the disease, occurring in 30-40% of patients. Etiological factors infectious diarrhea in patients most often are protozoa (cryptosporidium and isospores), “opportunistic” viruses (cytomegalovirus, herpes simplex virus), bacterial agents (most often Mycobacterium avium intracellulare). Infectious diarrhea in AIDS patients often takes a life-threatening course (primarily due to significant weight loss) and is difficult to treat.

In addition, diarrhea in AIDS patients can be caused by the direct action of the human immunodeficiency virus itself on the intestinal mucosa with the development of HIV-associated enteropathy and malabsorption syndrome. The ability of the human immunodeficiency virus to enhance the secretion processes in the intestine sometimes leads to secretory diarrhea with an increase in fecal volume up to 12-14 liters per day. The only drug effective in such cases is octreotide. Finally, when searching for the causes of diarrhea in AIDS patients, it must be borne in mind that it may be associated with a malignant lesion of the gastrointestinal tract (Kaposi's sarcoma, malignant lymphoma).

Antibiotic-associated diarrhea is of great clinical importance when it is caused by Clostridium difficile. The frequency of carriage of these microorganisms, which is 3-15% among the adult population, increases significantly (up to 15-40%) when taking antibiotics (primarily clindamycin, ampicillin, cephalosporins), which inhibit the growth of strains intestinal flora, which normally suppress the activity of Clostridium difficile.

The spectrum of clinical manifestations of this infection ranges from mild loosening of the stool to severe pseudomembranous colitis associated with the damaging effect on colonocytes of enterotoxins A and B produced by these microorganisms. Pseudomembranous colitis occurs, as a rule, with high fever, cramping abdominal pain, loose stools (often with an admixture of blood), and high leukocytosis. The disease can be complicated by electrolyte disturbances, development arterial hypotension and toxic megacolon. The diagnosis is confirmed with endoscopy(characteristic raids on the mucous membrane of the colon in the form of pseudomembranes) and the detection of Clostridium difficile (using the method of tissue culture) or its toxins ( enzyme immunoassay). Treatment of patients with pseudomembranous colitis is carried out with vancomycin (0.125-0.5 g 4 times a day) or metronidazole (0.25 g 4 times a day) for 7-14 days.

Bacterial overgrowth syndrome is a specific variant of infectious diarrhea, which is based on an increase in the content of bacteria in the small intestine (from 104-107 / ml to 1011 / ml). Bacterial overgrowth syndrome occurs when the passage of contents through the small intestine slows down (for example, after operations on the stomach and intestines, with adhesions, intestinal strictures) or the function of the ileocecal valve is impaired (resection of the blind and ileum), as a result of which the contents of the large intestine enter the lumen small intestine.

Bacterial overgrowth syndrome is clinically manifested by diarrhea followed by the development of malabsorption syndrome. Diagnosis is based on results breath test carried out with labeled lactulose, as well as on the detection high content microorganisms (>106) in the duodenal aspirate. Treatment of bacterial overgrowth syndrome should be aimed at eliminating the diseases that caused its development (tumor of the small intestine, adhesive process, fistulas, etc.).

Thus, the data presented show that clinical practice general practitioner can meet various forms and variants of infectious diarrhea, often with clinical features caused by the pathogen. Knowledge of these features is essential for setting correct diagnosis and prescribing appropriate treatment.

Literature
1. Speelman P. Acute gastrointestinal infections and their complications. Current topics in gastroenterology and hepatology (Ed. G.N.J. Tytgat, M. van Blankenstein). Stuttgart-New York, 1990; 81-7.
2. Ivashkin V.T. Infectious diarrhea in the practice of a gastroenterologist. Ross. magazine gastroenterology, hepatology, coloproctology. 1997; 5; 51-7.
3. Slutsker L., Ries A.A., Greene K.D. et al. Escherichia coli 0157: H7 diarrhea in the United States: clinical and epidemiologic features. Ann. Intern Med. 1997; 126:505-13.
4. Bogomolov B.P. Diarrhea in the differential diagnosis of infectious diseases. Wedge. honey. 1997; 7:8-12.
5. McQuaid K.R. Diarrhea. Current medical diagnosis & treatment (Ed.L.M.Tierney, S.J.McPhee, M.A.Papadakis). 38th Ed. Appleton & Lange. Stamford, 1999; 546-52.

Instead of an epigraph

"Doctor, the child has diarrhea, go and see." The dispatcher usually sends only a paramedic to such calls, but this time, as it happened, he sent a full brigade. We arrive and see: the child is a year and two months old, literally hanging in his mother's arms with half-closed eyes, his lips are parched, pale, already transparent. It turned out that he vilifies for 5 days, 5-6 times a day. Mom treats him with St. John's wort on the advice of her friends. And he does not even notice how the child is getting worse.

I am a doctor and have no right to scold patients for their idiocy. But this is it! However, he limited himself only to the question: “Mom, why didn’t they call the doctor earlier?”

A short examination, the temperature is normal, the baby is in serious condition. Further - a dropper in a vein, sirens, flashing lights, resuscitation. Saved! And everything could end sadly!

Diarrhea - a trifle or life-threatening?

Diarrhea at some far from perfect moment can visit each of us. She, like love, is submissive to all ages. But if an adult copes quite easily, then in children this symptom can be the cause of the development of severe complications.

Do not consider every diarrhea dangerous. International Standards describe diarrhea as 3 (or more) loose stools per day, leading to the loss of water and trace elements and accompanied by a deterioration in the general condition. One diarrhea is not a reason to sound the alarm, but it is a reason to increase vigilance.

With long-term diarrhea, the child may begin to lose fluid, which is sometimes difficult to replenish. The fact is that when dehydrated, children quickly run out of strength, and it’s hard for them even to drink. Therefore, and also because there is not so much water in the child's body, dehydration occurs quite quickly.

"Accomplices" of diarrhea

most common cause life-threatening diarrhea is infectious agent. In fact, diarrhea is just a symptom of an intestinal infectious disease, in which there are many other signs:

• temperature rise;
• nausea and repeated vomiting, which does not alleviate the patient's condition;
• pain in the abdomen from weak to fairly strong, colicky;
• severe physical weakness
• loss of appetite up to its complete absence.

In severe cases, intoxication can lead to impaired consciousness, delirium, severe headaches, and drowsiness. In the most severe cases (exactly what we saw), a picture of shock sets in with a decrease in body temperature, a drop in blood pressure, dysfunction of the heart, kidneys and brain.

How to deal with diarrhea

In most cases, diarrhea is caused by viruses. Much less often, it can be provoked bacterial microorganisms. The clinical picture of an intestinal infection directly depends on which microbe caused it, but no parent can determine this on their own. And that means for any loose stool more than 3 times a day, dial the number of the clinic and call the doctor at home.

Even at the very beginning, without waiting for the child to become completely ill, prepare a solution of rehydron and give the child a teaspoon every 5-10 minutes. Yes, it doesn't taste good, but that's what you and the parent are there to do to convince the kid to drink the vile medicine.

If the child is not a year old, do not wait for the visit of a doctor from the clinic. In such small children, the condition can worsen very quickly (literally within an hour!), Therefore, it is better to diagnose and treat them in a hospital setting. In this case, as well as with repeated vomiting, feel free to call the ambulance.

Parenting Mistakes

• Give chloramphenicol. From viruses that most often cause diarrhea in children, levomycetin does not help.
• They give herbs - St. John's wort and so on. diarrhea is defense mechanism. Its premature stop without affecting the cause of the disease leads to massive absorption of microbial poisons into the blood and worsening of the condition.
• They take medicines according to the principle “it helped the neighbor's child”. This is the biggest stupidity that can be done. Microbes are different, organisms are different, the condition of the child is different. This means that these children need to be treated differently.

Prevention is easier than cure

Of course, the easiest way not to get sick is to observe personal hygiene. Routine hand washing will greatly reduce the risk of infection. Careful heat treatment of all products, control of the expiration dates of everything that you give to the child, his upbringing ("do not put your fingers in your mouth") - that's the right way avoid stool problems. And if you get sick, get treated by specialists, and not by neighbors, friends or the Internet.