Analysis of feces for conditionally pathogenic flora decoding. Does the patient have an infectious disease? Norm of saprophytic staphylococci

Dysbacteriosis develops as a result of pathological processes occurring in the body. Due to the lack of specific symptoms specific to this disease, it can only be recognized by tests. Signs of violation of the microflora of the gastrointestinal tract resemble other diseases. In some patients, dysbacteriosis is hidden, without manifesting itself as symptoms. Laboratory research will help to identify the presence of an imbalance in the work of the intestine.

The task of the patient who does the stool culture for dysbacteriosis is the correct preparation for the test. The results of the work of laboratory assistants depend on this, so the procedure must be approached responsibly.

The small intestine absorbs nutrients, performs cavity and parietal digestion. Another important organ is the large intestine, a distinctive feature of which is that all kinds of microorganisms live in it.

A healthy person has no pathological changes: his intestinal microflora is in a stable state and functions in a calm mode. When a disease occurs that affects the intestines, the microflora loses its balance and provokes dysbacteriosis.

Bacteria that live in the body are in symbiosis with humans. They receive food from it for functioning, and the host is given vitamins that are synthesized due to the opportunistic flora. Also, bacteria are involved in the processing of food, for which the fermentation process is used.

Reference! Quantitative microflora is a significant element of the functioning of the stomach and intestines. About 90% of the composition of the flora is lacto- and bifidobacteria. The rest is bacteroids, fungi, staphylococci and other microorganisms.

Signs of dysbacteriosis

The main manifestations of the disease are flatulence, bloating, loose stools, nausea and vomiting. If the disease is not treated, metabolic processes are disturbed. Then the symptoms are added brittle hair and nails, dry skin, cramps, weakness in the muscles.

In the early stages, the patient cannot independently determine the violation of the microflora, since his stool remains unchanged. As the disease progresses, streaks of blood, diarrhea, and mucus appear in the stool. The smell during defecation becomes unpleasant, putrid.

Newborn children often suffer from dysbacteriosis. In infants, the microflora is disturbed due to the fact that the process of formation of colonies of beneficial bacteria did not have time to complete. By the year most often dysbacteriosis in children goes away without treatment.

On a note! The color of feces in a healthy person is brown. A change in shade is considered a pathology. Most often, an increase in pathogenic flora leads to a change in color.

Types of analyzes

If dysbacteriosis is suspected, the gastroenterologist prescribes a general or biochemical analysis of feces. Both methods will give a detailed view of the state of the intestinal microflora. The collected material is examined in an equipped laboratory.

After the required period, laboratory assistants count the colonies of bacteria that have developed in a beneficial environment. Checking feces makes it possible to assess the sensitivity of microorganisms to bacteriophages and antibiotics. Verification is carried out in two ways.

Bacteriological analysis

Checking the stool for microflora in the standard way is the observation of excrement for several days. In the process of checking, laboratory assistants determine the ratio of microorganisms.

The standard method allows you to get results 7-10 days after the test is delivered to the laboratory. This is the time it takes for the bacteria to grow and be visible under a microscope.

Information of bacteriological check of the analysis is not always accurate as a result of the influence of the following factors:

1. When collecting from feces, contact with air occurs, which leads to the death of anaerobic microorganisms. As a result, the amount of harmful and beneficial flora is calculated incorrectly.
2. The composition of the general microflora should include mucosal bacteria that live on the intestinal mucosa. This element does not fall into the bacteriological analysis of feces.
3. Diagnostic accuracy reduces the time spent transporting stool to the laboratory. Part of the microbial flora dies during transportation.

Attention! It is not allowed to collect material for analysis if defecation was performed as a result of taking laxatives.

Video - Examination of feces for dysbacteriosis

Biochemical analysis

This research method is more accurate and provides complete information about the state of the intestinal flora. Thanks to the speed of the check, the appropriate treatment is prescribed to the patient faster, without wasting time and aggravating the situation. Information can be obtained within a couple of hours after the transfer of the material to laboratory assistants. Feces intended for biochemical testing can be frozen and handed over at any time.

The principle of biochemical analysis is as follows: all bacteria produce fatty acids during their life. Many of them can be formed by only one type of microorganism. Having determined the type of acids, we can conclude that there are microorganisms in the gastrointestinal tract, as well as which section is inhabited by pathogenic flora.

An additional advantage of the method, in addition to the speed of obtaining results, is the complete detection of all types of microorganisms, including those that are based near the walls of the organ.

What information is obtained from the analysis?

In laboratory conditions, the composition of feces is evaluated by the content of beneficial and pathogenic and opportunistic organisms. Due to various factors, the flora loses the necessary bacteria, and the volume of pathogenic flora increases in it.

Analysis is necessary for the following symptoms:

• diarrhea, constipation;
• flatulence;
• discomfort or pain in the abdomen;
• intolerance to certain products;
• intestinal infection;
• allergy;
• skin rash;
• violation of intestinal biocenosis;
• long-term therapy with anti-inflammatory drugs.

Fecal culture is often prescribed for newborns at risk and adolescents suffering from regular allergies and SARS.

In addition to the presence of symptoms, the doctor may refer the patient for analysis for many reasons:

• rickets, anemia in children;
• the consequences of an intestinal infection, which was accompanied by diarrhea with blood;
• hormone therapy;
• weak immune system;
• taking antibiotics.

Also sent for analysis are newborns whose mother has mastitis or vaginitis and infants whose stay in the maternity hospital has exceeded certain standards.

The direction for the study is issued by a gastroenterologist, infectious disease specialist or therapist. The patient is required to collect the material correctly in order to obtain reliable results.

How to prepare for the study

For analysis, you will need fresh feces collected before taking chemotherapeutic or antibacterial agents. In a few days, you will need to remove the intake of tablets with a laxative effect, as well as vaseline and castor oil, and stop the administration of suppositories. Material obtained after barium or enema is unsuitable for testing.

To collect the analysis, you must first urinate, and then perform a bowel movement. In this case, you need to ensure that urine does not get into the feces. The container into which defecation will be carried out must be treated with a disinfectant or rinsed with boiling water.

The material is placed in a new disposable container with a tight-fitting lid. For collection, use the spoon that comes with the kit. You need to fill the container no more than one third of its volume (approximately 10 ml).

Attention! It is forbidden to collect feces from the toilet. So foreign microorganisms from the environment can get into it.

From the moment of taking feces to transfer to the laboratory, no more than three hours should pass. All this time the material must be kept cold. Do this using ice or a special package.

Be sure to follow the rules:

• long-term storage of feces (more than 5 hours) is not allowed;
• freezing is not allowed;
• the filled container must be tightly closed;
• not subject to verification on the eve of the collected feces.

On a note! The interpretation of the results is carried out by a gastroenterologist, taking into account the existing norms, the history of the disease, the age of the patient, symptoms and predisposing factors.

Analysis results

A specialist should decipher the analysis indicators. An analysis for dysbacteriosis with normal values ​​looks like this:

Table 1. Normal indicators of the material for dysbacteriosis

Recognition of values ​​is a significant procedure in determining the diagnosis. The specialist carefully examines the indicators in order to prescribe the appropriate treatment. If, when cultured, the number of positive bacteria is in the normal range, but the symptoms do not go away, you need to repeat the analysis. With the biochemical method of research, the indicators are more accurate.

Intestinal dysbiosis is a serious condition that requires treatment. Especially dangerous is the imbalance of microflora in children, who, more than adults, need timely intake of vitamins and microelements. To restore the flora, the patient is prescribed biologically active additives and food products in order to colonize the intestines with the necessary bacteria. With proper therapy, digestion is quickly restored, and unpleasant symptoms disappear.

Analysis of the intestinal group is a popular study. It is prescribed both for the diagnosis of acute diseases, and in order to identify the latent course in carriers of the disease. When an adult or a child has diarrhea, fever, abdominal pain, vomiting, it is impossible to make a diagnosis only on the basis of the clinic, since many intestinal infections occur with similar symptoms.

In addition, in order to prescribe the optimal antibacterial treatment, it is necessary to know the specific causative agent of the disease. According to the existing instructions of the Sanitary Service and the Ministry of Health, all people who work in the production of food or come into contact with them during transportation, sale, packaging, cooking, cleaning the premises are regularly tested for intestinal group.

The result is noted in their "Sanitary Book" along with the conclusion of the doctors. Why pay so much attention to the analysis of feces, we will try to tell in the article.

What is included in the "intestinal group"?

About 500 types of microorganisms live quietly in the intestines of a healthy person. They quite successfully coexist with the macroorganism, help it perform a number of important functions, and feed themselves from intestinal contents. It is customary to divide the entire flora into 3 types according to the principle of danger.

Useful - in any conditions support digestion, produce vitamins, provide immunity. Among them are the main ones:

• bifidobacteria;
• bacteroids;
• lactobacilli;
• Escherichia;
• mushrooms.

There are 15 such microorganisms in total. Conditionally pathogenic microorganisms are harmless if a person is strong and healthy, but in the event of a fall in protective forces, they become an additional aggressive factor and can cause significant harm.

Enemies can be:

• staphylococci;
• enterococci;
• coli;
• clostridia;
• mushrooms of the genus Candida.

Pathogenic - these are the causative agents of an infectious disease, which should not normally exist, but they can take such well-protected forms that they live in the intestines of the carrier for a long time in the form of cysts. And the person does not even suspect that he is a carrier of the infection. These include:

• salmonella;
• shigella;
• dysenteric amoeba;
• intestinal trichomonas;
• balantidia;
• cholera vibrio and others.

The presence of bacteria in the intestines is considered an absolute norm.

If the doctor prescribes a fecal analysis for the intestinal group, then he is primarily interested in the likely pathogens. After all, knowing their features and striking properties, you can:

• find out the source of infection;
• limit the spread of the outbreak of the disease;
• to examine contact persons;
• prescribe a course of optimal therapy.

What pathogenic microorganisms are detected most often?

A patient with acute indigestion and suspected infection is referred to an infectious diseases department of a stationary type. Children are hospitalized with their mothers. In the hospital, it is possible to isolate the patient, to conduct the most complete examination and treatment.

The most common intestinal group of pathogens is manifested by the following diseases:

1. Dysentery - caused by shigella, the main "blow" is applied to the stomach and large intestine. The causative agent is distinguished by good adaptability to environmental conditions. They live in garbage and feces for up to two months. A person gets an infection through dirty hands or contaminated products.
2. Salmonellosis - a favorite site of damage is the small intestine. The disease is accompanied by severe intoxication. For young children, it is especially dangerous because it causes severe complications (pneumonia, meningoencephalitis, general sepsis). Pathogens are divided into types, except for salmonellosis, which causes infection by the fecal-oral route, through insufficiently processed foods, dirty water.
3. Coli infections - diseases caused by different serotypes of E. coli. Most often occur in infants. They affect the large intestine. Transmitted from carriers or sick adults if basic rules of hygiene and care for the baby are not followed.

These examples show how important it is to timely analyze not only feces, but also food, drinking water, and washings from the hands of personnel. Especially if the disease is detected in children's institutions.

How to take an analysis?

To obtain reliable results, the patient must first prepare:

• it is recommended not to eat meat dishes for 4–5 days, not to take alcohol, to eat only dairy products, cereals, potatoes, white bread;
• three days before the collection of feces, stop taking antibiotics, laxatives, iron preparations (a negative result can be assumed in advance in patients who independently started antibiotic treatment), the introduction of rectal suppositories.

It is better to use a standard container purchased at a pharmacy, it has a resealable stopper and is sterile.

Collection rules include:

• prevention of foreign impurities (urine, blood during menstruation in women) entering the test material, the child should be given the opportunity to urinate beforehand, women should use a clean vaginal swab if the analysis period cannot be rescheduled;
• dishes for the test material cannot be treated with disinfectants (chlorine), the jar must be washed well with soap and poured over with boiling water;
• the baby's pot is processed in the same way;
• no more than two hours are given for delivery to the laboratory, storage in the refrigerator allows a 4-hour delay, the longer the delay in transport, the less effective the data will be, since some of the pathogens die.

The sampling is carried out:

• at home - in sterile dishes, in terms of volume, you should focus on approximately a full teaspoon;
• in the infectious diseases room or in the hospital, a rectal swab is taken with a swab, in the position of the patient on the side, the laboratory assistant inserts a sterile swab on a stick into the rectum to a small depth and turns it, then immediately places it in a test tube with a special medium;
• from a small child, you can take the material directly from the diaper.

A referral filled in by the doctor is attached to the container.

How is the research done?

For a more likely result, three stool samples are taken for the study. All methods used are of the “in vitro” type, which means “on glass”. Another possibility "in vivo", carried out by infecting animals, is not needed in this case.

The collected material in a small amount is placed for 4–5 days on a nutrient medium. Colonies grow here, from which it is possible to prepare a smear for the intestinal group even with a very small number of microorganisms.

Qualified bacteriologists are able to identify pathological pathogens, focusing on the appearance, mobility under a microscope. The method is called bacterioscopy.

When viewing a drop of feces diluted with water, a specialist on the first day can give a preliminary result

To be sure, you will need to examine the pathogen that has grown on a nutrient medium.

The microbiological method is accompanied by the obligatory sowing of feces on special media (for example, any universal medium is suitable for a dysentery pathogen, salmonella grows well in bile broth). If it is not possible to make an urgent sowing, samples of the material are preserved in a solution with glycerol or phosphoric acid salts.

Bacteriological examination allows not only to identify an infectious agent, but also to analyze its sensitivity to antibiotics. This is particularly important for the choice of treatment for carriers.

Biochemical tests - allow you to calculate the amount of fatty acids secreted by microorganisms in the contents of the intestine. Based on their content, conclusions are drawn about the quantity and qualitative composition of the intestinal group.

How long does the analysis take?

It takes about a week for the final result of the research. This period is not related to organizational problems, it is needed to ensure the possibility of maximum growth and identification of the pathogen.

To speed up the process, some institutions use express methods. But they tend to be less reliable. In diagnostics, the results of serological reactions of blood are obtained more quickly.

How are the results evaluated?

The result of the analysis for the intestinal group takes into account the presence of the entire spectrum of microorganisms.

The presence of pathogenic flora is noted separately with pluses in the standard form, fixed with stamps or entered into the conclusion before the doctor's signature

Quantification is measured in CFU (colony forming units) per gram of stool. Advanced analysis allows you to judge the presence of dysbacteriosis among the beneficial flora. This point must be taken into account, since it aggravates the course of the disease and requires correction after the acute symptoms subside.

Do not try to decipher the analysis yourself. Even physicians of various specialties who are not associated with infections do not have enough information on this issue. Therefore, only infectious disease specialists, bacteriologists and gastroenterologists can give the right advice and assessment.

Who should be tested for intestinal group?

In the presence of symptoms of the disease, all patients should be tested. During treatment and after it, at least three repetitions of the study will be required to be sure that there is no bacteriocarrier, safety for your family, members of the work team.

For a preventive purpose, they are forced to take an analysis (they are suspended from work if a study has not been carried out):

• medical workers of children's and infectious diseases departments, maternity hospitals;
• personnel of preschool institutions and schools, summer camps;
• catering workers (cooks, waiters);
• people by profession associated with the production and processing of products, packaging, transportation (workers of dairy plants, bakeries, cookery);
• people selling products in stores, on the market (sellers, meat cutters).

The listed contingents are tested in accordance with the approved schedule 2-4 times a year

If an epidemiologist investigates the identified infection, an additional general check is possible at the request of the sanitary supervision authority. Broad powers allow for a dangerous epid. situations to close institutions.

Often, in this way, the source of infection is identified - a bacteriocarrier, an ill person with the remnants of an infection, or simply an untreated patient. The dishonest attitude of some citizens contributes not only to their personal illness, but also becomes dangerous for others. In children's hospitals, a preliminary analysis of the intestinal group is required during planned hospitalization.

The role of the intestinal microflora is quite important for human health. Control with the help of stool analysis helps to maintain the normal process of digestion, to prevent unnecessary intoxication and signs of illness.

Intestinal infection is a common cause of indigestion in children. To quickly cure your child, you need to take tests and identify the true cause of intestinal upset. Laboratory diagnosis of intestinal infections includes an analysis of feces for a conditionally pathogenic group of microorganisms and an analysis for pathogenic flora (analysis for a disgroup and a typhoid and paratyphoid group of bacteria).

An analysis of feces for a disgroup is a study of fecal masses for the presence of pathogens of intestinal infections. This group includes bacteria that are not permanent inhabitants of the intestines in healthy children and can potentially cause an infectious process. These include the causative agents of dysentery (shigella) and salmonella.

Conditionally pathogenic microorganisms (enterococci, staphylococci, clostridia, fungi), along with "beneficial" bacteria, make up the natural intestinal microflora. They are called conditional, because. their ability to cause infection depends on specific circumstances: weakened immunity, a sharp decrease in the number of "helper bacteria" (lactobacilli, bifidobacteria), spoiled food.

In what cases it is necessary to examine the feces?

It is necessary to donate feces for a disgroup to clarify the diagnosis if an intestinal infection is suspected or as part of preventive measures.

For the development of an intestinal infection, pathogenic microbes must enter the intestines of the child. The source of infection is the feces of an infected person. Transmission of microbes can occur through contact with a sick person or a carrier of an infection, through the use of contaminated food or water. The waterway is considered the most common.

Not all bacteria manage to get to the intestines - gastric juice causes the death of most of them. Since infants (especially newborns) produce less gastric juice, they are at higher risk of infection. In infants, an intestinal infection can occur when complementary foods are added. If complementary foods are prepared without observing sanitary rules or have not undergone heat treatment, then opportunistic microbes may be present in it.

With an intestinal infection, a child may experience the following complaints:

• stomach ache;
• nausea, vomiting;
• liquid stool;
• fever, chills, general weakness.

Acute intestinal infection in children can occur in the form of gastritis, enteritis or colitis, it develops quickly. Diarrhea is a protective reaction of the body to remove the pathogen. But along with liquid and abundant stools, useful substances are also lost, and if treatment is not started on time, then dehydration develops from profuse diarrhea and vomiting. The skin and visible mucous membranes become dry, the child becomes lethargic, the amount of urine decreases, there is no sweat and tears. The newborn has a fontanel. In very severe cases, shock and multiple organ failure develop. Babies develop dehydration much faster.

The indication for analysis is the identification of carriage. These are the cases when children who have already had an intestinal infection continue to excrete a pathogenic microbe with feces. Therefore, the analysis of feces for the intestinal group for hospitalization is an indispensable procedure if the child needs to undergo surgery and treatment in a hospital for another disease.

A preventive study for the carriage of pathogens of intestinal infections is also carried out by medical practitioners, workers in the food industry and educational institutions and is included in the mandatory annual examination.

Can show if essential digestive enzymes are present in the body.

How to take an analysis? Stool collection rules

Before you donate feces to the intestinal group, you need to know how to do it correctly. The technique of taking is not difficult. Feces should be collected in a special plastic bottle, which can be bought at a pharmacy. Before taking feces, you need to prepare the child: for several days do not take activated charcoal, castor oil, do not put rectal suppositories and do not take antibiotics. They take feces after the child goes to the toilet “little by little”.

Collect feces from several places and fill one third of the container, this is about 2 cm. If you have to wait a long time for natural defecation, then feces taken from underwear (necessarily fresh) are suitable as material for analysis. A pipette can be used to collect stool if the stool is very loose. Excrement is taken from areas where there are a lot of pathological impurities, such as pus, mucus, flakes. The selected material should be free of blood. We collect feces in the morning. There are cases when taking a feces is not required, a rectal swab is sent for analysis. It is taken in the clinic with a special swab in the position of the child lying on his side. The taken feces or smear is handed over to the laboratory within 3 hours after sampling.

Laboratory diagnostics

Analysis of intestinal infection in children includes bacterioscopic and bacteriological examination of feces. The bacterioscopic method shows the presence of bacteria and protozoa in feces under a microscope. Bacteriological analysis of feces is the cultivation of a colony of microorganisms.

To do this, a stool culture tank is made on a nutrient medium. By the nature of growth, the type of infectious pathogens and their concentration are determined. When pathogenic microorganisms are detected, their sensitivity to antibiotics is determined.

The most frequently asked question is: “How long does it take to test for intestinal infections?” It takes time for a colony to grow. How many days the culture will grow depends on the specific type of microbe. Data is usually obtained within 1-2 weeks.

Sometimes the analysis of the intestinal group may not be informative enough. For example, if the cause of the infection is a virus or protozoa, or if not the pathogen itself was found in the feces, but its waste products. In this case, they donate feces for a polymerase chain reaction. PCR of feces determines the DNA of the pathogen, even if only one bacterium has entered the feces. The data comes within a day.

Additional diagnostic research methods for intestinal infections include a blood test, blood culture (if the child has a fever for more than 3 days) and serological analysis (allows to detect antibodies to pathogens).

Stool culture for pathogenic intestinal flora also helps to differentiate intestinal infection from other conditions that can cause the same symptoms. Differential diagnosis of intestinal infection is carried out with dysbacteriosis and food toxic infections. For the diagnosis of dysbacteriosis, a fecal analysis for UPF is given.

Decryption of received data

In a healthy child, there are no pathogenic microorganisms in the feces, i.e. the analysis should be negative for the disgroup and salmonellosis, as well as for the dysenteric amoeba and the typhoid and paratyphoid group. Normally, there are no such simple microorganisms as intestinal Trichomonas, balantidia.

High values ​​of pathogenic bacteria that are not part of the normal microflora are found in two cases: acute intestinal infection and bacteriocarrier.

An UPF analysis will tell you how many of these bacteria are in 1 gram of feces. Low values ​​of enterococci, clostridia, candida fungi and bacteroids are considered a negative result, because. for the development of infection, a certain amount of the pathogen is necessary, and not just its presence. If the conditionally pathogenic microflora prevails over the concentration of lactobacilli in the feces, this is dysbacteriosis.

If an intestinal group is detected, the analysis is supplemented with a test for the sensitivity of bacteria to antibiotics.

Antibiotic sensitivity is indicated by the following letter designations

• S - sensitive (h);
• R - stable, resistant (y);
• I - moderately stable (yy).

Treatment

If the stool test came back positive, then the sick child should be isolated. With a mild course of the disease, treatment can be carried out at home. It is necessary to restore the amount of fluid lost in the feces (rehydration). The doctor prescribes antibiotic therapy. In severe dehydration, the child should be urgently hospitalized!

Differential diagnosis can be difficult if one disease occurs under the guise of another. In such cases, an accurate diagnosis is established based on the results of successful treatment. If the therapy was effective, the diagnosis is correct.

Determine the state of the intestinal microflora in a child. Why can a doctor prescribe such a study and what should parents know about it?

Indications

Such a study is especially important for infants, who have an increased risk of developing intestinal pathology. It is also advised to make it for children who often get sick, for example, with frequent SARS.

Most often, stool analysis is done for intestinal disorders.

Kinds

1. Coprological examination of feces. He is prescribed the very first in case of suspected bowel problems. The analysis will show how food is digested in the intestines and reveal the inflammatory process.
2. Biochemical analysis of feces. Helps to identify fermentopathy.
3. Express seeding of feces. This is a quick method of research, during which the normal microflora is determined as a percentage.
4. Sowing feces for dysbacteriosis. Such a study allows us to assess the concentration and number of bacteria that are representatives of the normal microflora, as well as conditionally pathogenic flora. Feces of the child are sown on a nutrient medium. Within a few days colonies of bacteria grow, which are examined under a microscope and counted. The form indicates the number of microorganisms per 1 gram of feces, indicating the number of bacteria forming colonies (CFU). If pathogenic flora is detected, sensitivity / resistance to antibiotics is additionally determined.

Stool tests are aimed at identifying the number of different bacteria in the intestine and their ratio.

Where can you get tested?

Tests for dysbacteriosis can be taken both in public clinics and in private laboratories. At the same time, parents should remember that public medical institutions have their own opening hours and do not conduct research on weekends.

Is special training needed?

If the analysis is assigned to an infant who has begun to be fed, then three days before the study, the introduction of new products is excluded. Also, within a few days before the delivery of feces, you need to stop giving the baby any medications, including activated charcoal and anti-colic drugs.

It is also impossible to do an enema, use rectal suppositories and give the child laxatives before testing for dysbacteriosis.

How to collect feces?

A stool sample should be collected from a child who has already urinated to prevent urine from entering the test container. Also, before collecting the material, the child must be washed away.

For the study, you will need about 10 ml of the baby's feces, which is placed in a sterile container. It is best to take stool particles from different parts of the baby's stool. If there are any impurities in the feces, they are also placed in a container with feces for analysis.

Before taking feces, it is necessary to wash the genitals of the baby

How much and where can you store feces?

Feces are usually collected in the morning and taken for analysis within 1-3 hours after a bowel movement. If fresh morning feces are not immediately available, the sample container for analysis can be stored in the refrigerator for up to 6 hours. Stool storage at room temperature will distort the results of the study.

Norm values

Decryption

Most of all in the stool sample of a healthy child should be bifidobacteria. Normally, they make up about 95% of the total microflora. It is these bacteria that perform all the main functions of the intestinal microbial flora - assistance in the absorption of minerals and vitamins, the synthesis of vitamins, stimulation of intestinal motility, neutralization of toxins, and others.

No less important are lactobacilli, which also ensure the functioning of the intestine, produce lactase and protect the child from allergens. They are in a healthy intestine contains approximately 6% of all microorganisms. The normal microflora also consists of Escherichia coli (Escherichia), which help to remove oxygen and resist pathogenic flora.

Such a representative of the intestinal flora as bacteroids appear in the feces of infants older than 6 months. These bacteria help break down fats. Also in the healthy large intestine of babies, peptostreptococci and enterococci are normally found.

Normally, pathogenic enterobacteria, such as salmonella or shigella, are not detected in children's feces. Their detection does not indicate dysbacteriosis, but serious intestinal diseases. Also in the feces of the child should be absent Staphylococcus aureus and hemolytic Escherichia.

The presence of pathogenic bacteria in the feces of a child indicates the presence of an illness in a child

Reasons for deviations

• If the number of bifidobacteria and lactobacilli is reduced, and the indicators of opportunistic flora are increased, these are signs of dysbacteriosis. Also, this picture is typical for intestinal infections and pathologies of enzymes.
• The composition of the microbial flora of the intestine is also affected by malnutrition of the child. Excess consumption of fats will change the indicator of bacteroids, and an excess of carbohydrate food will affect the number of peptostreptococci and enterococci.
• A decrease in the number of typical Escherichia coli often occurs with helminthic invasions. Non-pathogenic Escherichia also becomes less with violations of feeding the child, intestinal infections and antibiotic therapy.
• An increase in the number of Escherichia coli, in which activity is reduced, indicates the initial stage of dysbacteriosis.
• An increase in the number of Candida fungi is characteristic of candidiasis.

It is quite simple, however, at the same time, very informative analysis - it allows you to diagnose almost all diseases of the digestive system, clarify the location of the lesion (stomach, current or colon) and detect the presence of uninvited guests - parasites and pathogenic microbes. However, most parents under the analysis of feces mean only "analysis for dysbacteriosis", which is so fond of prescribing to all babies. However, there are several analyzes of feces and microbiological seeding (“for dysbacteriosis”) is performed as the last one, when all other problems are excluded.

In children of the first year of life, fecal analysis reveals various digestive problems - disorders of the stomach. Intestines, problems with the liver and pancreas, infectious diseases and hereditary pathology of metabolism. What tests are given and what do they look at?

This analysis evaluates the main characteristics of feces - physical, chemical and microscopic, in addition, depending on the type of feeding and the age of the baby, it will have characteristic features. But in order for the analysis to show reliable data, it is necessary to collect it correctly, which in young children is a rather difficult task.
The analysis is collected from a diaper or oilcloth, since the diaper absorbs some of the liquid, and the analysis will be unreliable.

For analysis, at least 1-2 teaspoons of feces collected in a dry, clean container are required. But baby food jars should not be used - microscopic food particles remain on their bottom and walls, which will distort the result. Ideally, this should be a fresh analysis - the baby went in a big way, you collected and delivered the analysis to the laboratory. But if this is not possible, collect it in a container, tightly close the lid and place it in the refrigerator door - you can store it for a maximum of 6-8 hours.
It is unacceptable to collect material after an enema or the use of laxative products or medicines; there should be no particles of urine in the feces.

How is it assessed and what should be normal?
Consistency. For children of the first two years of life, the chair is acceptable in the form of porridge and unformed. On full breastfeeding, liquid porridge, with a little water, there may be thick sour cream. On IV, the chair can be soft sausage or gruel. With the introduction of complementary foods, the stool begins to take shape and becomes thicker, by the age of two it is usually a loose sausage. Stool in the form of "dry smoked sausage" or "sheep balls" is constipation. The chair is liquid, water with impurities and often it is constipation.

Color. In babies of the first year of life, the feces are usually yellow, with small admissible admixtures of greenery in the first 3-4 months. Then the stool becomes yellow-brown, and by the age of two it becomes about the same as in adults. Pieces of food are acceptable, especially in the first months of complementary foods, and when using bright foods, coloring of feces in the color of the product (beets, rhubarb, pumpkin).
Smell. In the first months of life, the stool of breastfed babies has the smell of sour milk, while artificial ones smell sharper. With the introduction of complementary foods, especially meat, the stool acquires the usual fecal smell.

pH (reaction). Normal is a neutral or slightly alkaline reaction, but in the first months when fed with formula or breast milk, it can also be slightly acidic.
Protein. healthy children should not have protein in the feces - its presence indicates inflammation of the intestines, the presence of mucus, bleeding, exudate, undigested food.
Reaction to occult blood. Normally, there should be no blood in a healthy intestine - this always indicates problems. Most often, blood appears with allergies, inflammation of the intestine. rectal fissures. prolapse of the rectum, hemorrhoids, polyps and malformations of the intestine.
response to bilirubin. Bilirubin is one of the breakdown products of hemoglobin, which is acceptable in feces until about three months of age, later, under the action of enzymes and microflora, it is completely transformed into stercobilin, giving a brown color. The appearance of it in the feces after this age indicates health problems.

Slime. Mucus is a jelly-like discharge that is clear or whitish in color. They are designed to protect against the aggressive effects of intestinal contents. However, normally little mucus is released, and at the exit it is completely mixed with feces. A noticeable presence of mucus in the feces is acceptable up to 3-5 months of life, especially in infants. And then they talk about the presence of an inflammatory process.
Leukocytes. A small amount of leukocytes, especially in the first months of life, is acceptable, however, if they are released in large quantities in combination with mucus and blood, this indicates inflammation and damage to the intestinal wall.

Muscle fibres. They talk about the degree of digestion of protein foods; before the introduction of meat complementary foods, they practically do not exist in a child, and in the future they should be single. If there are a lot of them, this indicates a violation of digestion in the stomach and intestines, problems with the pancreas, inflammation of the intestines.

Connective tissue. Normally, it should not be, it occurs only after the introduction of complementary foods with insufficient secretion of the stomach, problems with the pancreas.
Neutral fat. Fatty acid. Soap. In early childhood, small amounts of it may occur, but after six months it appears in violation of the pancreas, liver, or diseases of the small intestine.

Remains of undigested food. In the first years of life, the presence of plant food residues in the feces is acceptable - especially corn, carrots, apple skins, etc. If there is a lot of digestible fiber in the feces, this may indicate that food passes through the intestines too quickly. Undigested fiber may be normal.

Starch. It appears in food with the introduction of complementary foods, if there is a lot of it, it burns about the poor functioning of the pancreas, indigestion in the intestines, and intestinal infection.
iodophilic flora. These are special types of bacteria, the overgrowth of which occurs with dyspepsia (digestion disorders), disruption of the small intestine, disruption of the stomach and pancreas.

Test for carbohydrate content of feces.
This study is carried out with suspicion of lactase deficiency - a decrease in the amount of an enzyme that breaks down milk sugar (lactose) in the intestine. It is usually prescribed for dyspeptic symptoms - liquid, foamy stools, impaired weight gain that occurs when using dairy products. True lactase deficiency (when there is an enzyme deficiency) is rare. For the most part, there are false or secondary variants of lactase deficiency, when the enzyme is present, but it is either not yet mature, or blocked as a result of an intestinal infection, or there is an overload of milk sugar (for example, with an imbalance of fore and hind milk in infants).

This condition disappears after correction of nutrition, treatment of intestinal infection and normalization of microflora. The analysis of feces for carbohydrates is not the main one in making a diagnosis, but it helps to determine the nature of the insufficiency - primary or secondary.
In order to properly collect feces for the determination of carbohydrates in feces, it is necessary to collect it in a clean, dry dish, in a volume of at least 1-2 teaspoons. Feces must be delivered to the laboratory no later than 3-4 hours, otherwise the result will be distorted. Normal values ​​for children under one year old are:
Breastfeeding (before complementary foods) up to 0.5-0.6%,
On artificial feeding - up to 0.3%,
For children from the second half of the year - up to 0.25%,
Older than a year 0%.

With an increase in indicators, a feeding correction is prescribed, the imbalance of milk is eliminated if it is a baby or a low-lactose mixture is temporarily given if it is a baby on IV. If primary lactase deficiency is confirmed, the treatment will consist in the use of the enzyme lactase.

Analysis of feces for opportunistic flora (UPF).
It is this analysis of feces, usually referred to as "dysbacteriosis", that causes the greatest number of questions among parents. However, for the most part, this analysis is uninformative and not indicative. The thing is that the intestinal microflora is very unstable, and even if two analyzes are carried out in a row in the same child in the morning and in the evening, they will differ significantly.

To understand where microbes come from in the intestines, and who should be feared and who should not, let's briefly talk about how the intestines work. Immediately after childbirth, when the baby is applied to the breast, the baby's intestines are populated with microflora from the mother. It becomes like a multi-storey building - there are peaceful neighbors and most of them are bifido- and lactoflora. And there are violent neighbors, but their minority is the so-called conditionally pathogenic flora (staphylococcus aureus, Klebsiella, certain types of Escherichia coli). While all the microbes settle in the intestines, anxiety occurs - physiological dysbacteriosis, until everyone takes their proper places. In addition, the settlement and peaceful existence in the intestines of various potentially dangerous microbes, such as staphylococcus and Klebsiella, is facilitated by help from the mother - breast milk with antibodies to harmful microbes and special substances that help beneficial lactobacilli and bifidoflora grow. That is, all changes in the analysis of feces for microflora in the first 4-6 months of life are a physiological setting for the work and peaceful coexistence of microbes.

What is allowed and what is not?
In this analysis, there are some special indications, so the presence of the causative agent of salmonellosis, cholera, typhoid fever, dysentery and the pathogenic type of Escherichia coli is clearly unacceptable in the feces. But parents, however, are more concerned about the presence of staphylococcus, Proteus, Klebsiella, enterococci in the feces. However, in itself, the presence of any amount of these microbes, in the absence of a clinic for these diseases, that is, if the child does not have a fever, gains weight, grows and develops according to age, is a variant of the norm for this baby. The microflora is called conditionally pathogenic because it can become active and harmful only under certain conditions.

This occurs in children with immunodeficiencies, a sharp decrease in immune forces after severe and prolonged illnesses, after exposure or treatment with heavy drugs - antibiotics for a long course (three or more weeks), antitumor agents. Another reason for the activation of this flora can be intestinal infections and severe poisoning - they simply join the clinic of the disease. In all other cases, correction of the microflora is not required at all - the microbial balance will be restored on its own. The use of any drugs to correct the flora is not required - most of them simply do not reach the intestines, being destroyed by hydrochloric acid of the stomach or intestinal enzymes.

Of course, this is not all of the stool tests that can be performed on a child. However, all other studies are quite specific and are carried out only if significant deviations are found in the general analyzes. They are prescribed by a gastroenterologist and are necessary to clarify the diagnosis, or to monitor the effectiveness of treatment.