Milk-colored or rice-soup stools

Introduction Milk color or rice soup is one of the symptoms caused by infection of some pathogenic bacteria in Enterobacteriaceae. Enterobacteriaceae includes a large group of Gram-negative bacilli with similar biological traits. Most of these bacteria are found in the intestines of humans and animals, and can be widely distributed in water, soil and rot with human and animal excreta. Some of these bacteria have obvious pathogenic effects on humans, such as Salmonella, Shigella and certain pathogenic Escherichia coli; and most of them are normal intestinal flora, generally not causing disease, but when Changes in the state of the host organism or the entry of bacteria into the intestine can also cause various diseases such as bacteremia, meningitis, pneumonia, pyelonephritis or wound infections as conditional pathogens.

Cause

The bacterium is a Gram-negative bacterium, and has a size of (1.1 to 1.5) m × (2.0 to 6.0) m (live bacteria) or (0.4 to 0.7) m × (1.0 to 3.0) m (staining bacteria). Most strains have round flagella, can move, have pili on the body, no spores. Some strains have an envelope. The pili is located on the surface of the bacteria, fibrous attachments, and is a hydrophobic protein component. It has good antigenicity and can stimulate the body to produce corresponding antibodies. It is a facultative anaerobic bacterium, which can develop at 15 to 45 ° C. The optimum growth temperature is 37 ° C, and the optimum pH is 7.4 to 7.6. On the enteric bacteria selection medium, the sugar can be fermented to produce sugar, and the indicator is discolored to form colored colonies. Most of the pathogenic bacteria in the Enterobacteriaceae family do not decompose lactose, and the colonies are colorless. This point has a selective effect on the isolation of Enterobacteriaceae pathogenic bacteria. Fermentation of glucose, lactose, maltose, mannitol and other sugar alcohols to produce acid gas; for sucrose, dulcitol, raffinose, rhamnose and other strains vary. The IMVC test was ++--, negative for urease, phenylalanine, malonate, and the like. The antigen structure is more complicated, mainly including three antigens of O, H and K. The O antigen is a heat-resistant polysaccharide phospholipid complex, which has 171 species, which is the basis of serotyping; H antigen is a heat-labile protein, and 56 antigens have been established so far; K antigen is an envelope antigen, which is known to date. There are 100 kinds. The bacteria can survive for several weeks to several months in natural water and survive longer in lower temperature feces. Prone to drug resistance. The generation of drug resistance is mainly obtained by the delivery of a plasmid with a drug resistance factor (R factor).

an examination

Related inspection

Fecal faeces, stool color, regular fecal odor

Diagnosis: During the epidemic, infants and young children with diarrhea should first consider Escherichia coli gastroenteritis, first isolation treatment, waiting for pathogen examination to confirm the diagnosis. In the non-epidemic period, especially the sporadic cases, it is often difficult to diagnose by clinical only, and it must be confirmed by pathogen and serological examination.

Differential diagnosis

The causes of diarrhea are complex, such as bacteria, viruses, parasites, etc. Some chemicals can also cause diarrhea. Escherichia coli enteritis should be distinguished from the following diseases.

1. Bacterial dysentery: caused by Shigella, diarrhea with pus or mucus is more common, less, and often have urgency and heavy, mostly cold and heat. A large number of pus, red blood cells and phagocytic cells can be found in stool microscopy. Infant poisoning bacillary dysentery or atypical bacillary dysentery should be identified by pathogenic diagnosis.

2. Vibrio cholerae: After infection, severe diarrhea occurs first and then vomiting, rarely nausea, vomit and diarrhea stools are rice-like watery, the amount is large, no urgency and heavy, a small number of patients have a small amount of blood. Dehydration often causes muscle pain, skin wrinkles, body surface temperature is lower than normal, microscopic examination can find extremely active Vibrio, should be further identified by bacterial culture.

3. Vibrio parahaemolyticus food poisoning caused by Vibrio parahaemolyticus, mainly due to eating food contaminated by the bacteria (more related to seafood), rapid onset, first with chills, paroxysmal abdominal pain (upper abdomen) Colic) began, vomiting diarrhea, mostly watery stools or bloody watery stools, mostly for the same meal, the disease should be identified.

4. Salmonella food poisoning is caused by food contaminated with Salmonella typhimurium. Acute onset, often accompanied by cold, abdominal pain, bloating, nausea, vomiting, diarrhea, watery stools and stench, early bacteremia, and more common morbidity. Rely on pathogens, serological diagnosis and identification.

5. Viral diarrhea: Diarrhea caused by enterovirus infection, characterized by high contagiousness. Rotavirus, small round virus and other infections have vomiting in the early stage, followed by diarrhea, mostly watery stools and mucus, mostly in autumn and winter. Other viral diarrhea is more common in summer and autumn, there are nausea and vomiting, in addition to gastrointestinal symptoms, often have respiratory symptoms, pharyngitis, and convulsions, often involving the neck muscles, back muscles. In the age of one year, children often see green watery or egg-like water. Antibiotic treatment is generally ineffective, and the course of disease is self-healing in 5 to 7 days. Further identification by serology and virus isolation.

6. Campylobacter enteritis: Campylobacter jejuni causes mild and viral enteritis, and is similar to ulcerative colitis or Crohn's disease. There is fever, diarrhea watery or mucus-like stool, there is stench, it is bile color, severe pus and bloody stools, and more bacteria can recover in 1 week. Children often have abdominal cramps, and convulsions can occur when there is high fever. The incidence is mostly related to exposure to poultry, livestock or drinking unsterilized milk and raw water. Dark-field microscopy can detect the archaea-like active bacterium of the archery, and the bacterial culture is further diagnosed.

7. Yersinia enteritis: more common in children, related to food and water pollution. Abdominal pain, diarrhea, hypothermia, watery stool, may have sepsis, may be complicated by nodular erythema, pseudo appendicitis, arthritis. Bacterial culture can be further identified.

8. Others: Attention should be paid to the identification of diarrhea caused by Giardia and amoebic dysentery, and amoeba or Giardia can be found in stool microscopy.

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