ISSN:
2181-3906
2025
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
532
УДК
616.9-053.2 DOI 10.21685/2072-3032-2018-2-11
ACUTE INTESTINAL INFECTIONS: CLINICAL AND AETIOLOGICAL SPECTRUM
IN HOSPITALISED CHILDREN
Muradova Emma Vladimirovna
(PhD), Acting Assistant Professor, Department of Microbiology, Virology and Immunology
Samarkand State Medical University
ORCID ID 0009-0005-6147-9769.
+998915348765
Shakhnoza Farmonova
2nd year student of the Faculty of Medicine.
Samarkand State Medical University
https://doi.org/10.5281/zenodo.15652151
Abstract.
The etiological structure and peculiarities of clinical and epidemiological
manifestations of acute intestinal infections in hospitalised children are studied. A retrospective
study of the case histories of 2479 children hospitalised with the clinic of acute intestinal
infection was carried out. All patients underwent standard laboratory examination, including
clinical, biochemical, instrumental diagnostic methods, bacteriological and molecular-
biological studies to verify the causative agent. The epidemiological anamnesis of all children
was clarified, and the frequency of background and concomitant diseases was studied. The
diagnosis of intestinal infection was verified in 925 children (38%). Bacterial intestinal
infections were detected in 610 (65 % of the transcripts).
Key words:
acute intestinal infection, viral diarrhoea, bacterial infections, concomitant
intestinal infection.
OʻTKIR ICHAK INFEKSIYALARI: GOSPITALIZATSIYA QILINGAN BOLALARDA
KLINIK-ETIOLOGIK SPEKTR
Annotatsiya.
Госпитализация қилинган болаларда ўткир ичак инфекцияларининг
этиологик тузилиши ва клиник
-
эпидемиологик намоён бўлиш хусусиятлари ўрганилди.
Ўткир ичак инфекцияси клиникаси билан госпитализация қилинган 2479 нафар боланинг
касаллик тарихи ретроспектив тарзда ўрганилди. Барча беморларга қўзғатувчини
аниқлаш учун клиник, биохимиявий, инструментал диагностика усуллари, бактериологик
ва молекуляр
-
биологик тадқиқотларни ўз ичига олган стандарт лаборатория текшируви
ўтказилди. Барча болаларнинг эпидемиологик анамнези аниқланди, асосий ва ёндош
касалликларнинг учраш даражаси ўрганилди. “Ичак инфекцияси” ташхиси 925 нафар (38
%) болаларда тасдиқланди. Бактериал ичак инфекциялари 610 нафар (таҳлил қилинган
натижаларнинг 65 %и) болаларда аниқланди.
Калит сўзлар:
Ўткир ичак инфекцияси, вирусли диарея, бактериал инфекциялар,
ёндош ичак инфекцияси.
ОСТРЫЕ КИШЕЧНЫЕ ИНФЕКЦИИ: КЛИНИКО
-
ЭТИОЛОГИЧЕСКИЙ СПЕКТР
У ГОСПИТАЛИЗИРОВАННЫХ ДЕТЕЙ
Аннотация.
Представлены результаты исследования этиологической структуры
и клинико
-
эпидемиологических особенностей острых кишечных инфекций у
госпитализированных детей. Проведено ретроспективное исследование историй болезни
ISSN:
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2025
International scientific journal
«MODERN
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VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
533
2479 детей, госпитализированных с клиническими проявлениями острой кишечной
инфекции.
Все пациенты прошли комплексное лабораторное обследование, включающее
клинические, биохимические и инструментальные методы диагностики, а также
бактериологические и молекулярно
-
биологические исследования для идентификации
возбудителя.
Для каждого ребенка был собран эпидемиологический анамнез и изучена
частота сопутствующих и фоновых заболеваний.
Диагноз кишечной инфекции был
подтвержден у 925 детей (38%).
Бактериальные кишечные инфекции были выявлены у
610 человек (65% случаев с установленной этиологией).
Ключевые слова:
острая кишечная инфекция, вирусная диарея, бактериальные
инфекции, сопутствующая кишечная инфекция.
"Monobacterial etiology of AKI was established in 505 children (82% of bacterial
infections), while 82 patients (18%) were diagnosed with mixed bacterial infection. Among the
decoded cases of acute respiratory viral infection, the proportion of diarrhea of viral origin was
26% (241 patients), with a predominance of rotavirus infection (48% of all viral infections). In
560 children (22%), acute intestinal infection developed against the background of chronic
somatic pathology; concomitant diseases were detected in 468 (20%) patients.
In 41% of hospitalized children, the etiology of AKI was established. Bacterial infections
were diagnosed more frequently, while the etiology remained unclear in 39% of patients. In
mixed intestinal infections, 14 different combinations of bacteria were identified, with more
frequent associations of opportunistic microorganisms. To improve the accuracy of the diagnosis
of intestinal infections, it is recommended to make more extensive use of modern diagnostic
techniques.
Intestinal infections remain one of the most common groups of infectious diseases in
children. The peak incidence occurs in children under 5 years of age, with more than 123 million
patients requiring medical care each year, and 9 million children requiring hospitalization [1, 2].
The economic damage from intestinal infections is also significant, since acute intestinal
infections (AKI) rank II-III among the causes of childhood mortality from infectious diseases
second only to acute respiratory viral infections and HIV infection [3, 4]. More than 700,000
cases of diarrhoeal diseases are registered annually in the Russian Federation. OCI is
characterized by polyethology: viruses, fungi, bacteria, and protozoa can be their causative
agents [5]. Currently, the structure of intestinal infections is dominated by viral diarrhea;
bacterial and protozoal lesions of the gastrointestinal tract are detected in 1.5-15% of cases [6,
7]. About 139 million cases of rotavirus infection are registered annually in the world [9], while
in developed countries this disease affects older children more often than in developing countries
[8]. In Russia, rotavirus etiology is more common among viral gastroenteritis, while
gastroenteritis of norovirus etiology takes the second place [1]. The role of astro-, adeno - and
other viruses in the structure of non-bacterial gastroenteritis is actively studied: antibodies to
astroviruses were detected in 71-75% of cases when examining children aged 3-10 years [2, 3].In
modern conditions, the role of opportunistic microorganisms in the structure of intestinal
infection pathogens is increasing [4].
ISSN:
2181-3906
2025
International scientific journal
«MODERN
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АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
534
This is facilitated by the violation of environmental safety, frequent, sometimes
irrational, use of antibacterial drugs and other medicines that reduce the div's immunity [5].
According to S. M. Alabov and M. N. Yakushenko, the frequency of combined
pathologies in patients with diarrhoeal diseases is increasing [1]. The etiological causes of mixt-
infections are both representatives of the same family and representatives of different families
and larger taxa and kingdoms: associations of pathogenic and opportunistic microorganisms,
viruses and bacteria, bacteria and fungi are detected [6]. Thus, intestinal infections retain their
importance in infectology, the structure of diarrhoeal diseases undergoes changes, the study of
the etiology and clinical course of gastroenteritis of infectious origin is an urgent problem at
present. Aim of the study: to investigate the etiological structure, epidemiological and clinical
features of acute intestinal infections in hospitalised children. Materials and Methods The study
included 2379 children aged from 1 month to 4 years who were under treatment in the paediatric
infectious diseases department of the Penza Regional Clinical Centre for Specialized Medical
Care. All patients underwent laboratory examination, including clinical blood and urine tests,
biochemical parameters, stool coprogram examination. Instrumental methods (ultrasound
examination of abdominal cavity organs, radiological methods) were included in the examination
when indicated. Aetiological diagnosis was made using bacteriological method (sowing on dense
nutrient media) and polymerase chain reaction (PCR) to determine RNA of viruses (rota-, noro-,
astro- and enteroviruses) in faeces. To exclude hospital-acquired infection, faecal sampling for
examination was performed on the first two days of admission to the hospital. The diagnosis of
intestinal infection caused by opportunistic flora was made when bacterial counts of more than
105 CFU/g of faeces were determined. Statistical analysis and data processing were performed
using standard Statistica 7 software. Mean values (M) and standard deviations of the mean (m)
were estimated.
"The diagnosis of intestinal infection was confirmed in 928 children (39%). Bacterial
intestinal infections were detected in 601 (64.8% of patients with established etiology)patients.:
monobacterial infections were diagnosed in 511 children (84% of bacterial infections), and 90
(16%) patients were found to have a mixed bacterial infection. Staphylococcal enterocolitis
prevailed in the structure of monobacterial AKI
–
170 (33.7%) cases, salmonellosis was
diagnosed in 24 (4.3%) children, dysentery (Flexner and Sonne)
–
in 11 (2.3%) children,
klebsiellosis was detected in 89 (17.4%) cases, proteus-in 74 (14.1%), enterobacter
–
in 70
(13.7%) patients. 74 (14.5%) children were diagnosed with diseases caused by citrobacter,
Pseudomonas aeruginosa, hafnea, acinetobacter and enterococci.
In 90 cases of combined intestinal infections, 14 different combinations of bacteria were
detected; the most common associations were staphylococci and klebsiella (24 children-26.7%),
staphylococci with proteus (19 children
—
21.1%) and staphylococci with enterobacter (14
children
—
15.6%). Mixed infection of Pseudomonas aeruginosa and Staphylococcus was
detected in 8 (8.9%) patients, Staphylococcus and salmonella
–
in 5 (5.6%), Staphylococcus and
Citrobacter-in 5 (5.6%), proteus and klebsiella - in 7 (7.8%), staphylococcus and dysentery-in 2
(2.2%) patients. In 2 (2.2%) patients, the disease was caused by an association of three bacteria:
Staphylococcus aureus + Flexner's dysentery + Citrobacter and Staphylococcus aureus + Sonne's
dysentery + Klebsiella.
ISSN:
2181-3906
2025
International scientific journal
«MODERN
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АND RESEARCH»
VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
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Each combination of microorganisms: klebsiella and Sonne dysentery, Salmonella and
proteus, Sonne dysentery and citrobacter, Staphylococcus and acinetobacter was detected in 1
(1.1%) child.
The proportion of viral diarrhea among the diagnosed acute respiratory infections was
25.7% (239 patients).: rotavirus infection was diagnosed in 118 children (49.4% of viral
infections), norovirus gastroenteritis-in 78 (32.6%), astrovirus infection
—
in 12 children (5%),
enterovirus infection
—
in 3 (1.2%). Viral associations were found in 28 (11.7%) patients:
rotaviruses and noroviruses
—
in 19 children, rotaviruses and astroviruses
—
in 6 people,
noroviruses and astroviruses
—
in 2 patients. Three viruses (rota, noro, and astrovirus) were
detected simultaneously in 1 child. The low level of verification of acute intestinal infections of
viral etiology is explained by the fact that not all patients underwent laboratory testing by PCR.
Mixed forms of acute intestinal infections involving viruses and bacteria were detected in 88
children (9.5% of the confirmed cases). In 1451 (61%) patients, the etiology of intestinal
infection was not established. Epidemiological history revealed contact with diarrhoeal diseases
in 700 (29.5%) children: in 474 (19.1%) with relatives, in 166 (6.9%) with sick children,
including in a preschool institution, and in 60 (2.7%) patients - in-hospital infection during
hospitalisation for another disease. In 609 (25.8%) children, acute intestinal infection developed
against a background of chronic somatic pathology.
Thus, background pathology was more frequently registered in the groups of children
with bacterial and mixed infections (28.8 and 26.1 %, respectively). Associated diseases were
detected in 471 (19.8 %) children: acute tonsillitis - in 30 (1.3 %), pneumonia - in 58 (2.4 %),
acute respiratory viral infection - in 224 (9.4 %), acute bronchitis - in 78 (3.3 %), stomatitis - in
19 (0.8 %), infectious mononucleosis - in 17 (0.7%), enterobiasis - in 9 (0.4%), conjunctivitis -
in 12 (0.5%), sinusitis - in 4 (0.2%), acute pyelonephritis - in 20 (0.8%) patients. Associated
diseases were more frequent in children with viral diarrhoea - in 58 (24.3% of viral) cases, while
among patients with intestinal infections of bacterial origin - in 113 (18.8% of bacterial) patients,
and in 328 children (20.1% of diarrhoea of unknown aetiology). The clinical picture of the
diseases was determined by the severity of intoxication, dyspeptic, intestinal syndromes and the
degree of exicosis. The study revealed the following clinical features of viral diarrhoea. The
mean age of children with enteritis of viral aetiology was 21.8 ± 7.9 months; rotavirus infection
affected younger children: mean age was 17.9 ± 7.0 months, norovirus and astrovirus were
detected in older patients (24.0 ± 8.4 and 22.1 ± 6.9 months, respectively). The mean age of
children with mixed-
virus infections was 21.9 ± 8.1 months. The time of hospital stay ranged
from 4 to 11 days, with an average bed-
day of 7.7 ± 2.7 days. The severity of the children's
condition was assessed by the severity of the intoxication syndrome and the degree of
dehydration. The vast majority of children (210 children, 87.6 %) had an average degree of
severity of the disease. Increase of div temperature to febrile values in the first two days of the
disease was registered in 10 (8.5 %) children with rotavirus infection and in 5 (17.8 %) patients
with mixed diarrhoeal viral diseases. Subfebrile fever was noted in 38 (32.2 %) patients with
rotavirus enteritis, in 14 (16.1%) children with norovirus infection and in 9 (32.1 %) patients
with mixt-diarrhoeal diseases.
ISSN:
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2025
International scientific journal
«MODERN
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VOLUME 4 / ISSUE 6 / UIF:8.2 / MODERNSCIENCE.UZ
536
Dehydration of various degrees was detected in all hospitalised patients with viral
gastroenteritis. Excicosis of I degree was observed in 211 (88 %) patients, excicosis of II degree
- in 30 (12 %) children.
"Monobacterial intestinal infections were detected in 511 children. The mean age of the
patients was 18.9 ± 7.9 months. The distribution of patients by disease severity was as follows:
mild was observed in 34 (6.6%) children, moderate
—
in 399 (78.1%), severe
—
in 78 (15.3%)
children. Grade I-II exicosis was registered in 419 (82%) patients, grade II exicosis
—
in 92
(18%) children. Intestinal damage by the type of gastroenteritis was observed in 342 (66.9%)
patients, enterocolitis and gastroenterocolitis
—
in 169 (33.1%) children.
Clinical features of combined bacterial intestinal infections were studied (n=90). The
average age of hospitalized children was 21.2 ± 6.6 months. The duration of hospitalization
varied from 7 to 15 days, and the average length of hospital stay was 10.3 ± 1.4 bed days. The
disease was mild in 4 (4.4%) children, moderate in 68 (75.6%), and severe in 1 (20%). Various
degrees of dehydration were detected in all patients: 60 (66.7%) children had I
—
II degree
exicosis, 25 (31.1%) patients had II degree dehydration, and 2 (2.2%) children had II-III degree
exicosis. In 82 (93.3%) children, the disease was accompanied by fever in the first days, in 19
(21.1%) patients, the temperature exceeded 38.7 °C.
Analysis of the nature of stool in the acute period of the disease showed that enteritis was
observed in 33 (36.6%) children, enterocolitis
—
in 53 (56.7%), including 6 (6.7%) patients with
hemocolitis. The most severe course of the disease was observed with a combination of
salmonellosis and staphylococcal infection, as well as with a mixed infection caused by Shigella
sonnei and Klebsiella oxytoca.
Conclusion:
the etiology of acute intestinal infections was established in 39% of
hospitalized children. Bacterial infections were diagnosed more often
—
in 601 (64.8% of
decoded) patients. Among bacterial infections, monobacterial infections were diagnosed in 511
children (85%), while mixed bacterial infections were detected in 90 (15%) patients. In children
with combined intestinal infections, 14 different combinations of bacteria were identified; the
most common associations of staphylococci with other opportunistic microorganisms were
recorded. Viral diarrhoea was diagnosed in 239 (25.7%) patients, the most common being
rotavirus infection (49.4% of viral infections). Background diseases were detected in 25.4% of
patients; pathology was more often registered in groups of children with bacterial and mixed
infections. The low level of verification of intestinal infections, especially viral infections,
requires a wider introduction into clinical practice of a modern and inexpensive method for
verifying pathogens -immunochromatography.
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«MODERN
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