What is Bacillus Cereus in children?
Bacillus Cereus is the name of the bacteria and the diseases they cause. The infection process can be either localized or generalized. Most often the disease passes as acute gastroenteritis.
At risk are newborns, debilitated, children with immunodeficiency states, as well as patients with malignant tumors. In such cases, Bacillus cereus is accompanied by persistent bacteremia and often takes the form of sepsis.
Epidemiology. Bacteria of the genus Bacillus are common in all countries. They “live” in the soil, the air, on the surrounding objects and in the water. Infection can be picked up from food products, medical instruments, medical equipment, which are used for invasive treatments and research (valve equipment, hemodialysis systems, catheters, etc.). Ways of transmission of Bacillus cereus: alimentary, contact. The incidence is sporadic (isolated, unrelated, intermittent cases), but outbreaks of acute gastroenteritis can occur with foodborne infections.
Causes of Bacillus Cereus in children
Bacillus cereus belong to the genus Bacillus. They are rod-shaped. The size of bacteria is 2.2 x 1.2-7 microns; they are motile, have laterally located flagella. Gram stained positive. They belong to strict aerobes, form endospores. Bacillus is divided into 3 morphological groups depending on the shape and swelling of the cell during sporulation. Pathogens in children, adults and animals belong mainly to the first group.
Currently, science knows about 20 serotypes of this bacterium. They can not be killed by common, traditional disinfectant solutions and drugs.
Bacillus cereus produces hemolysin, similar to streptolysin C, pro-solitic enzymes, phospholipases, penicillipase, lecithinase, etc.
Pathogenesis during Bacillus Cereus in children
The infection enters the body through the oropharynx, airway or skin lesions. Invasive operations play an important role: insertion of catheters, valve apparatuses, shunts, connection of the hemodialysis system, etc. Such ways B. cereus can get into the blood in large quantities, while on the instruments listed above.
If the infection path is alimentary, these bacteria lead to acute gastroenteritis. Enterotoxin at the same time leads to the defeat of the gastrointestinal tract. It also stimulates the system of cyclic nucleotides in the epithelial cells of the small intestine, causes damage to the mucous membrane of the stomach and small intestine and impaired vascular permeability. Because of this, symptoms such as vomiting and diarrhea appear.
The severity of the gastrointestinal tract and other organs depends on the amount of pyogenic toxin produced by B. cereus. This toxin causes ulceration of the respiratory tract epithelium, destruction of the intestinal mucosa, abscessing (including brain tissue).
Food poisoning B. cereus ends favorably due to the localization process. Infection caused by B. cereus becomes septic (and persistent bacteremia is observed) in children weakened by stress or immunodeficiency, as well as in newborns. In these cases, morphological changes in organs (intestines, lungs, brain) are expressed in the appearance of acute inflammatory foci with areas of necrosis, fibrinoid necrosis of the arteries, in which large clusters of B. cereus are detected.
Symptoms of Bacillus Cereus in children
The infectious process to which the bacteria in question lead can manifest itself by various symptoms. Food poisoning “pours” acute gastroenteritis. In other ways of infection, the development of meningitis, bronchopneumonia, osteomyelitis, brain abscess, panophthalmitis, endocarditis, sepsis, and bacteremia is observed.
The incubation period for acute gastroenteritis is from 1 to 16 hours. The disease has an acute onset, the child becomes sick, he complains of abdominal pain. There is usually no increase in temperature. Vomiting appears (possibly multiple), and after a few hours watery diarrhea is noted. There are painful urges to defecate (“in the toilet”). In some cases, the disease can pass by analogy with foodborne diseases. Then, first of all, profuse vomiting appears, but there is no diarrhea.
Acute gastroenteritis can be mild or moderate. Heavy forms are very rare. The disease can last for several hours or 2 days.
Pneumonia, caused by Bacillus cereus, begins sharply – fever and shortness of breath appear. There are pains in the sternum. X-ray is shown X-ray reveals a single or bilateral infiltrative process with a lesion of one or more lobes of the lung and pleural involvement. Pneumonia can be hemorrhagic, in which case deaths are frequent.
Meningitis has an acute onset, the temperature is very high, vomiting is repeated, meningeal symptoms develop, repeated convulsions. The condition of the sick child is severe. In the cerebrospinal fluid show significant pleocytosis, and lymphocytes and neutrophils are present in equal numbers. In the peripheral blood, there may be neutrophilic leukocytosis. Symptoms appear for quite a long time, penicillin preparations do not help.
Septicemia. The infectious process caused by Bacillus cereus may be manifested by septicemia with or without inflammation. An indicative symptom is persistent fever, which becomes intermittent (intermittent). The source of infection can not be established always (as well as the “entrance gate”). In this form of infection, B. cereus is secreted in pure culture.
Diagnosis of Bacillus Cereus in children
For an accurate diagnosis, only the isolation of the pathogen from biological material from a sick child and evidence of the pathogenicity of the isolated bacteria are used. For analysis, blood, vomit, sputum, urine, feces, discharge from the source of inflammation (pus, mucus) are used. A large number of bacteria in acute gastroenteritis is of diagnostic importance. For other lesions, it is necessary to obtain the seeding of a microbe in repeated portions of blood.
Since the clinical manifestations of B. cereus infection cannot be distinguished from other infections, the repeated detection of B. cereus in large quantities in the material from the patient is of decisive importance in the absence of isolation of other microorganisms. However, it must be borne in mind that B. cereus may cause a pathological process in conjunction with other infectious agents, for example, Proteus or Escherichia.
Treatment of Bacillus Cereus in children
Acute gastroenteritis caused by B. cereus is treated by prescribing an appropriate diet and oral rehydration. Under rehydration understand the replenishment of the normal water balance in the body.
Severe processes (meningitis, bronchopneumonia, septicemia, osteomyelitis) require the prescription of antibiotics. B. cereus due to the production of r-lactamase, resistant to penicillin and preparations based on it. But they can be destroyed by cephaloslorins of the 3rd and 4th generations.
Antibiotics are used in doses corresponding to the age. Duration of treatment is from 5 to 10 days. Antibiotics are canceled after the rehabilitation from the pathogen, the topic has come to the temperature standards and the elimination of symptoms.
Also used for the treatment of colibacterin. It is a drug with antibacterial and antidiarrheal action, it restores the intestinal microflora and immune system, fights against pathogenic and conditionally pathogenic non-physiological microorganisms.
Prevention of Bacillus Cereus in children
Specific prophylaxis of this infection is not currently developed. It is necessary to prevent V. cereus from entering the care of newborns and weakened children, as well as medical instruments, especially those used for invasive methods of treatment and examination of children and adults.
Prevention of acute gastroenteritis is in compliance with basic hygienic rules and complete heat treatment of food.