What is Klebsiella in Children?
Klebsiella infection is also known as Klebsiella or Klebsiella (by the name of the pathogen) – a group of infectious diseases that are caused by opportunistic microorganisms that are common in newborns and young children.
An infected adult / child or a healthy carrier of the infection spreads the infection. The main route of transmission is fecal-oral. Such paths as contact and airborne are also possible. From patients, along with secretions, the causative agent of the disease enters the external environment. They maintain their vital activity at room and low temperatures. In the refrigerator, Klebsiella do not die. It is also difficult to kill them with disinfectant solutions and most antibiotics.
Klebsiella often cause nosocomial outbreaks. In children, the disease mainly excites K. pneumoniae. Newborns and infants are very sensitive to it. Contribute to the development of the disease, malnutrition and congenital heart defects, prematurity, acute respiratory viral infections, immunodeficiency states. Klebsiella cause group and sporadic incidence, approximately equal in all seasons.
Causes of Klebsiella in Children
Klebsiella are gram-negative fixed capsule rods. Their size is 0.3-1.5×0.6-6 microns. They are located singly, in pairs or grouped in short chains. On nutrient media at a temperature of 35–37 ˚С, Klebsiella growth is observed, which form mucous shiny colonies similar to domes.
Processing with bactericidal soap often does not kill the causative agent of Klebsiella infection. The same goes for disinfectants.
The disease in humans is excited by three types of Klebsiella: K. pneumoniae, K. rhino-scleromatis and K. ozaenae.
Pathogenesis during Klebsiella in Children
Some strains of K. pneumoniae produce a fairly strong enterotoxin, which causes severe morphological changes in various organs and systems. This enterotoxin leads to disseminated intravascular coagulation.
At the same time, in the area of primary foci, immune complexes are rapidly formed that have a pathogenic effect on tissues. Enterotoxin leads to hemodynamic disturbances in the lesions: in bronchial tissue, in the intestinal wall. In the lungs, under the influence of enterotoxin, the decomposition of surfactant occurs and the formation of atelectasis.
Symptoms of Klebsiella in Children
Klebsiella in children is of the following types:
- Klebiella pneumonia;
- Klebsiella intestinal infection;
- Klebsiella sepsis, etc.
This is a division according to the localization of the pathological process.
Klebsiella pneumonia is also known as Friedlander’s pneumonia. In terms of symptoms, they are similar to pneumonia of another bacterial nature – pneumococcal, for example. The disease has an acute onset, body temperature reaches about 39 ° C, but it can be higher. The child is shivering, a cough appears (persistent, with a bloody, mucous, viscous sputum).
Auscultation shows a weakening of breathing over the inflammatory lesions and moist rales. With the help of X-ray, small-focal, large-focal, capturing several segments, as well as lobar pneumonia, are detected. The course of the disease is generally severe. Klebsiella pneumonia in most cases is combined with other infections – for example, respiratory viral infections.
With Klebsiella pneumonia, the pathological process passes to the alveoli, exudation with a hemorrhagic component is observed. Pneumonia has a tendency to abscess formation; there are cases in which gangrene of the lung develops.
Klebsiella intestinal infection is similar in symptomatology and course to gastroenterocolitis, enterocolitis, gastroenteritis and enteritis. The onset of the disease is characterized by an increase in temperature to a level of 37-39 ° C, vomiting or repeated regurgitation (in infants), loose stools. The stool is profuse, watery, yellow-green, undigested food particles are observed in the stool. In 10-12% of sick children, there is blood impurity in the stool.
Children may complain of abdominal pain that is paroxysmal in nature. In infants and preschoolers, parents observe bouts of anxiety, which are aggravated by palpation of the abdomen.
A high temperature persists for 2-12 days (on average, from 3 to 5 days). In the first 2-3 days of illness, the child vomits 2-8 times throughout the day and night. Further, vomiting either stops or happens quite rarely. Diarrhea lasts from 3 to 10 days. Stool frequency depends on each individual case. Sometimes stool happens about 20 times.
Severe forms of the disease occur with the development of toxicosis with exicosis for 3-6 days. In half of the sick children, the severity of dehydration of the II degree is observed. Vomiting is repeated in almost all cases, it happens 3 to 7 times a day and night.
These symptoms are recorded:
- a sharp decrease in appetite.
There are no changes in the parenchymal organs, no neurotoxicosis. In peripheral blood – moderate leukocytosis, in half of cases there is neutrophilia, and in a third of cases, an increased ESR is recorded (up to 15-20 mm / h). Intestinal infection is caused by many strains of Klebsiella.
Features of the disease in newborns and children 1 year of life. The disease, as a rule, manifests itself in premature infants with symptoms of prenatal dystrophy and encephalopathy. The infection can affect different organs and systems, but intestinal infection and pneumonia prevail.
Intestinal infection in infants has an acute onset, intestinal syndrome, hemodynamic and metabolic disorders develop rapidly. Children refuse to suckle, their parents notice their lethargy and regurgitation. Stool in babies in this case occurs from 8 to 20 times a day. Feces of a liquid consistency, watery, yellow-green hue, there is an admixture of cloudy mucus. In some sick babies, intestinal disorders are manifested by short-term increased frequency and thinning of the stool.
Most newborns with Klebsiellosis are in serious condition. In the first few days of illness, they lose a significant percentage of body weight (100-500 g) due to toxicosis with dehydration. The skin acquires a grayish-pale shade, there is a pronounced perioral and periorbital cyanosis, as well as weakness, hyporeflexia, lethargy.
Enterocolitis can be necrotizing, because of this, blood appears in the stool and complications arise – intestinal perforation. Respiratory failure occurs due to the addition of pneumonia. When an intestinal infection is combined with pneumonia, neurotoxicosis comes to the fore among the symptoms. Children show the following symptoms of klebsiellosis:
- hemodynamic disorders
- moderately pronounced symptoms of enteritis or enterocolitis.
The following complications may occur:
- toxic hepatitis
- encephalitic reactions
- toxic-infectious myocarditis
- purulent meningitis
- hemorrhagic syndrome.
In peripheral blood in newborns and infants, leukocytosis and hyperleukocytosis (35 x 109 / l) with the appearance of myelocytes up to 3-7%, as well as moderate anemia, are observed.
In newborns, Klebsiella can multiply primarily on the scalp at the place of attachment of the electrodes for monitoring observation, in the areas of damage with obstetric forceps and in the area of the hematoma. An infiltrative-necrotic process develops up to the development of phlegmon and abscesses.
Klebsiella sepsis often affects bone and joint tissue. Symptomatically, this manifests itself as a swelling swelling in the area of tissue or joint inflammation, limited movement of the affected limb, and a sharp anxiety for the baby when swaddling. Body temperature is normal. Usually the pathological process is localized in the area of the femur, humerus and tibia.
Diagnosis of Klebsiella in Children
To make a diagnosis, it is necessary to detect the pathogen or detect an increase in the titer of antibodies to the autostrain. Bacteriological methods are used for the study of feces, vomit, blood, sputum secreted from inflammatory foci on the skin and visible mucous membranes, urine. The isolation of Klebsiella from the patient in the amount of 106 microbial bodies or more in 1 g of feces and a decrease in the number of bacteria as the child recovers are of diagnostic value. An auxiliary role is played by the increase in antibody titers to the kauto strain of Klebsiella in the course of the disease. Titers of antiklebsiella agglutinins range from 1:20 to 1:80 or from 1: 8 to 1:64.
Treatment of Klebsiella in Children
Treatment requires a correct diet and timely oral rehydration. For the treatment of moderate and severe forms of the disease, antibacterial drugs are needed. Doctors usually prescribe gentamicin (a broad-spectrum antibiotic of the aminoglycoside group), nitrofuran drugs, 5-NOK (a drug of the oxyquinoline group).
Treatment of Klebsiella pneumonia is carried out with drugs such as cephalosporins, carbenicillin, chloramphenicol. Circulating strains of Klebsiella cannot be killed with penicillin, oleandomycin, ampicillin, oxacillin. Doctors recommend taking probiotics in the treatment of Klebsiella in children: bifidumbacterin, polybacterin, etc.
Prevention of Klebsiella in Children
To prevent infection with Klebsiella, it is necessary to strictly observe the anti-epidemic regime in maternity hospitals, in somatic and surgical hospitals, in newborn departments. Active prophylaxis is carried out with the help of Klebsiella acellular vaccine, which has a protective effect against various serovars of K. pneumoniae.