The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition
Autor(a) principal: | |
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Data de Publicação: | 2000 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://dx.doi.org/10.1590/S1516-31802000000100006 http://repositorio.unifesp.br/handle/11600/899 |
Resumo: | Diarrheal disease is still the most prevalent and important public health problem in developing countries, despite advances in knowledge, understanding, and management that have occurred over recent years. Diarrhea is the leading cause of death in children under 5 years of age. The impact of diarrheal diseases is more severe in the earliest periods of life, when taking into account both the numbers of episodes per year and hospital admission rates. This narrative review focuses on one of the major driving forces that attack the host, namely the enteropathogenic Escherichia coli (EPEC) and the consequences that generate malnutrition in an early phase of life. EPEC serotypes form dense microcolonies on the surface of tissue-culture cells in a pattern known as localized adherence (LA). When EPEC strains adhere to epithelial cells in vitro or in vivo they cause characteristic changes known as Attaching and Effacement (A/E) lesions. Surface abnormalities of the small intestinal mucosa shown by scanning electron microscopy in infants with persistent diarrhea, although non-specific, are intense enough to justify the severity of the clinical aspects displayed in a very young phase in life. Decrease in number and height of microvilli, blunting of borders of enterocytes, loss of the glycocalyx, shortening of villi and presence of a mucus pseudomembrane coating the mucosal surface were the abnormalities observed in the majority of patients. These ultrastructural derangements may be due to an association of the enteric enteropathogenic agent that triggers the diarrheic process and the onset of food intolerance responsible for perpetuation of diarrhea. An aggressive therapeutic approach based on appropriate nutritional support, especially the utilization of human milk and/or lactose-free protein hydrolyzate-based formulas and the adequate correction of the fecal losses, is required to allow complete recovery from the damage caused by this devastating enteropathogenic agent. |
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The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutritionEscherichia coliInfantile diarrheaLethality riskPersistent DiarrheaAcute DiarrheaEscherichia ColiDiarréia infantilRisco de mortalidadeDiarréia persistenteDiarréia agudaDiarrheal disease is still the most prevalent and important public health problem in developing countries, despite advances in knowledge, understanding, and management that have occurred over recent years. Diarrhea is the leading cause of death in children under 5 years of age. The impact of diarrheal diseases is more severe in the earliest periods of life, when taking into account both the numbers of episodes per year and hospital admission rates. This narrative review focuses on one of the major driving forces that attack the host, namely the enteropathogenic Escherichia coli (EPEC) and the consequences that generate malnutrition in an early phase of life. EPEC serotypes form dense microcolonies on the surface of tissue-culture cells in a pattern known as localized adherence (LA). When EPEC strains adhere to epithelial cells in vitro or in vivo they cause characteristic changes known as Attaching and Effacement (A/E) lesions. Surface abnormalities of the small intestinal mucosa shown by scanning electron microscopy in infants with persistent diarrhea, although non-specific, are intense enough to justify the severity of the clinical aspects displayed in a very young phase in life. Decrease in number and height of microvilli, blunting of borders of enterocytes, loss of the glycocalyx, shortening of villi and presence of a mucus pseudomembrane coating the mucosal surface were the abnormalities observed in the majority of patients. These ultrastructural derangements may be due to an association of the enteric enteropathogenic agent that triggers the diarrheic process and the onset of food intolerance responsible for perpetuation of diarrhea. An aggressive therapeutic approach based on appropriate nutritional support, especially the utilization of human milk and/or lactose-free protein hydrolyzate-based formulas and the adequate correction of the fecal losses, is required to allow complete recovery from the damage caused by this devastating enteropathogenic agent.A doença diarréica ainda é o problema mais prevalente é importante na saúde pública dos países em desenvolvimento, a despeito dos avanços nos conhecimentos da fisiopatologia e do manejo clínico que vem ocorrendo ao longo destes últimos anos. Diarréia é a principal causo de morte entre as crianças menores de 5 anos nas populações de baixa renda dos países em desenvolvimento. O impacto da doença diarréica faz-se notar de forma mais intensa nos períodos mais precoces da vida, em especial no primeiro ano, quando são levados em consideração o número de episódios de diarréia por ano e as taxas de admissão hospitalar. Esta revisão tem o escopo de enfatizar um dentre os inúmeros agentes enteropatogênicos que agridem o hospedeiro, particularmente os sorogrupos enteropatogênicos clássicos da Escherichia coli (EPEC) e suas respectivas conseqüências que levam ao agravo nutricional em fases precoces da vida. Os sorogrupos de EPEC formam densas microcolônias sobre a superfície de células epiteliais mantidas em cultura de tecido determinando um padrão de comportamento denominado aderência localizada (AL). Quando as cepas de EPEC aderem a células epiteliais in vivo ou in vitro provocam alterações características conhecidas como Attaching e Effacement (A/E). As alterações da superfície da mucosa do intestino delgado visualizadas pelo microscópio eletrônico de varredura em lactentes com diarréiapersistente, embora não específicas, são suficientemente intensas para justificar a gravidade dos aspectos clínicos observados. Diminuição no número e na altura das microvilosidades, borramento dos limites dos enterócitos, perda do glicocálice, diminuição do número de vilosidades e a presença de uma pseudomembrana recobrindo a superfície mucosa, foram as anormalidades descritas na maioria dos pacientes. Essas altarações ultraestruturais podem ser devidas à associação entre o agente Woccioso que deflagra o processo diarréico e a instalação de intolerâncias alimentares que perpetuam a diarréia. Uma abordagem terapêutica agressiva, baseada em suporte nutricional adequado, em especial utilizando-se leite humano e/ou fórmulas a base de hidrolisado protéico, além da correção das perdas hidro-eletrolíticasfecais, é necessária para proporcionar a recuperação clínica e nutricional nessa enfermidade.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciELOAssociação Paulista de Medicina - APMUniversidade Federal de São Paulo (UNIFESP)Fagundes-neto, Ulysses [UNIFESP]Scaletsky, Isabel Cristina Affonso [UNIFESP]2015-06-14T13:24:59Z2015-06-14T13:24:59Z2000-01-06info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion21-29application/pdfhttp://dx.doi.org/10.1590/S1516-31802000000100006São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 118, n. 1, p. 21-29, 2000.10.1590/S1516-31802000000100006S1516-31802000000100006.pdf1516-3180S1516-31802000000100006http://repositorio.unifesp.br/handle/11600/899engSão Paulo Medical Journalinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-05T09:04:24Zoai:repositorio.unifesp.br/:11600/899Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-05T09:04:24Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
title |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
spellingShingle |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition Fagundes-neto, Ulysses [UNIFESP] Escherichia coli Infantile diarrhea Lethality risk Persistent Diarrhea Acute Diarrhea Escherichia Coli Diarréia infantil Risco de mortalidade Diarréia persistente Diarréia aguda |
title_short |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
title_full |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
title_fullStr |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
title_full_unstemmed |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
title_sort |
The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition |
author |
Fagundes-neto, Ulysses [UNIFESP] |
author_facet |
Fagundes-neto, Ulysses [UNIFESP] Scaletsky, Isabel Cristina Affonso [UNIFESP] |
author_role |
author |
author2 |
Scaletsky, Isabel Cristina Affonso [UNIFESP] |
author2_role |
author |
dc.contributor.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Fagundes-neto, Ulysses [UNIFESP] Scaletsky, Isabel Cristina Affonso [UNIFESP] |
dc.subject.por.fl_str_mv |
Escherichia coli Infantile diarrhea Lethality risk Persistent Diarrhea Acute Diarrhea Escherichia Coli Diarréia infantil Risco de mortalidade Diarréia persistente Diarréia aguda |
topic |
Escherichia coli Infantile diarrhea Lethality risk Persistent Diarrhea Acute Diarrhea Escherichia Coli Diarréia infantil Risco de mortalidade Diarréia persistente Diarréia aguda |
description |
Diarrheal disease is still the most prevalent and important public health problem in developing countries, despite advances in knowledge, understanding, and management that have occurred over recent years. Diarrhea is the leading cause of death in children under 5 years of age. The impact of diarrheal diseases is more severe in the earliest periods of life, when taking into account both the numbers of episodes per year and hospital admission rates. This narrative review focuses on one of the major driving forces that attack the host, namely the enteropathogenic Escherichia coli (EPEC) and the consequences that generate malnutrition in an early phase of life. EPEC serotypes form dense microcolonies on the surface of tissue-culture cells in a pattern known as localized adherence (LA). When EPEC strains adhere to epithelial cells in vitro or in vivo they cause characteristic changes known as Attaching and Effacement (A/E) lesions. Surface abnormalities of the small intestinal mucosa shown by scanning electron microscopy in infants with persistent diarrhea, although non-specific, are intense enough to justify the severity of the clinical aspects displayed in a very young phase in life. Decrease in number and height of microvilli, blunting of borders of enterocytes, loss of the glycocalyx, shortening of villi and presence of a mucus pseudomembrane coating the mucosal surface were the abnormalities observed in the majority of patients. These ultrastructural derangements may be due to an association of the enteric enteropathogenic agent that triggers the diarrheic process and the onset of food intolerance responsible for perpetuation of diarrhea. An aggressive therapeutic approach based on appropriate nutritional support, especially the utilization of human milk and/or lactose-free protein hydrolyzate-based formulas and the adequate correction of the fecal losses, is required to allow complete recovery from the damage caused by this devastating enteropathogenic agent. |
publishDate |
2000 |
dc.date.none.fl_str_mv |
2000-01-06 2015-06-14T13:24:59Z 2015-06-14T13:24:59Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1590/S1516-31802000000100006 São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 118, n. 1, p. 21-29, 2000. 10.1590/S1516-31802000000100006 S1516-31802000000100006.pdf 1516-3180 S1516-31802000000100006 http://repositorio.unifesp.br/handle/11600/899 |
url |
http://dx.doi.org/10.1590/S1516-31802000000100006 http://repositorio.unifesp.br/handle/11600/899 |
identifier_str_mv |
São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 118, n. 1, p. 21-29, 2000. 10.1590/S1516-31802000000100006 S1516-31802000000100006.pdf 1516-3180 S1516-31802000000100006 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
São Paulo Medical Journal |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
21-29 application/pdf |
dc.publisher.none.fl_str_mv |
Associação Paulista de Medicina - APM |
publisher.none.fl_str_mv |
Associação Paulista de Medicina - APM |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
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1814268353938718720 |