The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition

Detalhes bibliográficos
Autor(a) principal: Fagundes-neto, Ulysses [UNIFESP]
Data de Publicação: 2000
Outros Autores: Scaletsky, Isabel Cristina Affonso [UNIFESP]
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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spelling 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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