Pathogenetic aspects of exicosis associated with acute intestinal infections in early age (review)

Abstract

Acute intestinal infections are one of the most urgent challenges in pediatrics due to a high morbidity, development of severe forms and mortality, especially in children under five years. In most cases, severity of the disease is due to development of exicosis induced by loss of electrolytes and fluids as a result of emetic and diarrheal syndromes. However, the mechanisms of dehydration differ depending on the type of infectious agent. Thus, dehydration caused by viruses is due to the mechanism of absorption disorders induced by dystrophic changes in enterocytes and reduced number of cells that could absorb fluid from the intestine. The increase in osmotic pressure under disturbed fermentation of unsplit disaccharides results in translocation of water into the intestinal lumen, which explains the development of osmotic diarrhea and ensuing severe dehydration in the absence of timely correction of this pathological condition.
After invasion of bacterial intestinal pathogens, various enterotoxins impact membrane complexes. Specifically, production of inflammatory mediators is stimulated, levels of intracellular cyclic adenosine monophosphate or cyclic guanosine monophosphate increase, or specific proteins of invading pathogens affect the permeability of intestinal mucosa and, eventually, change the activity of normal ion exchange process.
The article also addresses alternative mechanisms of diarrhea involving enteroendocrine-neural reflexes and focuses on types of dehydration with a detailed description of water-electrolyte disorders and modern approaches to rehydration therapy. Knowledge and understanding of the pathogenetic and diagnostic features specific for a dehydration type are necessary for practitioners to choose the tactics for pathogenetic therapy of children’s acute intestinal infections. The aim of this review was to summarize modern aspects of the pathogenesis of exicosis syndrome in acute intestinal infections in young children.