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E COLI ENTERITIS IN VARNA DISTRICT FOR THE PERIOD 2013-2019
Monov D, M. Kolarova - Dimitrova
1. Medical College - Medical University of Varna Educational Sector "Public Health Inspector"
2. Medical University - Varna, Department of Hygiene and Epidemiology "Educational Sector"
Epidemiology "
SUMMARY
E coli enteritis is an acute intestinal infectious disease caused by pathogenic species of Eshcerihia coli and occurring with diarrhea, marked intoxication and disturbances in the water-electrolyte balance of the body.
Aim and tasks: To study the incidence of E coli enteriditis in Varna district and the country for 2013-2019 and to analyze the main socio-demographic indicators indicators: sex, seasonality, age, etiological structure, place of work, settlement, etc..
Materials: analyzes, reports, bulletins, microbiological tests of RHI Varna and NCIPD Bulgaria, publications, visual materials.
Methods: epidemiological analysis, statistical, documentary, graphical presentation of the results.
Results: We consider the registered infections in Varna district for a period of 7 years and analyze the main epidemiological indicators for patients (age, sex, place of work, place of work, hospitalization) on the one hand and the contact persons found in epidemic outbreaks and preventive prophylaxis of the population. their etiological characteristics.
Conclusions: 1. The incidence of E coli enteriditis in Varna district for 2013-2019. is 2 to 4 times above the national average. 2. The diseases occur throughout the year with a peak in August, mainly in cities (95.81%) among women (56.09%). 3. Leading is the group of sick children cared for at home (53.95%), followed by attending kindergartens (20.86%) and schools (9.11%). 4. Leading in the etiological characteristic are the cases determined up to the second and third group, respectively E. coli 0 78, E. coli 055, E. coli 0125, E. coli 086 and others.
Key words: analysis, cholenteritis, serotypes, prevalence, children's groups
Introduction: Escherichia coli are normal inhabitants of the intestinal tract of humans and some animals. However, there are serotypes that are pathogenic and cause disease. They can release a number of toxic substances - endotoxin, enterotoxins and exotoxin (Shiga like toxin). Escherichia coli belong to the family Enterobacteriaceae, genus Escherichia. They are Gram-negative bacteria from 5 groups, which are resistant to the external environment, but are sensitive to disinfectants. Their antigenic structure includes: Somatic O-antigen - part of the cell wall and identical to the bacterial endotoxin; H-antigen of protein nature; F-antigen associated with bacterial adhesive files; K-antigen - capsular antigen. Escherichia coli pathogens produce endotoxin, which is released upon lysis of bacterial cells and enterotoxins, and E. Coli 0157: H7 produces the so-called Shiga-like toxin similar to that produced by Sh.dysenteriae. [2,8] E coli enteritis is an acute intestinal infectious disease caused by pathogenic species of Eshcerihia coli and occurring with diarrhea, marked intoxication and disturbances in the water-electrolyte balance of the body. The disease mainly affects infants and children up to 3 years, especially premature and hypotrophic children. The front door is the mouth. The causative agents overcome gastric acidity and reach the small intestine. Here they stick to the cells of the intestinal mucosa, damage them and cause inflammation of the lining of the small intestine - enteritis. Conducting laboratory, microbiological and, if necessary, serological tests are an integral component in making an accurate diagnosis. The source of infection are sick and healthy carriers that excrete the causative agent in the feces. The main mechanism of transmission is fecal-oral, and the roads are contact-domestic and alimentary
- through contaminated hands, objects, pacifiers or contaminated food, water. [3,10,11,12,13]
Aim and tasks: To study the incidence of E coli enteriditis in Varna district and the country for 20132019 and to analyze the main socio-demographic indicators indicators: sex, seasonality, age, etiological structure, place of work, settlement, etc.. Materials: analyzes, reports, bulletins, microbiological tests of RHI Varna and NCIPD Bulgaria, publications, visual materials. Methods: epidemiological analysis, statistical, documentary, graphical presentation of the results.
Results: Varna District occupies an area of 3819.5 sq. Km., Which represents 3.44% of the territory of the Republic of Bulgaria. The population is 474,344 people or 6.5% of the country's population. There are 11 towns and 148 villages in Varna district. It covers 12 municipalities - Avren, Aksakovo, Beloslav, Byala, Varna, Vetrino, Valchi Dol, Devnya, Dolni Chiflik, Dalgopol, Provadia, Suvorovo. [7]
The organization of the medical care of the population for infectious diseases is in implementation of Ordinance № 21 of July 18, 2005 on the procedure for registration, notification and reporting of infectious diseases, in force since 01.01.2006 (Promulgated in the State Gazette No. 62 of July 29). 2005, amended, SG No. 52 of 8 July 2011, amended and supplemented, SG No. 56 of 8 July 2014, amended and supplemented, SG No. 5 of 15 January 2019)
We examine the registered infections in Varna district for a period of 7 years and analyze the main socio-demographic indicators for patients (age, sex, place of work, place of work, hospitalization) on the one hand and the contact persons found in epidemic outbreaks and preventive etiology of the population. characteristic.
The incidence of E coli enteritis in Varna district and the Republic of Bulgaria for 2013-2019 Shows that for the entire study period the incidence in Varna region is above the national average, exceeding it by 2 to 4 times and more: in 2017 twice (3.38% ooo against 7.4% ooo ), 3 times in 2014, 2016, 2018 (5.08% ooo against 15.36% ooofor 2014), four times in 2015 (5.3% ooo to
19.32% ooo), and in 2019 eight times (5.5% ooo against 46.47 % ooo) (Fig. .№1) Relative share of E coli enteritis in the structure of infectious diseases in Varna and Bulgaria districts for 2013-2019 confirms this, but the relative share is not large. 2.35% for 2013 to 4.42% for 2018 (Figure 2),
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Fig № 1 Incidence of E coli enteritis in Varna and Bulgaria for 2013-2019
Fig №2 Relative share of E coli enteritis in the structure of infectious diseases in Varna and Bulgaria
for 2013-2019
Diseases are registered throughout the year, with a markedly high number in May-August and a peak in August (Fig. №3).
Fig.№3 Seasonal dynamics ofpatients with E coli enteritis in Varna district for 2013-2019
The distribution by age groups (Fig. 4) outlines the highest morbidity in children from zero to 1 year, respectively from 287.5% ooo (2013, 2014) to 364.5% ooo (2015), 278 , 79% ooo (2016) 159.78% ooo (2017)
and 132.5% ooo (2018) In age group 1 to 4 years. the morbidity is in a wide range 42.86% ooo (2013), 93.12% ooo (2014), 187.7% ooo (2015), 187.31% ooo
Fig № 4 Morbidity by age groups in Varna district for 2013-2019
(2016), 79.5% ooo (2017) up to 228.26% ooo (2018) (Fig. №4)
The diseases are registered mainly in the cities (95.35%) and only (4.64%) in the villages. Women suffer more (56.09%) than men (43.9%).
Escherichia coli is caused by diarogenic serotypes of Escherichia coli of 5 types of serotypes:
• Enteropathogenic - cause diarrheal syndrome in infancy
• Enterotoxigenic - causing the so-called. tourist diarrhea;
• Enteroinvasive - causing diseases clinically indistinguishable from Shigellosis;
• Enterohemorrhagic - cause hemocolitis and hemolytic-uremic syndrome;
• Enteroaggregative - cause recurrent diarrhea in infants
Depending on the O-antigen, the known causes of enteropathogenic coli enteritis are E. coli O26, O56, O86, O111 and O12.
The analysis of the etiological interpretation in Varna region shows a great variety with a descending course from 19 (2014) to 5 (2018) circulating serotypes. (Fig. № 5)
Fig №5 Types of etiological agents by years in Varna district for 2013-2018
In Fig. №6 we show the most often isolated E.coli 078, E.Coli 055, E.Coli 0125, E.Coli 086
serotypes ranked by rank for 2013-2018. Leading are and others (Fig№6) the cases assigned to the second and third groups, followed by
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Fig. 6 of Circulating etiological causes (ranking) of E coli enteritis in Varna district for 2013-2018
Hospitalized patients occupy a small relative share of 6.84% (2018), 7.4% (2015), 11.42% (2017) to 16.22% (2016), most are treated on an outpatient basis, with a good outcome . There are no registered outbreaks and IBD from E coli enteritis. Of the 94
The analysis of E coli enteritis according to attendance at a kindergarten shows that the contingent is mainly of children who do not attend organized children's groups, raised at home 53.95%, in kindergarten are 20.86%, nurseries 9.11%. 5.03% of patients with public catering were found (Fig. № 8). Patients (%) of E coli enteritis, visiting organized groups in the district of Varna for 2013 -2019.
Of great importance for the detection of carriers of E. coli are the prophylactic examinations of the contacts in the foci of infection and the ones examined under Ordinance № 15 of 27 June 2006 on the health requirements for the persons working in the kindergartens, the specialized institutions for children
patients registered in 2015, only 7 people were hospitalized - (7.4%), compared to 73 patients in 2014. and 2018 9 and 5 people were hospitalized, and in 2017 35 people were hospitalized in 35 patients - 11.42%. (Fig.7)
and adults sites, enterprises that produce or trade in food, barbershops, hairdressers and beauty salons, Issued by the Minister of Health (Promulgated SG No. 57 of 14 July 2006, amended SG No. 14 of 15 February 2011, amended and supplemented, SG No. 82 of 26 October 2012, amended, SG No. 14 of 12 February 2013, amended and supplemented, SG No. 106 of 10 December 2013, amended and supplemented, SG No. No. 87 of 31 October 2) 2017.
Following the studied contacts and the patients among them, we find that of the more than 2845 contacts found, 47.49% were examined. 2.05% of them have positive results. The patients are 17 (1.24%) of the studied and 60.71% of the positive ones. (Table 1)
20 16,07 15 12,33 ф* 0 2013 2014 7,4 7,4 2015 16,22 11,42 2016 2017 6,84 % "ИТ- 1 1 1 2018 219
Fig № 7 Hospitalized patients (relative share) of E coli enteritis in Varna district for 2013-2019
Table №1
Open contacts in the epidemic outbreaks of E.cpH enteritis in Varna district by years for 2013-2019
Contact Number Tested Number Positive Number % Ill Number
2013 310 223 5 2,24 5
2014 432 89 4 4,49 2
2015 383 161 1 0,62 0
2016 421 269 0 0 0
2017 171 54 1 1,85 1
2018 381 323 3 0,92 0
2019 747 245 14 5,71 9
Total 2845 1364 28 7,69 17
During the follow-up period, different E. coli 2014 20 serotypes, followed by only 6 serotypes in serotypes were detected in 2013. - 18 serotypes and in 2015. and 5 serotypes in 2017 (Fig№9)
Fig № 9 E. coli serotypes isolated during prophylactic studies in Varna district for 2013-2018
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In Fig. № 10 we present the most commonly found E.coli serotypes (Fig. №10).
During the monitoring period, only one explosion caused by E. coli in 2019 was isolated. in a kindergarten. Twenty-five individuals with positive microbiological testing for intestinal pathogenic flora were reported, with only two children having enteric and enterocolitis symptoms. The other 20 people, 3 of whom from the kitchen staff are contagious. Isolated different serological groups of E. coli. The epidemic outbreak of food poisoning has an unknown source of infection. Transmission factor - ready meals. There are no hospitalized persons. Discussion: In the past, the importance of E coli enteritis in the country was determined by the infection of a large number of children (morbidity 16.93% ooo in 1970), severe course of the disease, accompanied by high mortality
(6.26% in 1978). Since the early 1980s, there has been a decline in morbidity. In Dobrich region for the period 1996-1998 occupy from 2.25% in 1996 to 6.53% in 1998 in the structure of intestinal infectious diseases. In 2007-2011 in the country were registered between 514 and 829 patients per year (morbidity 6.85% ooo -10.9% ooo), Plovdiv (2011-2007 E coli enteritis - 11.99% ooo), and deaths are reduced to 1-2 per year (mortality 0.17-0.24%). In 2016 The number of patients with E coli (Escherichia coli) in the country is 360 and the incidence drops to 5.03% with mortality and mortality zero. During the different years there is an alternation of the enteropathogenic (O44: K59 O55: K59, O125: K70) and enterotoxigenic (O6 and O78) serotypes of car bacteria isolated from sick persons as leading
etiological agents. They are also characterized by diversity in terms of colicinogenicity and hemolyticity. In 2007-2011. 11 outbreaks of E coli enteritis have been reported, with a total number of 129 patients and 35 proven healthy carriers. [1,5,6,9] In 2011, the source of intestinal infection in Europe resulted in the death of 22 people and more than 2 200 patients have found the culprit of the epidemic - E. coli (shiga toxin producing escherichia coli STEC) in Germany. More than 270 Germans are infected with a deadly bacterium found in cucumbers imported from Spain. (Angelika Warmuth (AFP)) The death toll from the mysterious bacterium has risen two weeks after its appearance in Germany, and fears of infected vegetables are paralyzing trade. [14,15]
In our study we found that there were no registered deaths during the entire observation period, there was only one outbreak of food poisoning, no nosocomial infections, which confirms the downward course of the disease in recent decades in the country. The summarized data on the epidemic situation give an idea of an epidemic process of intestinal infection (Escherichia coli) in a certain area, in which the incidence is above the national average of two to four times, but with a downward course. This is due to the timely measures taken for: removal of the products that caused the infections, removal of the sources, treatment of the epidemic outbreaks with examination of the contacts, without the potential for further spread in the human population. The circulation of serotypes in diagnostic (19 to 5 species) and prophylactic (20 to 10) studies shows a great variety in favor of prophylactic, which confirms their wide distribution in society. The crucial importance of prevention for children in Varna district is found in the analysis of patients at work and visits to organized teams, which found that in kindergartens there are 20.86%, in schools 9.11%, and the majority are sick in the home 53.95%.
Conclusions:
1. Incidence of E coli enteriditis in Varna and Bulgaria for 2013-2019 shows that the incidence in Varna is 2 to 4 times higher than the national average.
2. The diseases occur throughout the year with a peak in August, mainly in cities (95.81%) and among women (56.09%).
3. Sick children are cared for at home (53.95) followed by attending kindergartens 20.86%,%, and schools 9.11%.
4.. Leading in the etiological characteristic are the cases determined up to the second and third group, followed by E. coli 0 78, E. coli 055, E. coli 0125, E. coli 086 and others.
Literature:
1. Valkanova, N., K. Kircheva, T. Panayotova, S. Marazova, G. Kuyumdzhieva
Some data on the prevalence of E coli enteritis in the Dobrich region during the period 1996-1998.
2. Valkanova N., R. Konstantinov, Ts. Paunov, B. Belchev, E Kalchev. Etiologically deciphered paraproctitis with peritonitis and sepsis such as E. coli o 6
annual collection imab 6 (1), 2000, 135-136
3. Dimitrova T, P. Georgiv, V. Doycheva, R.Konstantnov, D.Shalamanov Epidemiology of infectious diseases, arso sofia, 2012 E coli enteritis 104-107,203p.
4. Ordinance № 21 of 18 July 2005 on the procedure for registration, notification and reporting of communicable diseases, in force as of 01.01.2006 (promulgated in SG No. 62 of 29 July 2005, amended in SG No. 52 of July 8, 2011, amended and supplemented, SG No. 56 of July 8, 2014, amended and supplemented, SG No. 5 of January 15, 2019)
5. Parmakova K., G. Aseva, K. Ivanova, P. Petrov, Supervision of bacterial intestinal infections in Bulgaria in 2007-2011. Medinfo, 2012, br11https: //www.medinfo.bg/spisanie/2012/11/statii/nadzor-na-bakterialnite-chrevni-infekcii-v-bylgarija-prez-2007-2011-g-1400
6. Troyancheva M., Vatev N., Stoycheva M, Semerdzhieva M, Velcheva R Dynamics of. the incidence of intestinal infections (salmonellosis, shigellosis, e coli enteritis, enterocolitis) in Plovdiv, 2007-2011. preventive medicine issue 3/2013, 33-36
7.bg.guide-bulgaria.com >northeast> varna
8.https://medpedia.framar.bg/%d0%b7%d0%b0 %d0%b1%d0%be%d0%bb%d1%8f%d0%b2%d0%b0 %d0%bd%d0 % b8% d1% 8f /% d0% bc% d0% ba% d0% b1-a040-4 /% d0% b5% d0% bd% d1% 82% d0% b5% d1% 80% d0% be% d0 % bf% d0% b0% d1% 82% d0% be% d0% b3% d0% b5% d0% bd% d0% bd% d0% b0-% d0% b8% d0% bd% d1% 84% d0% b5% d0% ba% d1% 86% d0% b8% d1% 8f-% d0% bf% d1% 80% d0% b5% d0% b4% d0% b8% d0% b7% d0% b2% d0% b8 % d0% ba% d0% b0% d0% bd% d0% b0-% d0% be% d1% 82-escherichia-coli
9.https://www.ncpha.government.bg/images /_
ncpha/__mainactivities/_analyzes/healthstatusofcitize ns_anualreport_2016 .pdf
10. https://www.puls.bg/aktualno-c-6/esherikhiia-koli-chestiiat-prichinitel-na-diarii-n-22328
11. https://apteka-optima.com/blog/stomashno-chrevni-infektsii/ stomach-intestinal infections
12. https ://www.puls.bg/aktualno -c-6/4-zarazi-ot-zamrsena-piteina-voda-n-23923 four infections from contaminated drinking water
13.
https://www.dnes.bg/health/2016/02/04/diariia-nai-chesto-pri-nalichie-na-esherihiia-koli.291921
14.https:
//bg.legaltechnique.org/articles/mir/kishechnaya-infekciya-v-evrope-bull-novosti-v-fotografiyah.html cucumbers from spain explosion in germany
