Bacterial and viral infections

Improved sanitation has led to a decreased prevalence of infectious enterocolitis in the developed world. However, infectious enterocolitis accounts for up to 50% of all deaths before the age of five worldwide, and over 12 000 deaths each day in the children of developing countries. The small bowel may become infected by any of the following types of agents.

Enterotoxigenic bacteria can produce enterotoxins that stimulate the active secretion of electrolytes into the lumen of the small intestine. This results in watery diarrhoea, which is associated with fever. Examples of enterotoxigenic bacteria are Bacillus cereus, Clostridium perfingens and Staphylococcus aureus.

Penetrating bacteria may invade the mucosal lining of the distal small intestine. They often cause extraintestinal disease, sepsis and fever. Salmonella typhi is a common example of penetrating invasive bacteria which damage the intestinal mucosa of the distal small bowel. These often produce scant, bloody, mucoid stools, with fever and faecal polymorphnuclear leukocytes. Examples of invasive bacteria that affect the lining of the small intestine are the Salmonella species, Shigella species, Escherichia coli, Clostridium difficile and Vibrio cholerae.

Viruses, such as rotavirus and adenovirus, may invade the small bowel mucosa, resulting in diarrhoea and malabsorption.

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