Dysentery - Causes, Symptoms, Diagnosis And Treatment

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Dysentery - Causes, Symptoms, Diagnosis And Treatment
Dysentery - Causes, Symptoms, Diagnosis And Treatment

Video: Dysentery - Causes, Symptoms, Diagnosis And Treatment

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Video: What is Dysentery? Causes, Signs and symptoms, Diagnosis and treatment. 2023, February
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Dysentery is an intestinal infection caused by bacteria of the genus Shigella, characterized by the predominant localization of the pathological process in the mucous membrane of the large intestine. Dysentery is transmitted by the fecal-oral route (food or water). Clinically, a patient with dysentery has diarrhea, abdominal pain, tenesmus, intoxication syndrome (weakness, weakness, nausea). The diagnosis of dysentery is established when the pathogen is isolated from the patient's feces, with Grigoriev-Shiga dysentery - from the blood. Treatment is carried out mainly on an outpatient basis and consists of rehydration, antibacterial and detoxification therapy.

The content of the article:

  • 1 Etiology of dysentery
  • 2 Epidemiology
  • 3 Symptoms of dysentery
  • 4 How is infection with dysentery
  • 5 Forecast of dysentery
  • 6 Classification of dysentery
  • 7 Diagnosis of dysentery
  • 8 Differential diagnosis
  • 9 Treatment of dysentery

    • 9.1 Treatment of acute dysentery
    • 9.2 Treatment of chronic dysentery
  • 10 Prevention of dysentery
  • 11 Activities in the outbreak

Etiology of dysentery

Dysentery
Dysentery

The causative agents of dysentery belong to the genus Shigella. Family - Enterobacteriaceae.

There are 4 types of shigella

1) Sh. dysenteria, these include the bacteria of Grigoriev-Shigi, Stutzer-Schmitz, and Large-Sachs;

2) Sh. flexneri with the Newcastle subspecies;

3) Sh. boydii;

4) Sh. sonnei.

Currently, there are over 50 serological varieties of dysentery bacteria.

The first three types are subdivided into serological variants. Shigella Zonne strains have the same antigenic structure, but are subdivided into different enzymatic types.

Morphology. Morphologically, all Shigella are similar to each other, They have the form of rods measuring (0.3–0.6) x (1.0–3.0) microns with rounded ends. Shigella is immobile, Spores and capsules do not form, Gram-negative, Grow well on simple nutrient media.

Antigenic structure. Shigella contain a thermostable somatic O-antigen.

Toxin formation. When the antigen is destroyed, endotoxin is released, which is largely associated with the development of intoxication syndrome. Shigella are capable of producing exotoxins.

Among them are enterotoxins (heat-labile and thermostable), which increase the secretion of fluid and salts into the intestinal lumen, and cytotoxin, which damages the membranes of epithelial cells. Grigoriev's bacteria - Shigi, besides. produce a potent neurotoxin.

Virulence. The virulence of Shigella is determined by three main factors - the ability to adhere to the membranes of epithelial cells, invasion into them and the production of toxins.

Pathogenicity. Different types of Shigella are characterized by unequal pathogenicity. It is exceptionally high among the Shigella Grigoriev - Shigi. The pathogenicity of other types of dysentery bacteria is much lower.

Stability in the external environment. Depending on temperature, humidity, pH of the environment, type and number of microorganisms, the duration of survival of dysentery bacteria ranges from several days to months. Food is a favorable environment for bacteria. Shigella Sonne in milk and dairy products are able not only to exist for a long time, but also to reproduce.

The causative agents of dysentery tolerate drying and low temperatures well, but quickly die under the influence of direct sunlight and heating (at 60 ° С - after 30 minutes, 100 ° С - almost instantly). Disinfectants (hypochlorites, chloramines, lysol, etc.) in normal concentrations kill dysentery bacteria within a few minutes.

Epidemiology

Dysentery
Dysentery

Dysentery. The source of infection are patients with acute or chronic dysentery, convalescents and persons with a subclinical form of the infectious process (bacterial excretors). The greatest epidemiological danger is posed by patients with acute dysentery, who release a huge number of pathogens into the environment during the height of the disease.

Dysentery, like other acute intestinal diseases, is characterized by a pronounced autumn-summer seasonality. The number of diseases registered in July - September is, as a rule, half of the total amount of diseases per year.

Transfer mechanism. Dysentery is an infection with the fecal-oral mechanism of transmission of pathogens, the implementation of which is carried out by food, water and contact-household routes. Shigella transmission factors are food, water, hands and household items, flies, soil.

The main route of transmission for Grigoriev-Shigi dysentery is contact-household, Flexner - water, Sonne - food (especially milk).

The main reasons for the unequal distribution of pathways for various etiological forms of dysentery are significant differences in the pathogenicity and infectious dose of pathogens, as well as their resistance in the external environment.

Susceptibility to dysentery varies among people of different age groups. The leading age group among patients with dysentery are children of preschool age (more than 1/3 of all cases of this intestinal infection are recorded in children under 6 years of age).

Post-infectious immunity is short-lived and is species- and type-specific within a year.

Dysentery symptoms

Dysentery. The first symptoms of dysentery begin to appear 2-3 days after infection, with the alimentary route this time can be reduced to hours, with the contact-household route it can be extended up to 7 days. In most cases, the disease begins acutely, sometimes there may be a prodrome in the form of malaise, chills or headache. According to the severity, there are mild, moderate, severe and very severe forms.

The disease, as a rule, begins with the appearance of pain in the abdomen, followed by an upset stool. Dysentery can begin with general manifestations - weakness, lethargy, fever, headache, etc. The manifestation of the disease is most pronounced on the 2-3rd day of the disease. This form of dysentery is characterized by the predominance of local phenomena.

The most complete signs of dysentery are presented with a moderate form of the disease. Characterized by an acute onset, an increase in temperature with chills (up to 38-39 ° C), which lasts 2-3 days. Weakness, headache, loss of appetite are worried. Intestinal disorders occur in the first 2-3 hours from the onset of the disease and are manifested by discomfort in the lower abdomen, rumbling, periodic, cramping pains in the lower abdomen, stool frequency ranges from 10 to 20 times a day. The stool initially has a fecal character, then an admixture of mucus, blood and pus appears, the volume of feces decreases, they can take the form of spitting - mucus and blood.

Acute urge to defecate is noted. The skin becomes pale, the tongue becomes covered with a thick brown coating. On the part of the cardiovascular system, there is a rapid heartbeat, a decrease in blood pressure. The most common signs are spasm and tenderness when probing the left iliac region.

Dysentery. The duration of intoxication with a moderate form of dysentery is 4-5 days. The stool is normalized by the 8-10th day of the disease, but the disease can take up to 3-4 weeks.

How dysentery infection occurs

The mechanism of infection in dysentery is fecal-oral, i.e. bacteria from the intestines of a sick person enters the gastrointestinal tract of a healthy person.

Dysentery. There are several ways of transmission of the pathogen. This is a contact-household way - through unwashed hands if the rules of personal hygiene are not followed; food - when bacteria get into food; and also water - when drinking infected water.

In addition, infection is possible when swimming in polluted water bodies.

Dysentery prognosis

In dysentery, the prognosis depends on the patient's age, the severity of the disease, concomitant pathology, complications and timely treatment. In general, it can be assessed as favorable for Sonne's dysentery, the prognosis for Flexner's dysentery and especially for Grigoriev-Shiga dysentery should be considered more serious.

Classification of dysentery

Dysentery. The clinical classification of dysentery is currently used. Its acute form is distinguished (it differs in the predominant symptomatology for typical colitis and atypical gatroenteritis), chronic dysentery (recurrent and continuous) and bacterial excretion (convalescent or subclinical).

Diagnosis of dysentery

Dysentery
Dysentery

In typical cases, the diagnosis of dysentery does not cause difficulties, with the exception of the atypical course of the disease. The diagnosis is established on the basis of data from the epidemiological history, clinical course of dysentery, instrumental and laboratory studies.

Bacteriological research remains the leading one. However, the seeding rate of pathogens varies from 22 to 80% and largely on the method, time and frequency of sampling, choice of medium, etc. Along with bacteriological studies, a serological method is used to diagnose dysentery - an indirect hemagglutination reaction with erythrocyte diagnosticum (RNGA). Positive answers from RNGA can be obtained from the 5th day of illness. At the 2nd week, antibody titers increase, and from the 4th to 5th week, there is a tendency to their decrease. The minimum diagnostic antibody titer in RNGA is 1: 200.

Dysentery. The method of fluorescent antibodies (MFA), RNGA with immunoglobulin (antibody) diagnostics, enzyme-linked immunosorbent assay (ELISA), etc. are used as express diagnostics of epidemic outbreaks of dysentery.

In recent years, serological methods for the detection of Shigella antigens have been developed, complementing, but not replacing the bacteriological diagnosis of Shigella.

A simple, universally available auxiliary method for diagnosing dysentery is a scatological study. When coprocytoscopy of the feces of a patient with dysentery, mucus, an accumulation of leukocytes with a predominance of neutrophils (more than 30-50 in the field of view), erythrocytes and various numbers of altered epithelial cells are found with great constancy.

Sigmoidoscopy remains a valuable method that expands the diagnostic capabilities of the doctor and allows you to monitor the progress of recovery.

Allergic methods (skin-allergic test with Zuverkalov's dysenterin) in the diagnosis of dysentery play a purely auxiliary role.

Differential diagnosis

Dysentery
Dysentery

Dysentery must be differentiated from salmonellosis, escherichiosis, food toxicoinfections, cholera, amebiasis, balantidiasis, giardiasis, intestinal trichomoniasis, some helminths, candidiasis. Symptoms similar to dysentery can be observed in case of poisoning with mushrooms and salts of heavy metals, uremic colitis, intestinal tuberculosis, chronic enterocolitis, ulcerative colitis.

Often there is a need to differentiate dysentery from acute surgical diseases (acute appendicitis, thrombosis of mesenteric vessels, intestinal obstruction) and acute gynecological pathology (ectopic pregnancy, adnexitis, pelvioperitonitis). A well-collected medical history, epidemiological history and a thorough clinical and laboratory examination of the patient make it possible to correctly and timely recognize dysentery.

Dysentery. An important diagnostic task is to exclude other intestinal diseases of a bacterial or infectious nature. Often parasitizing many types of microorganisms in the intestines causes identical symptoms. It is possible to identify the main symptoms that are similar in the course of the disease, but with characteristic differences from dysentery:

  1. Salmonellosis. With salmonellosis, feces have a shade of swamp mud, light or dark greenish in color.
  2. Food poisoning. In this condition, there is no severe cramping pain in the ileal part of the peritoneum due to the absence of damage to the large intestine. There is also no urge to defecate.
  3. Cholera. The disease is not accompanied by pronounced signs of colitis, begins with severe diarrhea, vomiting, and the color of feces resembles rice water. There is no false urge to defecate.
  4. Amoebiasis. The disease is not accompanied by an increase in body temperature, febrile syndrome. Feces include blood and mucous components that resemble crimson jelly. The main pathogen is amoeba.
  5. Intestinal colitis. If colitis is of a non-infectious nature, then it often occurs due to toxic lesions of the body with uremic syndrome, with pathological development of the small intestine, cholecystitis, gastritis of various nature. Usually the disease has no seasonality and special antecedents against the background of the patient's general health.
  6. Typhoid fever. The disease has no signs of specific colitis, but a pink rash appears, severe hyperthermia, and the large intestine cavity is affected.
  7. Oncogenic formations. Colon cancer is accompanied by severe bloody diarrhea. The stool is regular. There are symptoms of general intoxication, but the rapid nature of the disease, as in dysentery, is absent.
  8. Hemorrhoids. With inflammation of hemorrhoids, as well as with advanced hemorrhoids after an act of defecation, the appearance of bloody blotches in the feces can be noted. The disease proceeds without pronounced inflammatory foci in the rectum.

Timely determination of dysentery and the type of its causative agent allows you to draw up the necessary treatment plan, speed up the patient's recovery, and eliminate the risks of complications of the disease.

Dysentery treatment

Treatment of acute dysentery

Dysentery. The basic principles of therapy for patients with dysentery remain the earliest possible start of treatment, an individual approach to therapeutic measures for each patient, and the complexity of therapy.

Dysentery patients can be treated both at home and in a hospital. The question of hospitalization is decided on the basis of clinic-epidemiological data. Patients with moderate and severe course of dysentery, persons with severe concomitant diseases, as well as patients posing an increased epidemiological hazard (food workers and equated contingents) are subject to hospitalization.

Nutrition for patients with dysentery is prescribed depending on the period of the disease and the severity of intestinal lesions. First, diet No. 4 (or No. 46) is applied, which provides chemical and mechanical sparing of the gastrointestinal tract. After stool normalization, diet number 4c is shown, followed by transfer to diet number 2.

Dysentery
Dysentery

Of the etiotropic drugs in the treatment of patients with mild dysentery, the best effect is given by drugs of the nitrofuran series. Furazolidone (furazolin, furadonin, furagin) is prescribed at 0.1–0.15 g 4 times a day after meals for 5–7 days. Quinoline derivatives are another group of drugs for the treatment of mild dysentery. Chlorquinaldol is prescribed orally 0.2 g 4 times a day after meals, intrix - 2 capsules 3 times a day with meals. The duration of the course is 5-7 days. Nitrofuran preparations and quinoline derivatives not only have a depressing effect on Shigella, but also contribute to the preservation of normal intestinal flora, which is extremely important for persons who have suffered from dysentery.

For the treatment of patients with moderate dysentery, drugs of the sulfamethoxazole group (bactrim, septrin, biseptol-480, groseptol) are used 2 tablets 2 times a day (morning and evening after meals) or quinolone derivatives: ciprofloxacin (tsiprobay, tsifran) 0.25– 0.5 g 2 times a day, ofloxacin (tarivid) 0.2–0.4 g 2 times a day, norfloxacin (nolicin) 0.4 g 2 times a day.

Patients with severe concomitant pathology, nutritional disorders, the elderly, along with quinolones, are prescribed antibiotics, preferably from the group of aminoglycosides (gentamicin sulfate, sisomycin sulfate, tobramycin, amikacin sulfate), which are administered parenterally.

Levomycetin, which is prescribed 0.5 g 4–6 times a day, and tetracyclines at a dose of 0.3 g 4 times a day, retain their value.

Dysentery. With moderate and severe course of the disease, accompanied by repeated vomiting, chloramphenicol succinate is parenterally administered in a daily dose of 3-4 g or tetracycline antibiotics (morphocyclin, glycocycline). A good therapeutic effect is also obtained by semisynthetic penicillin of a broad spectrum of action - ampicillin in a daily dose of 4–6 g, distributed over 4–6 doses.

Dysentery
Dysentery

In severe cases of the disease, the best effect is achieved with parenteral administration of quinolones (for example, ofloxacin 200 mg 2 times intravenously) in combination with aminoglycosides (for example, gentamicin sulfate 80 mg 3 times a day intramuscularly), as well as a combination of these drugs with cephalosporins.

Pathogenetic therapy of patients with severe and sometimes moderate dysentery should include detoxification agents. Isotonic saline solutions are used (Ringer's solution, solutions "Trisol", "Acesol", "Lactasol"), which are administered intravenously in a volume of 1–2 liters. Along with crystalloids, in a severe course of the disease, colloidal solutions (hemodez, reopolyglucin, etc.) are prescribed in a daily dose of 400-800 ml, and sometimes corticosteroids (short course).

The enterosorption method is also used for detoxification purposes. From enterosorbents, polyphepan, lignosorb, enterosorb, enterocat M, etc. are prescribed.

Vitamin therapy is of great importance in the treatment of patients with dysentery, which helps to accelerate the processes of regeneration and detoxification.

In addition, the introduction of vitamins is necessary to cover their deficiency in dysentery, especially in conditions of antibiotic therapy and intestinal dysbiosis. Balanced vitamin complexes (dekamevit, glutamevit, etc.) should be used.

The use of synthetic preparations of pyrimidone bases of pentoxil and methyluracil (metacil) is due to their effect on the processes of tissue metabolism. Pentoxil is prescribed orally up to 0.2-0.4 g, methyluracil - 1 g 3-4 times a day.

Dysentery
Dysentery

To eliminate intestinal dysbiosis, colibacterin (dry, liquid, in tablets, in capsules), bifidobacterin, combined preparation bifikol or lactobacilli are used. They are prescribed 24–48 hours after stopping antibacterial therapy. The course of treatment is 2-4 weeks.

The restoration of the microbial biocenosis in the intestine is accelerated by the association of lyophilized colibacterin with the Proteus bacteriophage. The use of these drugs prevents relapses of the disease, the development of bacterial excretion, as well as the transition of acute dysentery to protracted or chronic.

Dysentery. Local treatment in the acute period of dysentery should be carried out very carefully. During the period of convalescence, agents are used that enhance the regeneration of the colon mucosa. These include vegetable oils, fish oil, vinylin (Shostakovsky's balm), 30-50 ml per enema. A method of irrigation of the rectum and sigmoid colon with polyglucin, which increases the resistance of epithelial cells, has been proposed. Irrigation is carried out for 5 days daily or every other day (at a dose of 50 ml of the drug per procedure).

In order to correct and compensate for the disturbed functions of the gastrointestinal tract, polyenzyme drugs are used (abomin, pancreatin, oraza, panzinorm forte, polysim, festal, mezim forte, etc.). With pronounced violations of the motor function of the intestine, especially in the acute period of dysentery, antispasmodics are indicated. The best of them are metacin, spasmolitin, as well as atropine and other belladonna drugs, which also give an analgesic effect.

Astringents, enveloping, antiseptic and adsorbing agents, including medicinal herbs and fruits (chamomile flowers, St. John's wort, bird cherry fruits, leaves and fruits of blueberries, rhizomes of Potentilla erect, rhizome of medicinal burnet, etc.) have not lost their importance.

Chronic dysentery treatment

Dysentery
Dysentery

Dysentery. Treatment of chronic dysentery is carried out on the basis of the general principles of therapy for patients with acute dysentery: ensuring maximum sparing of the gastrointestinal tract, relief of acute events, measures to normalize intestinal functions, immunoregulatory measures.

The course and outcome of the infectious process in this case is largely determined by the influence of factors of specific and nonspecific protection. Of the specific agents that increase the body's resistance and have a pronounced therapeutic effect, in the past, the alcoholic therapeutic vaccine of Chernokhvostova was widely used, and later - an enteral live vaccine (immunogen).

Pyrogenal, prodigiosan and other lipopolysaccharides of bacterial origin have a nonspecific stimulating effect - they promote regenerative processes, stimulate phagocytosis, and activate the pituitary-adrenal cortex system.

Prevention of dysentery

Dysentery
Dysentery

Dysentery. The successful fight against dysentery is ensured by a complex of treatment-and-prophylactic and sanitary-hygienic, as well as anti-epidemic measures.

Measures aimed at the source of infection include early detection, mandatory registration of all patients with acute intestinal infections and their treatment. Of particular importance is the timely recognition of erased, subclinical forms of dysentery. The search for the source of infection is carried out in foci of dysentery, with planned and unscheduled examination of decreed professional groups, as well as children's groups. In the focus of dysentery, the current disinfection is carried out, and after the patient is hospitalized, the final disinfection is carried out. Reconvalescents are discharged after complete clinical recovery with negative bacteriological test results. After discharge from the hospital, convalescents are subject to dispensary observation in the office of infectious diseases in the polyclinic.

With regard to the third link of the epidemic process, i.e. susceptible contingents, measures are aimed at increasing their nonspecific resistance. Vaccination of the population is not carried out due to the lack of effective vaccination drugs.

Outbreak activities

Dysentery
Dysentery

Dysentery. Before hospitalization or recovery of the patient, if he is left at home, current disinfection is carried out in the outbreak, and after hospitalization or recovery - final disinfection.

For persons in contact with the patient, medical observation is carried out for 7 days (thermometry, examination of the stool, palpation of the intestines, etc.). If there are workers of food enterprises and persons equated to them in the outbreak, the workers of the sanitary-epidemiological station take material from them for research on the carrier of bacteria.

In the outbreak, if necessary (at the request of the sanitary and epidemiological station), sanitary and preventive measures are carried out (improvement of wells, construction and repair of toilets, waste bins, extermination of flies, etc.), as well as sanitary and educational work.

In order to identify patients with dysentery and bacteria carriers among children of preschool institutions, daily careful monitoring of the nature of the stool and its frequency is necessary.

When intestinal dysfunction appears or an intestinal infection is suspected, the patient is isolated. For those who come into contact with sick children, medical supervision is established (double temperature measurement, examination of the chair). When repeated cases of the disease appear, a single bacteriological examination of all children and group personnel is carried out.

With the simultaneous appearance of diseases in several groups of the children's institution, in addition to children, the personnel of the catering unit and the corresponding groups are subjected to bacteriological examination.

Phaging is carried out only for prophylactic purposes in preschool institutions that are unfavorable in terms of morbidity. Due to the low efficiency, specific immunization of the population against dysentery is not carried out.

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