Dysentery - an acute infectious disease that affects the gastro - intestinal tract and mainly distal colon, and manifested palpitations painful defecation, symptoms of intoxication, as well as liquid chair with an admixture of pusand mucus.Dysentery is found in almost 50% of children older than one year, cases of acute intestinal infection (AII).
The disease is caused by bacteria of the genus Shigella, which are in the form of rods and are gram-negative organisms.This type of bacteria has no flagella, do not form spores and capsules, however, produces neuro - vascular poison endotoxin.At ambient conditions, dysentery bacteria can persist for thirty - forty five days.Under the influence of a temperature of 100 degrees, Shigella killed instantly at sixty degrees - in thirty minutes, and in the feces, they die within a few hours.Bacteria are very sensitive to various disinfectants and antibiotics (ampicillin, tetracycline, and chloramphenicol).
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Dysentery can occur in the form of individual cases, and to give the whole outbreak, thus affecting large numbers of people.The disease affects all age groups, but still more common in children.The disease has a pronounced seasonality, with a peak incidence in August - September.
Infection always occurs through the mouth.During the first days, some have fallen into the stomach microbes are killed, and the survivors penetrate into the lower bowel, where they are reproduction and development.Microbes proliferate, thus releasing a toxin that is absorbed into the bloodstream and begins to affect the central nervous system, vascular walls;the metabolism observed liver toxicity, as well as other systems and organs.In addition, due to microbial activity observed blennosis colon.
In most cases, after the necessary remedial measures, there comes a full recovery, but sometimes the bacteria are able to sufficiently long period of time stored in the cells of the intestine, resulting in possible relapse
Signs and during dysentery
Dysentery can occur in chronic,and in acute form.The incubation period is short enough - from 1 to 7 days (usually two - three days).
acute form begins after 24 - 48 hours after infection.In most cases, there is the so-called colitis variant of infection, when only the colon is affected.Less common gastroenteritis and gastroenterokolitichesky that affects the small intestine and gastric mucosa
main manifestations of acute dysentery :
- The body temperature rises to high numbers (of children - up to 40-41ºS)
- At the beginning of the disease canobserved intermittent watery diarrhea, but then stool frequency comes to 10 - 30 times per day.The stool is observed admixture of large amounts of blood, mucus, and sometimes pus.It is blood in the stool (indicates ulceration of the intestinal mucosa) to distinguish dysentery from other acute intestinal infections
- Painful urging to stool, very painful during and after a bowel movement in the anus
- Stomach cramps
Forgastroenteriticheskogo and gastroenterokoliticheskogo variants of the disease characterized by profuse watery stools, nausea and vomiting.
In less severe disease, recovery occurs spontaneously within a week.In severe cases, may develop serious complications so that does not exclude death.
If the disease continues for more than three months, diagnosed with chronic dysentery, which, by its flow can be continuous, or recurrent with periodic exacerbations.Periods of chronic dysentery while alternating with periods of exceptional health.During relapse symptom severity is much less than in the acute form.Symptoms of intoxication also significantly reduced - a frequent chair, but the pain is not as painful, and blood in the stool more often than not;body temperature almost never exceeds 37.5ºS.
of bacteria can be convalescent - is when the bacteria already transferred after dysentery continue to stand out from the human intestine, in the absence of any - any signs of the disease
consequences and complications of dysentery
- Dehydration .It is quite rare, in most cases, gastroenteriticheskom variant of the disease, which is characteristic of abundant watery stools
- Rectal prolapse .As a result of the painful parts of the chair, from the anus may fall portion of the rectum.This complication most susceptible young children
- intestinal bleeding .With extensive ulcerations of the intestinal mucosa may develop intestinal bleeding.This condition requires immediate hospitalization
- Gamolitiko - uremic syndrome .This condition is characterized by kidney damage and the subsequent development of acute renal failure.Frequently hemolytic - uremic syndrome is the end of the first week after onset of the disease, while when the patient has already cured.Oliguria (sharp decrease in amount of urine) is the first manifestation of the syndrome.In patients with renal dysfunction survivors continues to progress, and almost fifty percent of the holding to chronic kidney failure, which requires dialysis or a kidney transplant
- toxic megacolon .It is a rare complication of dysentery, which is characterized by thinning of the wall and stretch the entire lower part of the rectum.Consequently, the toxins are enteric bacteria in large amounts enter the blood, leading to severe toxicity.Quite often, toxic megacolon fatal
- bacteremia .It characterized into the blood of the sick person, and bacteria, in most cases occurs in patients who are immunocompromised or suffer from malnutrition.Bacteremia always runs hard and very often ends lethal
- Postdizenteriynaya intestinal dysfunction .As a result of the defeat of the infectious process of the intestinal mucosa, there is so seriously damaged that even after the recovery may remain a violation of the chair.Often there is a liquid, not suffering delivering a chair that does not lead to any significant effects, but delivers serious discomfort
- opportunistic infections .When long-dysentery on the background of the current depletion may join any infectious processes as pneumonia and urinary tract infection
- Dysbacteriosis .It is often after a previous infection and often effectively corrected zubiotikami
- postinfectious fatigue syndrome .In the majority of cases occur in young children after undergoing a severe infection and manifest exhaustion, weakness and fatigue.
dysentery can be suspected in case of frequent stools mixed with blood.The leading role in the diagnosis of dysentery belongs bacteriological examination of faeces.In addition to the bacteriological, serological survey method used polymerase chain reaction
dysentery can be treated in the hospital and at home.Compulsory hospitalization to be small children, patients with severe, and patients are burdened with various comorbidities.In the early days of the disease is shown to bed only to patients with moderate - severe and severe dysentery.
nutrition of patients should be given special attention.This should take into account the severity of colitis symptoms and severity of the disease.In severe cases, patients designate table №4 or №4b, and after the return of appetite, converted on the table №2.If there is vomiting, for the first ten - twelve hours of fasting shows with abundant drinking.Eating must be fractional, 4 - 5 times a day.
used drugs: ftalazol (0.1gr. 4 times a day), furadonin (0.1gr. 4 times a day) - duration 5 - 6 days;sulfa drugs (1g. 3-4 times a day rate of 5-6 days).
Drugs used in severe: rondomitsin (0.3gr. 2 times a day), tetracycline (0.3gr. 3-4 times a day course of 5-6 days), ampicillin (adults 1g. Every six hours, children 100mg / kgtotal body weight per day).Perhaps the appointment of doxycycline (0.1-0.2gr. Per day).Also shown kanamycin (0.5gr. 4 times per day rate of five days) and chloramphenicol (0.5gr. 4 times a day, 6 days a course).
In severe cases, in addition to antibiotics, is shown holding a detoxification therapy.
Intravenously administered isotonic sodium chloride solution, Ringer-Locke, and saline solutions "Trisol" and "Kvartasol".
In the case of infectious - toxic shock shown by intravenous administration - drop the following drugs: polyglukin, reopoligljukin, albumin, strophanthin, Korglikon, 10% solution of glucose with prednisolone and ascorbic acid.
Daily fluid intake typically ranges from a half to two liters and depends on the amount of fluid loss from diarrhea and vomiting.
In less severe disease, as well as in the absence of vomiting, oral rehydration is carried out.Inside appointed saline solutions: Enterodez, Oral, rehydron.Also shown is a complex vitamins (nicotinic acid, riboflavin, ascorbic acid, thiamine).
Prevention of dysentery is directly related to carrying out sanitary - hygienic measures in public places and observance of generally accepted rules of personal hygiene.
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