Dysentery ( Shigellosis ) - Causes, Symptoms and Treatment .MF .
Dysentery (or shigellosis) refers to a group of acute intestinal infections - diseases with fecal-oral mechanism of transmission, which is characterized by symptoms of intoxication and diarrhea.
causative agent of dysentery is a bacteria of the genus Shigella, and therefore the disease itself is called "shigellosis".The name "dysentery" formed of two words of Greek origin - «dys» (violation) and "enteron" (intestine).
Shigella ubiquitous.Infection occurs through the fecal-oral mechanism - that is,bacteria from human intestinal patient fall in the gastro-intestinal tract of a healthy person.This can occur through dirty hands, in contact with bacteria in food and water, through insects.The most common infection is gained in developing countries, where this contributes to overcrowding and unsanitary conditions.
Shigella cause damage colonic mucosa that is manifested loose stools with mucus and blood impurities, pain during defecation.However, many patients with only a slight watery diarrhea observed
causative agent of dysentery shigellosis
causative agent is a bacterium - fixed coli genus Shigella.
There are 4 types of bacteria, each of which can cause dysentery in man: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.
peculiarity of Shigella is their ability to rapidly acquire resistance to antibiotics.All the more common bacteria that are resistant to conventional treatment.Furthermore, the bacteria are extremely stable in the environment - under favorable conditions can maintain its pathogenic properties to a few months, including foodstuffs.
Shigella possess a number of properties that provide their pathogenicity for humans, ie,the ability to cause disease.
- invasin - proteins providing invasion - penetration of bacterial cells in the intestinal mucosa.Most often, the bacteria affect the lower large intestine.
- Endotoxin - toxin, which is part of most of the bacterial cells.Is the cause of the intoxication symptoms - fever, feeling of weakness, pain in muscles and joints.
- exotoxin - a toxin that is produced by bacteria and vybrazyvaetsya in blood.Most pathogenic toxin is Shigella dysenteriae serovar 1 (Shigella Grigoriev-Shiga), which is called Shiga-toxin.Exotoxin is the cause of diarrhea.
How infection occurs dizentiriey
mechanism of infection with dysentery - fecal-oral, iebacteria of the sick person enters the intestinal gastro-intestinal tract of a healthy person.
There are a number of transmission paths.
It is contact-household way - through unwashed hands under poor personal hygiene;food - in contact with the bacteria in the food;and water - in the use of contaminated water.
In addition, infection is possible when bathing in contaminated waters.
Disease begins acutely - within 24-48 hours after infection.Most often there is a colitis variant of infection - ieonly defeat of the large intestine.However, sometimes there gastroenterokolitichesky or gastroenteritis options - with gastric mucosal lesions and small intestine.
Manifestations of acute dysentery:
- Fever.The temperature rises to high numbers.In children, it can reach 40-41ºS.
- Diarrhea.At first, the disease is sometimes observed intermittent watery diarrhea, but then the chair becomes frequent up to 10-30 times a day and is released in small quantities.The stool appears admixture of large amounts of mucus, blood, sometimes - pus.blood in the stool is the hallmark of dysentery among all acute intestinal infections and evidence of lesions (ulceration) of the intestinal mucosa.The appearance of blood in the stool is a reason for immediate treatment to the doctor.
- Stomach cramps.
- tenesmus - painful urge to defecate, as well as pain in the anus during and after stool.
When gastroenterokoliticheskom and gastroenteritis cases the disease can cause nausea, vomiting, profuse watery stools.
In less severe disease Spontaneous recovery occurs within a week.In severe cases, may develop serious complications can not be ruled death.
chronic dysentery is diagnosed when the disease lasts for more than 3 months.
This flow may be different.
observed or continuous course of the disease, or recurrent, which is characterized by periodic exacerbations.At the same time periods of chronic dysentery, interspersed with periods of complete health.The severity of symptoms during relapse is usually much smaller than in acute dysentery.Signs of intoxication is significantly reduced - the temperature rarely exceeds 37,5ºS;frequent stools, but the pain is not so painful, blood is often absent.
carriage of Shigella can be convalescent - in the case if the bacteria continue to stand out from the intestine of the patient recovering from dysentery in the absence of any signs of the disease.
In addition, isolated transient bacteriocarrier, which is diagnosed by a single isolation of pathogenic Shigella from stool of a healthy person, without a history of dysentery.Most often this happens by chance in prophylactic examination and has no effect on human health.
How To Avoid Getting dizentiriey
Prevention Shigella infection is reduced to comply with the rules of personal and communal hygiene:
- Wash hands before eating and after using the toilet.
- Young children are most susceptible to acute intestinal infections;parents need to monitor the behavior of the child, to teach the rules of personal hygiene from an early age.
- Compliance with rules governing the storage and preparation of food.
- When patient care is very important disinfection of bedding and faeces, it is necessary to wash your hands after contact with a patient.
- Sick children should not attend kindergarten or school until a negative stool culture results.
- Workers catering must return to work and only after obtaining a negative result fecal seeding.
Complications and consequences of dysentery Dysentery
dangerous severe complications as caused by intestinal lesions and extra-intestinal.
- Rectal prolapse.Due to the frequent painful stools, tenesmus of the rectum can fall out of the anus.The most common complication vstrachaetsya in young children.
- Dehydration.Rarely, more often at gastroenteriticheskom variant of the disease, ie,with profuse watery stool.
- intestinal bleeding.When a massive defeat, extensive ulcerations of the intestinal mucosa may develop intestinal bleeding.It requires immediate hospitalization.
- toxic megacolon.A rare complication of dysentery.It is characterized by stretching the lower portion of the colon, thinning of its walls.Consequently, the toxins of bacteria in the gut in large numbers enter the blood, leading to severe toxicity.Toxic megacolon often ends in death.
- Hemolytic-uremic syndrome.It is characterized by the development of renal disease with severe renal insufficiency, as well as red blood cell hemolysis - the destruction of red blood cells with the development of severe anemia;moreover there is a decrease in blood platelet count.Hemolytic-uremic syndrome usually develops at the end of the first week of the disease, when the patient is already recovering.The first manifestation is the sharp reduction in the amount of urine - oliguria.Surviving patients with kidney damage continues to grow, and in 50% of cases leads to chronic renal failure, requiring dialysis or kidney transplantation.
- bacteremia - bacteria getting into the bloodstream of the patient man.It is found mostly only in malnourished patients or suffering from any kind of immunodeficiency.Bacteremia runs hard and often ends lethally.
- opportunistic infections.Against the background of the current depletion during long dysentery can join other infectious processes.Most often, pneumonia, urinary tract infection.
- Postdizenteriynaya intestinal dysfunction.Due to the fact that the infectious process affects the intestinal mucosa, often causing serious damage after recovery from feces seeding negative result may be stored disorders chair.Usually diarrhea is observed;it is not so painful, does not lead to significant negative effects, however, gives some discomfort.
- postinfectious fatigue syndrome.After undergoing severe infections, especially in young children, in a few months may be weakness, fatigue, exhaustion.Dysbacteriosis.It occurs quite often after infection.Usually eubiotics corrected effectively.
Frequent stool mixed with blood must be suspected dysentery.Furthermore, due to the widespread disease gastroenterokoliticheskogo embodiment, shigellosis diagnosis is performed at either frequent loose stools, accompanied by signs of toxicity, i.e.under the diagnosis of acute intestinal infections.
- bacteriological examination method.The most reliable method for diagnosis of intestinal infections.It lies in the stool plating to detect pathogenic bacteria.
- Serological surveys.It is to determine the blood to Shigella antibodies.However, in daily practice, this method is not used, due to availability, ease and reliability of bacteriological method.
- Polymerase chain reaction (PCR) - is to identify the genes of Shigella in the stools.PCR refers to a costly inspection techniques, so for the diagnosis of acute intestinal infections is rarely used.
Diet for dizentirii
important component of treatment is diet.While maintaining diarrhea recommended therapeutic diet №4, which is characterized by a reduced content of fat and carbohydrate content of the normal protein and abrupt limitation any stimuli gastrointestinal tract.Also excluded are the products that can cause flatulence (increased formation of gas in the gut).
- wheat crackers, thinly sliced and not too fried.
- soups low fat meat or fish broth with the addition of cereals: rice, semolina and egg flakes;and finely minced cooked meat.
- soft lean meat, poultry or fish cooked.
- freshly prepared low-fat cottage cheese.
- eggs not more than 2 per day in the form of boiled or cooked steam omelet.
- porridge on the water: oatmeal, buckwheat, rice.
- vegetables only boiled while adding to the soup.
products to be excluded:
- bakery and flour products;
- soups with vegetables on a solid fat broth;
- fatty meat, meat piece, sausage;
- fat, salted fish, canned;
- whole milk and other dairy products;
- eggs hard-boiled, scrambled eggs;
- millet, barley, barley porridge;pasta;
- vegetables, fruits, berries, uncooked;as well as fruit drinks, jam, honey and other sweets;
- coffee and cocoa with milk, soda and cold drinks.
After normalization of stool can go to medical diet №2.It is somewhat softer diet №4.In the diet added:
- yesterday's bread baking or the dried.Nesdobnoe bakery products, biscuits;
- meat and fish can be cooked piece;
- dairy products, including cheese;
- eggs except hard boiled eggs;
- vegetables: potato, zucchini, cauliflower, carrots, beet, pumpkin;
- ripe fruits and berries are pureed;
- creamy caramel, jellies, marshmallows, candy, jam, honey.
- If you have signs of dehydration taking salt solutions: Regidron.
- sorbents are used to reduce the manifestations of diarrhea: Smecta, Enterosgel 3 times a day.
- Reception loperamide (Imodium) is contraindicated !!!Protivodireynye means slow release of agent from the intestinal lumen, which can slow down the disease and symptoms to weight.
- Antibiotics.In less severe disease usually goes away without treatment.At the time of discharge from the stool pathogen and determination of its kind, comes improvement, and the need for antibiotics is not necessary.However, in severe cases, when the diarrhea is accompanied by blood in the stool, tenesmus, abdominal pain shows antibiotics.The drug of choice in this case is ciprofloxacin 500 mg 2 times a day.However, also apply ampicillin, tetracycline.Course duration is determined by a physician, in standard cases it is 5 days.