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Dysentery( shigellosis) - Causes, symptoms and treatment. MF.

  • Dysentery( shigellosis) - Causes, symptoms and treatment. MF.

    Jun 14, 2018

    Infectious Diseases

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    Dysentery ( or shigellosis) belongs to the group of acute intestinal infections - diseases with a fecal-oral transmission mechanism that are characterized by symptoms of general intoxication and diarrhea.

    The causative agent of dysentery is the bacteria of the genus Shigella, therefore the disease itself is called "shigellosis".The name "dysentery" was formed from two words of Greek origin - "dys"( violation) and "enteron"( intestines).

    Shigellas are ubiquitous. Infection occurs through the fecal-oral mechanism - i.e.bacteria from the intestine of a sick person enter the gastrointestinal tract of a healthy person. This can happen through dirty hands, when bacteria get into food, water, through insects. The most widespread infection is in developing countries, where this is facilitated by crowding and unsanitary conditions.

    Shigella cause damage to the mucosa of the large intestine, which is manifested by a loose stool with mucus and an admixture of blood, a pain in defecation. However, in many patients only mild watery diarrhea is observed.

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    causative agent of dysentery

    The causative agent of shigellosis is a bacterium - immobile rod of the genus Shigella.

    There are 4 species of this bacterium, each of which is capable of causing dysentery in humans: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

    The peculiarity of Shigella is their ability to quickly acquire resistance to antibacterial drugs. Bacteria that are resistant to traditional treatment are becoming more common. In addition, the bacteria are extremely stable in the environment - under favorable conditions they can retain their pathogenic properties up to several months, including in food.

    Pathogenicity factors:

    Shigella have a number of properties that ensure their pathogenicity for humans, i.e.ability to cause disease.

    • Invazins are proteins that provide invasion - the penetration of bacterial cells into the intestinal mucosa. Most often, the bacteria affect the lower part of the large intestine.
    • Endotoxin is a toxin that is part of the bacterial cell itself. It causes the appearance of signs of intoxication - a rise in temperature, a sense of weakness, pain in the muscles and joints.
    • Exotoxin is a toxin that is produced by bacteria and is released into the bloodstream. The most pathogenic is the toxin Shigella dysenteriae serovar 1( Shigella Grigoriev-Shiga), which is called Shiga toxin. Exotoxin is the cause of diarrhea.

    How does infection with dysentery occur?

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

    There are several ways to transmit the pathogen.

    This is a contact-household way - through unwashed hands when the rules of personal hygiene are not respected;food - when bacteria get into food;as well as water - with the use of infected water.

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

    Acute dysentery

    The disease begins acutely - within 24-48 hours after infection. Most often there is a colitis variant of infection - i.e.defeat exclusively of the large intestine. However, sometimes there are gastroenterocolitis or gastroenteric variants - with lesions of the gastric mucosa and small intestine.

    Manifestations of acute dysentery:

    • Fever. The temperature rises to high figures. In children, it can reach 40-41 ° C.
    • Diarrhea. In the beginning of the disease, there is sometimes a short-term watery diarrhea, but then the stool becomes more frequent 10-30 times a day and is released in small amounts. In feces there is an admixture of a large amount of mucus, blood, sometimes - pus. The admixture of blood in the feces is the hallmark of dysentery among all acute intestinal infections and indicates the defeat( ulceration) of the intestinal mucosa. The appearance of an admixture of blood in the stool serves as an excuse for immediate contact with a doctor.
    • Cramping abdominal pain.
    • Tenesmus - painful urge to defecate, as well as painful sensations in the anus during and after defecation.

    With gastroenterocolitic and gastroenteric variants of the disease, nausea, vomiting, abundant watery stools may occur.

    With mild disease, spontaneous recovery occurs within a week. In severe cases serious complications can develop, death is not excluded.

    Chronic dysentery

    Chronic dysentery is diagnosed if the disease lasts more than 3 months.

    The flow can be different.

    There is either a continuous course of the disease, or a recurrent, which is characterized by periodic exacerbations. In this case, periods of chronic dysentery alternate with periods of full health. The severity of symptoms during relapse is usually significantly less than in acute dysentery. Signs of intoxication are much less pronounced - the temperature rarely exceeds 37.5 ° C;the chair is frequent, but the pain is not so painful, the blood is most often absent.

    Bacteriosis

    Shigella can be reconstituted - in the event that bacteria continue to secrete from the intestine of the patient after the dysentery that has been transferred, in the absence of any signs of disease.

    In addition, the transient bacteriocarrier is isolated, which is diagnosed with a single isolation of pathogenic shigella from the stool of a healthy person who did not suffer from dysentery. Most often this happens by accident during a preventive examination and does not have any effect on human health.

    How to avoid infection with the dispensary

    Prevention of infection with shigella is reduced to compliance with the rules of personal and communal hygiene:

    • Washing hands before meals and after the toilet.
    • Young children most susceptible to acute intestinal infections;parents need to monitor the behavior of the child, to teach personal hygiene rules from an early age.
    • Compliance with the rules for storage and cooking of food.
    • When nursing a patient, disinfection of bed linen and feces is very important, it is necessary to wash hands after contact with the patient.
    • Sick children should not go to kindergarten or school until negative stool results are obtained.
    • Employees of public catering establishments should return to work also only after receiving a negative result of stool culture.

    Complications and consequences of dysentery

    Dysentery is dangerous for severe complications, both due to intestinal damage, and extraintestinal.

    Rectal prolapse. In connection with a frequent agonizing stool, tenesmus, part of the rectum may fall out of the anus. The most common complication occurs in young children.
  • Dehydration. Occurs rarely, more often with a gastroenteric variant of the disease, i.e.with an abundant watery stool.
  • Intestinal bleeding. With massive lesions, extensive ulceration of the intestinal mucosa, intestinal bleeding may develop. Requires immediate hospitalization.
  • Toxic megacolon. A rare complication of dysentery. It is characterized by stretching the lower part of the large intestine, thinning its walls. As a result, toxins of bacteria in the intestine enter the blood in large amounts, leading to severe intoxication. A toxic megacolon often ends in a fatal outcome.
  • Hemolytic-uremic syndrome. Characterized by kidney damage with the development of severe kidney failure, as well as hemolytic erythrocytes - the destruction of red blood cells with the development of severe anemia;In addition, there is a decrease in the number of platelets in the blood. Hemolytic-uremic syndrome usually develops by the end of the first week of the disease, when the patient is already recovering. The first manifestation is a sharp decrease in the amount of urine - oliguria. In surviving patients, renal damage continues to increase and in 50% of cases leads to chronic renal failure requiring hemodialysis or kidney transplantation.
  • Bacteremia - the ingress of bacteria into the blood of a sick person. It occurs mostly only in depleted patients or suffering from any kind of immunodeficiency. Bacteremia is severe and often ends lethal.
  • Concomitant Infections. Against the background of depletion with long-term dysentery, other infectious processes may join. Most often this is pneumonia, infection of the urinary tract.
  • Postdizenteric intestinal dysfunction. Due to the fact that the infectious process affects the intestinal mucosa, often resulting in serious damage, after recovery with a negative result of stool culture, stool disorders may persist. Usually there is a loose stool;it is not so painful, does not lead to significant negative consequences, but it gives a certain discomfort.
  • Syndrome of postinfection asthenia. After a severe infection, especially in young children, for a few months, weakness, fatigue, exhaustion may remain. Dysbacteriosis. It occurs quite often after the infection. It is usually effectively corrected by eubiotics.

    • Diagnosis of dysentery

    With frequent stools with blood impurities, it is necessary to suspect dysentery. In addition, in connection with the wide spread of the gastroenterocolitis variant of the disease, shigellosis is diagnosed with any frequent liquid stool, accompanied by signs of intoxication, i.e.in the diagnosis of acute intestinal infection.

    • Bacteriological method of investigation. The most reliable method of diagnosing intestinal infections. It lies in the sowing of feces to identify pathogenic bacteria.
    • Serological examination method. It is the definition of antibodies to shigella in the blood. However, in everyday practice this method is not used, due to the availability, simplicity and reliability of the bacteriological method.
    • Polymerase Chain Reaction( PCR) - is to determine shigella genes in stool. PCR refers to expensive methods of examination, therefore it is extremely rare to diagnose acute intestinal infections.

    Diet in case of

    Diet is an important component of treatment. With the preservation of diarrhea, a therapeutic diet No. 4 is recommended, which is characterized by a low content of fats and carbohydrates with a normal protein content and a sharp restriction of any irritants of the gastrointestinal tract. Also excluded are foods that can cause flatulence( increased formation of gases in the intestine).

    Featured Products:

    • wheat crumbs, thinly sliced ​​and not very toasted.
    • soups on low-fat meat or fish broth with the addition of cereals: rice, semolina or egg flakes;as well as finely ground boiled meat.
    • lean soft meat, a bird or fish in a cooked form.
    • low-fat freshly made curd.
    • eggs no more than 2 per day in the form of boiled soft-boiled or steam omelet.
    • porridge on the water: oatmeal, buckwheat, rice.
    • vegetables are only boiled when added to soup.

    Products to be excluded:

    • bakery and flour products;
    • soups with vegetables, on strong fat broth;
    • fatty meat, meat, sausage;
    • fatty, salted fish, canned food;
    • whole milk and other dairy products;
    • hard-boiled eggs, fried eggs;
    • millet, barley, pearl gruel;pasta;
    • beans;
    • vegetables, fruits, berries in raw form;as well as compotes, jam, honey and other sweets;
    • coffee and cocoa with milk, carbonated and cold drinks.

    After normalization of the chair, you can go to the therapeutic diet number 2.It is somewhat milder than diet number 4.In addition, the diet adds:

    • bread yesterday's pastries or dried. Uncomfortable bakery products, biscuits;
    • meat and fish can be cooked by the piece;
    • sour-milk products, including cheese;
    • eggs, except hard-boiled eggs;
    • vegetables: potatoes, zucchini, cauliflower, carrots, beets, pumpkin;
    • mature fruits and mashed berries;
    • creamy caramel, marmalade, marshmallow, pastille, jam, honey.

    Treatment of disentry

    • If there are signs of dehydration, salt solutions are taken: Regidron.
    • Sorbents are used to reduce the occurrence of diarrhea: Smecta, Enterosgel 3 times a day.
    • The reception of loperamide( imodium) is contraindicated! !!Antidiarrheals slow the release of the pathogen from the lumen of the intestine, which can slow the course of the disease and weight the symptoms.
    • Antibiotics. With an easy course of the disease usually passes without treatment. By the time of isolation from the feces of the pathogen and determining its type, there is an improvement, and the need for antibiotics is no longer necessary. However, in severe cases, when diarrhea is accompanied by blood in the stool, tenesmus, abdominal pain, antibiotics are indicated. The drug of choice in this case is ciprofloxacin 500 mg 2 times a day. However, ampicillin, tetracycline is also used. Duration of admission is determined by the doctor, in standard cases is 5 days.

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