Dysentery

Dysentery (bacterial dysentery, shigellosis) is an infectious disease with a fecal-oral mechanism of transmission, caused by bacteria of the genus Shigella. Protekaet primary lesion of the mucosa of the distal part of the large intestine.

Etiology, pathogenesis. The causative agents are 4 types of shigella: 1) Shigella dysentery; 2) Shigella Flexner (with the subspecies Newcastle); 3) Shigella Boyd and 4) Shigella Sonne. The most common are Shigella Zon-not and Flexner. Pathogens can last for a long time in the external environment (up to 1.5 months). On some foods, they are not only preserved, but can also multiply (dairy products, etc.). There is an increase in Shigella resistance to various antibiotics, and most strains are resistant to sulfanilamides. Avirulent strains of Shigella have been obtained, which are used to develop live attenuated vaccines for enteric immunization. Infectious dose for dysentery is small. The possibility of parasitizing shigella in the intestinal epithelium is proved. The disease occurs when the shigella toxins penetrate the blood. Dysentery toxins act on the wall of blood vessels, central nervous system, peripheral nervous ganglia, sympathetic-adrenal system, liver, circulatory system. In severe forms of dysentery, patients usually die from an infectious-toxic shock.

Symptoms, course. The incubation period is from 1 to 7 days (usually 2-3 days). According to clinical manifestations, dysentery can be divided into the following forms. I. Acute dysentery: a) typical (of varying severity); B) atypical (gastroenterocolytic); C) subclinical. II. Chronic dysentery: a) recurrent; B) continuous (protracted). III. Postdysenteric dysfunction of the intestine (postdisenteric colitis). Typical forms of dysentery start acutely and manifest symptoms of general intoxication (fever, worsening of appetite, headache, adynamia, lowering blood pressure) and signs of lesions of the gastrointestinal tract. Pain in the abdomen at first blunt, diffuse throughout the abdomen, constant, then becomes more acute, cramped, localized in the lower abdomen, more often on the left or above the pubis. Pain is worse before stool. There are also tenozmy - pulling pain in the rectum, giving in the sacrum. They occur during defecation and continue for 5-15 minutes after it. Teneemas are caused by inflammatory changes in the mucosa of the ampullar part of the rectum. With the defeat of the distal part of the large intestine, there are false desires and a protracted act of defecation, a sense of its incompleteness. When palpation of the abdomen, there is a spasm and soreness of the large intestine, more pronounced in the region of the sigmoid colon. The chair is quickened (up to 10 times a day or more). Feces are initially feces, then an impurity of mucus and blood appears in them, and in more severe cases, only a small amount of bloody mucus is released during defecation.

In mild forms (up to 80% of all diseases), the patients' state of health is satisfactory, the body temperature is subfebrile or normal, the abdominal pain is insignificant, tenesmus and false urges may be absent. A chair 3-5 times a day, it is not always possible to detect an admixture of mucus and blood in the bowel movements. Subclinical forms of dysentery are usually detected during bacteriological examination, clinical symptoms are poorly expressed. Such patients often consider themselves healthy and do not complain about it. In atypical forms against the background of the above symptomatology, acute gastritis (epigastric pain, nausea, vomiting) are noted, which makes it difficult to diagnose.

Severe form of dysentery occurs in 3-5% of cases. It occurs with high fever or, conversely, with hypothermia. There is a sharp weakness, adynamia, appetite is completely absent. Patients are hindered, apathetic, skin pale, pulse frequent, weak filling. A picture of an infectious collapse (a progressive drop in blood pressure, cyanosis, a feeling of cold, dizziness, a pulse hardly probed) can develop. A chair up to 50 times a day, slimy-bloody. In severe cases, sometimes paresis of sphincters, the gaping of the anus, from which bloody mucus is released, can sometimes occur.

For diagnostics, in addition to clinical symptoms, great importance is given to a sigmoidoscopy. Depending on the severity of different degrees of manifestation of changes in the mucous membrane of the large intestine (catarrhal, catarrhal-hemorrhagic, erosive, ulcerative, fibrinous) are revealed. The most characteristic for dysentery hemorrhagic and erosive changes in the background of mucosal inflammation. Proof of the dysenteric nature of the disease is the isolation of shigella from feces, but this is only possible in 50% of patients (during outbreaks more often). For the diagnosis of chronic dysentery, it is important to point out the acute acute dysentery during the last 6 months.

Chronic dysentery first proceeds in the form of separate exacerbations (relapses), then goes into a continuous (protracted) form, when there are no periods of remission. Postdysenteric dysfunction of the intestine is formed 2 years after the transferred dysentery. In this period shigell from the patient can not be distinguished.

Dysentery should be differentiated from acute colitis of another etiology (salmonella, etc.), as well as amebiasis, balantidiasis, ulcerative colitis, colon cancer.

Treatment. Patients with dysentery can be treated both in an infectious hospital and at home. Hospitalized patients with moderate and severe forms, children under the age of 3, weakened patients, as well as the inability to organize treatment at home; On epidemiological indications, children who attend pre-school institutions, food workers, persons living in dormitories are hospitalized. As etiotropic drugs prescribe antibiotics, sulfonamides, derivatives of nitrofuran 8-hydroxyquinoline. Of antibiotics, tetracyclines (0.2-0.4 g 4 times a day) or levomycetin (0.5 g 4 times per day) are often used. More effective ampicillin (1 g4-6 times in the soup). The course of treatment is 5-7 days. Nitrofurans (furazolidone, furadonin, furaeolin) are prescribed 0.1 g 4 times a day for 5-7 days. Derivatives of 8-hydroxyquinoline (enteroseptol, meksaz) give 2 tablets 4 times a day for 5-7 days. Sulfanilamidy (sulfazol, supraphatiaeol, sulfadimezin) can be prescribed 1 g 3-4 times a day for 5-6 days. Assign a complex of vitamins. To prevent recurrence of dysentery, careful detection and treatment of concomitant diseases is necessary.

The prognosis is favorable. Transition to chronic forms is observed with perfect therapy relatively rarely (1-2%).

Prevention. Reconvalvesent after dysentery is discharged no earlier than 3 days after clinical recovery, normalization of the stool, temperature of the tepa and a single negative bacteriological study, conducted no earlier than 2 days after the end of etiotropic treatment. Nursing staff and persons who are equated with them, as well as patients with chronic dysentery, are subject to follow-up. The period of dispensary observation is 3-6 months. When leaving a sick house in the apartment, the current disinfection is carried out. For persons in contact with patients, medical supervision is established within 7 days.