DYSENTERY

DYSENTERIA (syn: shigellosis) is an infectious disease that occurs with intoxication, predominantly affecting the distal part of the colon, which is manifested by a cramping pain in the abdomen and a frequent loose stool with an admixture of blood and mucus. It is one of the most common infectious diseases, especially in developing countries.

The causative agent is bacteria of the Shigella genus. Some species are represented by several serovars. In total about 40 serovars are known. All Shigella contain endotoxin, some produce exotoxin of protein nature, which causes a more severe course of the disease. The most stable in the external environment shigella Sonne. All Shigella bear drying and low temperatures, but quickly die by the action of sunlight, heating (at 60 ° C perishes in 30 minutes, at 100 ° C - instantaneously) and disinfectants. Some Shigella can reproduce under favorable conditions in food.

The source of the infectious agent is a person suffering from acute, chronic, subclinical forms of dysentery, as well as a bacteriovirus. The transmission route is fecal-oral, the transmission factors are food products, water, household items, flies, soil. The main transmission factor for Flexner dysentery is water, Sonne - food products. There is a summer-autumn seasonality of morbidity.

Penetrating into the body together with water and food, the shigella is partially killed by digestive juices, normal microflora and local immunity factors, partially embedded in the wall of the colon mainly in its distal part, causing local inflammation with the formation of erosions, ulcers, hemorrhages. Under the influence of toxins of the pathogen, the processes of digestion and absorption of food, intestinal motility, disrupt the symptoms of intoxication. Characteristic of the development of dysbiosis. Shigella dysentery can overcome local barriers and enter the bloodstream. Immunity is type-specific, so repeated diseases are possible.

Clinical picture. The incubation period ranges from several hours to 7 days, usually 2 to 3 days. Depending on the features of the course of the disease distinguish between the colitis, gastroenterocolitic and in rare cases gastroenteric forms of the disease, which in turn can occur in mild, moderate and severe forms. In addition, the erased form of the disease and bacteriocarrier are isolated. Duration of the course distinguish acute dysentery (up to 1 month), acute dysentery with a prolonged course of the disease (up to 3 months) and rarely occurring chronic dysentery (more than 3 months).

The colitis form of the disease is most typical. The disease begins acutely, almost simultaneously there are symptoms of intoxication (malaise, chills, headache , muscle pains, tachycardia) and the symptoms of distal colitis. Patients complain of cramping abdominal pain, mainly in the left ileal region, which often precede the act of defecation. The stool is liquid, feces, after a few hours streaks of mucus and blood appear in the feces. At the height of the disease, stools are poor, they lose their stool and are the secret of the inflamed mucous membrane of the colon - a lump of mucus soaked in blood ("rectal spittle"). Often there are tenesmus - sharply painful acts of defecation, false desires. Intoxication, weakness, dizziness increase . When examining a patient, the sigmoid colon is palpated in the form of a sharply painful dense strand. The peak period lasts from 1-2 to 12-14 days.

Gastroenterocolitis is characterized by the fact that in the first days of the disease symptoms of stomach damage predominate (pain in the epigastric region, vomiting) and the small intestine (abundant loose stools, pain around the navel), and the symptoms of colitis are joined later.

The gastroenteric form is very similar to foodborne disease. The incubation period is several hours. The onset of the disease is violent, there are pains in the epigastrium, vomiting , watery stools. Duration of the disease from several hours to 2 - 3 days.

With an erased course of the disease intoxication is absent, dyspeptic syndrome is weakly expressed, short-lived, may also be absent. The diagnosis in these cases is possible only on the basis of the results of bacteriological examination and detection of endoscopic inflammatory changes in the distal part of the colon.

Chronic dysentery is characterized by periodic exacerbations of the colitis syndrome with mild intoxication. The diagnosis in these cases is possible only with the repeated allocation of the same serovar pathogen.

The main criteria for the severity of the disease are body temperature and stool frequency. With mild disease, the temperature is up to 38 ° C, the stool frequency is up to 10 times a day; At moderate flow - temperature up to 39 ° C, stool frequency - up to 20 times; In severe cases, the temperature exceeds 39 ° C, the stool frequency is more than 20 times, often without counting. With gastroenteric and gastroenterocolitic forms, the severity is evaluated taking into account the degree of dehydration of the body.

The diagnosis is made on the basis of clinical data (acute onset, stool with mucus and blood, sygmoid spasm, intoxication), epidemiological data (contact with the patient, illness of several people who consumed the same food or water from the same source) and confirmed by the results Bacteriological study of stool and sigmoidoscopy.

Treatment. Patients are hospitalized according to clinical (medium and heavy course of the disease, unfavorable premorbid background) and epidemiological (workers of food enterprises, water supply, trade, children's institutions, living in unsuitable dwellings, hostels, etc.). Treatment of patients at home includes the appointment of an appropriate diet, furazolidone, 0.1 g 4 times a day before the arrest of diarrhea, according to indications, antispasmodics and enzyme preparations (panzinorm, digestal, festal , abonin), eubiotics (bifidumbacterin, bifikol, etc.) are used. , A biococktek NK, which has a pronounced antidiarrheal effect. In the hospital, derivatives of fluoroquinolone (pefloxacin, etc.), biseptol, detoxification therapy are used.

For an extract from the hospital, the authorization of labor activity for persons treated as an outpatient, 3 days of normal stool and a negative result of the study on the copra culture of Shigella are sufficient. Reconvalvesentam from the number of decreted groups is necessary 2 days after the abolition of antibiotics control study. In addition, these people are put on dispensary supervision at the polyclinic. In the presence of bacterial excretion, a control study of feces is shown to all convalescents. Reconvalvesentes from the decreed groups are observed in the polyclinic for 3 months, and patients with chronic dysentery - until complete recovery.

Prevention is primarily aimed at identifying and treating sources of infection, especially among persons of decreed groups. Compliance with sanitary and hygienic standards is important: supervision of water supply, sanitation, collection of sewage and their neutralization, sanitary control at food industry enterprises (especially in milk processing plants) and catering.