Dysentery (shigellosis)

Description:

Dysentery – an acute anthropozoonotic disease with a fecal and oral way of transfer which is caused by bacteria of the sort Shigella and is characterized by defeat of preferential distal departments of intestines and intoxication.

Reasons of Dysentery (shigellosis):

Dysentery (shigellosis) is caused by Enterobacteriaceae family bacteria, the sort Shigella which contains about 40 serovars of shigellas. Shigellas are mobile gram-negative sticks with the zaokruglenny ends, facultative aerobes. The having 2 appearance of antigens – About and To. Favorable conditions for life and development of shigellas the ambient temperature 37C, рН 7,2 is considered.
Infection source – the person or a bakteriovydelitel. At convalescents allocation of bacteria continues within several weeks and even months. Ways of distribution of a microbe are various and depend on a species of a shigella. For Grigoriev's shigella it is generally household way, for Fleksner's shigella - water, Zonne's shigella extends in the food way.
Factors of transmission of infection – the infected milk, sour cream, cheese, etc. Seasonality of a disease is noted – the peak of incidence falls on July – September.

Pathogeny:

The disease of dysentery arises only when infection occurs through a mouth. The possibility of a course of a disease in case of the same infecting dose at different persons is various, it considerably depends on an initial condition of their protective barriers. Chemical barriers – hydrochloric acid, bile, pancreatic juice. Mechanical barriers – an intestines peristaltics, integrity of an intestinal epithelium. Factors of natural resistance – a lysozyme and beta lysines, secretory immunoglobulins A, humoral factors are of great importance. Disturbance of above-mentioned barriers is resulted by penetration of shigellas into a stomach and upper parts of intestines. Part of them perishes, releasing endotoxin. Endotoxin promotes local irritation on a mucous membrane of a stomach, it is soaked up in blood, promoting emergence of the all-toxic phenomena of various intensity. Then the dysenteric stick gets into an intestines gleam. The main pathological process is developed in a large intestine. The vegetative innervation of a large intestine is surprised, its trophicity, microcirculation in all covers of a gut, regeneration process, a peristaltics is broken.

Symptoms of Dysentery (shigellosis):

The course of dysentery can be acute (up to 2 months) and long (more than 2 months).
Weight of a current is estimated on degrees:
- subclinical current (carriage);
- erased (very easy form of a disease);
- easy;
- moderately severe;
- heavy.
- very heavy.
Allocate only 3 forms of a disease: gastroenterokolitichesky, enterokolitichesky and kolitichesky.
The incubation interval at acute dysentery averages 2-3 days, but can fluctuate from 3-12 hours to 10 days. Duration of an incubation interval depends on a type of a dysenteric stick, a dose, conditions of infection, virulence of the activator, a condition of a macroorganism. Longer incubation interval is observed at a kolitichesky form.
Integuments are pale, dry, language with a plaque. At a palpation of a stomach the expressed enterospasm, its consolidation and morbidity is found. Along with toxicosis or a bit later the kolitichesky syndrome develops. The abdominal pain, tenesmus, a chair liquid, frequent to 25 times a day appears or amplifies.
The Gastroenterokolitichesky form of dysentery is caused by a dysenteric stick of Zonne.
The incubation interval lasts of several o'clock, temperature, oznoba increases. At moderately severe currents for the 1st days appears obezvozhivaniye1-2 degrees. Moderate dryness of language, mucous membranes, decrease in the ABP, increase of pulse.
The short incubation interval, the rough beginning, dehydration of 3-4 Art., hypovolemic shock, vomiting of 10 times a day is characteristic of a heavy current and is more often. The chair is speeded up to 25 times a day.
Dysentery complications: infectious and toxic shock at Grigoriev's dysentery; acute adrenal insufficiency, the IDCS, leykozopodobny reactions at children, peritonitis, hypovolemic shock, intestines invagination, intestines gangrene.

Diagnosis:

In the general blood test: moderate neutrophylic leukocytosis, shift of a formula to the left, increase in SOE. At the heavy course of dysentery anemia, thrombocytopenia takes place.
Koprotsitogramma finds availability of slime, erythrocytes and leukocytes.
Identification of the activator perhaps thanks to use to a bacteriological and bakterioskopichesky method of a research.
Excrements of patients – the main material for a bakissledovaniye. In sterile ware select grudochka a calla which contain slime and pus. Material is sowed on dense environments (Ploskireva, Endo).
Express diagnosis carries out by means of use of lyuministsentry microscopy.
Carry out also RPGA, RSK, RKOA (material – urine and excrements) and IFA and RAGA.

Treatment of Dysentery (shigellosis):

At detection of dysentery it is necessary to adhere to a rigid diet. The diseased should not eat from one ware with healthy faces at all, they should allocate individual ware. First of all, it is necessary to strengthen a water relationships, consumption of juice, broth of a dogrose, clear water especially well affects. After disappearance of symptoms of dysentery and normalization of a chair to patients appoint a diet No. 4B. By means of this diet it is necessary to achieve the maximum exception of a diet of the products strengthening and promoting gas generation in intestines  - fruit, vegetables, bakery products, whole milk, smoked products, fat food.
It is necessary to avoid the use of meat during a disease and 2 weeks after disappearance of symptoms of a disease. Also it is not recommended to take alcohol, sugar and coffee.
After stopping of symptoms of dysentery it is authorized to eat fresh fruit, cottage cheese, boiled rice. Within 2-3 months the patient gradually switches over to a usual diet.  
The main pathogenetic to drugs for treatment of dysentery are antibiotics. The antibioticotherapia course at dysentery makes from 5 to 7 days. Recently in treatment of dysentery drugs of group of ftorkhinolon are often used  (гатифлоксацин, ciprofloxacin, ofloxacin and др).
For treatment of dysentery of a ftorkhinolona appoint inside (orally) 200 mg a day within 7 days. Drugs of ftorkhinolon should be used to food.
At children at dysentery prescription of antibiotics of group of penicillin or furasolidone is reasonable.
At Fleksner and Zonne's dysentery purpose of a polyvalent bacteriophage is possible.
At unsharply expressed symptoms of dehydration it is necessary to have sweet tea or 5% glucose solution. At dehydration of deeper degree infusional therapy is appointed.  
Enterosorbents (for example, Enterodesum) apply for the purpose of elimination of toxins from an organism. Fermental drugs are appointed as replacement therapy, festal, digestal, Pancreatinum are most popular.  
At a recovery stage after the postponed disease purpose of eubiotik follows. Correction of an intestinal dysbiosis allows to eliminate conditions for preservation of a dysenteric stick that interferes with further spread of a disease.