Who causes dysentery. Dysentery (shigellosis): symptoms and treatment
Dysentery (shigellosis) is an intestinal infectious disease characterized by damage to the intestines (mainly the distal colon). The disease is widespread; according to statistics, about 80 million people become ill with shigellosis every year.
Table of contents:Causes
The causative agent of dysentery is bacteria of the genus Shigella. There are about fifty serovars of bacteria of this genus, but Shigella Flexner, Sonne and Grigoriev-Shiga are often the culprits of dysentery.
The source of infection is an infected person. This can be either a person with an acute or latent form of the disease, or a bacteria carrier. The mechanism of transmission of dysentery is fecal-oral, which can be realized through water, food or household contact. Thus, a person can become ill with shigellosis by consuming contaminated water, food, through contaminated household items, or hands. Most often, children, especially preschoolers, suffer from shigellosis, since they do not have developed hygienic skills. If a child with dysentery appears in kindergarten, bacteria from him get onto household items, toys that other children pick up and then put into their mouths.
A feature of dysentery is the fact that the bacteria are localized mainly in the distal part of the large intestine. Shigella secretes toxins that have a destructive effect on the intestinal wall.
Intestinal damage occurs in four stages:
- Catarrhal inflammation (swelling, hyperemia of the mucous membrane);
- Fibrinous-necrotic inflammation;
- Formation of ulcerative defects;
- Healing of ulcers.
Symptoms of dysentery
The duration of the incubation period varies from one to seven days, but this period can sometimes be sharply shortened to several hours. Often the incubation period is two to three days.
Features of the clinical picture are determined by the type of pathogen, course and severity.
There are the following types of dysentery:
- Colitic;
- Gastroenterocolitic;
- Gastroenteretic.
option
This variant of dysentery is called typical. The disease begins suddenly, the body temperature rises, the person suddenly feels weak, weak, and chills. After a couple of hours, the patient begins to be bothered. Initially, the pain is spread throughout the abdomen and is dull in nature, and then it is concentrated in the lower abdomen, especially on the left, and the pain becomes cramping in nature. The pain intensifies with defecation. The urge to defecate is often false and is accompanied by excruciating and nagging pain in the rectal area - this symptom is called tenesmus.
When the doctor palpates the patient’s abdomen, he is able to discover that the large intestine is tense and spasmodic, especially the sigmoid intestine. During palpation, the patient may have an increased urge to defecate.
Another symptom of dysentery is the frequency of stools can reach twenty to thirty times per day. Defecation often does not bring the patient a feeling of relief.
At the beginning of the disease, stool is profuse, gradually becoming more and more liquid, and its quantity decreases. They appear in the stool, less often blood. The stool may consist of only a small amount of mucus and blood, a symptom called “rectal spitting.”
The duration of the height of the disease is from one to two to eight days. After which the signs of the disease gradually fade away.
Gastroenterocolitic variant
Characterized by a short incubation period and sudden onset. This variant of dysentery is characterized by damage not only to the intestines (enterocolitis), but also to the stomach (). The disease also begins with fever, chills, and weakness. But soon they arise, multiple and spilled. Then appears abundant watery discharge without pathological impurities. The stool becomes less abundant, and it is possible to detect mucus and streaks of blood in it.
Diagnosis of shigellosis
To confirm the diagnosis, the doctor will need test results. The patient must undergo the following tests:
Treatment of dysentery
The basis of dysentery therapy is the prescription of etiotropic drugs. Thus, in the treatment of patients with mild severity, nitrofurans (furazolidone), as well as quinolines (chloroquinaldone), are prescribed. For the treatment of patients with moderate severity, medications of the sulfamethoxazole group (Bactrim), fluoroquinolone derivatives (ciprofloxacin, ofloxacin) are prescribed. In severe cases of the disease, the best effect can be achieved by prescribing a combination of parenteral fluoroquinolones with aminoglycosides (for example, gentamicin), cephalosporins (ceftriaxone).
The patient is also required to be prescribed detoxification agents (Ringer's solution, Trisol, Acesol). In severe cases, colloidal solutions are also prescribed (for example, hemodez, rheopolyglucin).
After an active course of treatment, if signs are present, the doctor may prescribe the patient drugs that normalize the intestinal flora (lactobacteria, bifidumbacteria).
We recommend reading:Please note: dysentery, like other intestinal infections, can occur in a latent form. In this case, the symptoms of the disease are mild and do not bring severe discomfort to the person. As a rule, a person does not turn to doctors. So, the patient, without knowing it, is a source of infection. Therefore, if signs of intestinal infections occur, you should definitely consult a doctor.
Definition of disease. Causes of the disease
Shigellosis (dysentery)- a group of acute/chronic diseases caused by bacteria of the genus Shigella, which affect the gastrointestinal tract (mainly the distal colon). Manifest forms (clinical picture) of dysentery: syndrome of general infectious intoxication, syndrome of gastrointestinal tract damage (distal colitis), dehydration syndrome. In the absence of adequate treatment, it leads to serious complications and chronicity.
Etiology
Kingdom - bacteria
family - intestinal bacteria (Enterobacteriaceae)
genus - Shigella
types - 4 main:
- Dysenteriae (serovar - Shigella Grigoriev-Schig, Stutzer-Schmitz, Large-Sachs);
- Flexneri (Flexner);
- Boydii (Boudii);
- Sonnei (Sonne).
They are facultative anaerobic (able to exist both in the presence and absence of oxygen), gram-negative, immobile rods. They grow well on regular nutrient media.
They have an O-antigen (serological specificity) and a K-antigen (shell structure). The cell wall consists partly of endotoxin (lipopolysaccharide), which is released when the microorganism dies. Bacteria of the species Shigella Dysenteriae serovar Grigoriev-Shiga produce a highly active cytotoxin that disrupts protein synthesis by ribosomes of intestinal epithelial cells. Cytotoxin, in combination with enterotoxin (increasing the secretion of fluid and salts into the intestinal lumen) and neurotoxin (having a neurotoxic effect on the Auerbach plexuses) forms an exotoxin - a toxin released during the life of Shigella (Cytotoxin + enterotoxin + neurotoxin = exotoxin). Also, this group of microorganisms releases hemolysins - substances that destroy the endothelium of capillaries and cause ischemia in the intestinal tissues).
Pathogenicity factors of Shigella (mechanism of bacterial adaptation):
- adhesion (attachment to the intestinal mucosa);
- invasion (penetration into the epithelial cells of the mucous membrane of the large intestine);
- toxin formation;
- intracellular reproduction.
Tinctorial properties (features of microorganisms when stained): quickly change sensitivity to antibacterial drugs. Characterized by high survival in the external environment (in water, soil and food at room temperature they remain up to 14 days, in sewage - up to 30 days, under favorable conditions they can be viable for up to 4 months). Capable of reproduction in food products. When exposed to UV rays (ultraviolet irradiation) they die in 10 minutes, in 1% phenol - in 30 minutes, when boiling - instantly.
An interesting feature: the higher the enzymatic activity of Shigella, the lower the virulence (the minimum dose of the pathogen that can infect a person) and vice versa.
Epidemiology
Anthroponosis (widespread).
The source of infection is a person (patient, carrier and persons with a subclinical form of the disease).
The minimum infectious dose for the Grigoriev-Shiga bacterium is 10 microbial bodies in 1 gram of substance, for Flexner - 10 2 bacteria, for Sonne - from 10 7.
For a long time, cases of infection caused by Shigella Flexnera 2a prevailed in the Russian Federation, but currently, due to the widespread development of tourism, there is no long-term predominance of any form.
The transmission mechanism is fecal-oral (food, water, contact-household), of which mainly:
- Grigorieva-Shiga (contact and household path);
- Sonne (with milk and dairy products);
- Flexner (waterway);
- Dysentery (food route).
Food and water workers pose the greatest danger. Patients are contagious from the onset of the disease (end of the incubation period) until three weeks of illness.
Immunity is short-lived and monospecific (produced only to one serotype that caused the disease).
If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
The incubation period is from 1 to 7 days.
The onset of the disease is acute (the development of the main syndromes is observed on the first day of the disease), and a constant type of fever is characteristic.
Syndromes:
- general infectious intoxication - first of all;
- lesions of the gastrointestinal tract (GIT) - ;
- dehydration - dehydration of the body.
Characteristics of gastrointestinal tract lesion syndromes
The disease begins with the gradual appearance of chilliness of the extremities, discomfort in the lumbar region, an increase in body temperature to 39 ° C and above, chills, severe weakness, and a feeling of weakness. Appetite decreases, adynamia, headache, and dizziness appear. Sometimes nausea and vomiting occur. The mouth becomes dry, hiccups may appear, and pain in the eyes due to dry conjunctiva.
Abdominal pain is diffuse, initially dull and constant, then turns into acute cramping in the lower abdomen, intensifying before defecation. At the end of the first day, tenesmus occurs - convulsive contractions of the muscles of the sigmoid and rectum at the time of defecation and continuing thereafter in an amount of 10-15 times. There is an increase in the frequency of stools up to 10 times or more (several hours after the onset of the disease), accompanied by a feeling of incompleteness of the act of defecation.
Objectively: dry, pale skin, pointed facial features, sunken eyes. The stomach is pulled in. Lymph nodes are not affected.
From the cardiovascular system: in case of mild illness - bradycardia (rare heart rhythm), decreased blood pressure. In moderate and severe forms - tachycardia, low-fill pulse, muffled heart sounds, sometimes an increase in heart size, emphasis of the first tone on the pulmonary artery.
From the respiratory system: in severe forms of tachypnea (rapid shallow breathing over 20 per minute).
From the gastrointestinal tract: upon palpation, spasm and soreness of the large intestine (mainly the sigmoid), mushy stool with blood, mucus (sometimes a type of meat slop), initially of normal volume, then its reduction to “rectal spit” (a small lump of mucus streaked with blood) is observed. In an extremely severe form, there is a gaping of the anus due to paresis of the sphincters, rumbling, splashing noise, and possibly bloating.
From the urinary system: frequent urge to urinate (reflexive in nature).
During pharyngoscopy: dry mucous membrane of the oropharynx, dry tongue, covered with a brown coating.
Severity criteria:
- mild course (without dehydration);
- moderate course (dehydration of the first degree, stool up to 20 times);
- severe course (dehydration of II-III degree, uncounted stools).
Clinical manifestations of dehydration (according to Pokrovsky)
Forms of the disease
Erased current: There are no or minimal complaints. Spasm and tenderness of the sigmoid colon are moderate; sigmoidoscopy reveals catarrhal proctosigmoiditis (inflammation of the rectum and colon).
Subclinical form: absence of clinical manifestations, isolation of Shigella when stool is cultured on nutrient media, positive serological reactions.
Protracted current: clinical manifestations, Shigella excretion for more than two weeks in case of mild disease, three weeks in case of moderate disease and four weeks in case of severe disease (reasons: immunodeficiency, inadequate etiotropic therapy).
Chronic relapsing: the period of exacerbation is replaced by a period of clinical well-being, which is interrupted by the next exacerbation. The patient's condition is relatively satisfactory, he stools up to five times a day. It can last up to three months.
Chronic continuous: no remission (improvement), steady progression of the pathological process and deterioration of the condition. The syndrome of general infectious intoxication is moderately expressed.
Bacterial carriage:
Pathogenesis of dysentery
The entrance gate is the oral cavity, where the influence of nonspecific immunity factors on the pathogen (lysozyme, macrophages, IgA) begins. Shigella then enters the stomach, where they come into contact with hydrochloric acid, after which the microorganisms partially die, releasing endotoxin. The surviving bacteria move into the small intestine, producing a mildly expressed process due to the lack of their affinity for enterocytes, and the pathogenic effect of lymphocytes in relation to Shigella is manifested. Afterwards, the pathogen reaches the distal parts of the large intestine, where active proliferation of bacteria and their partial death occur, accompanied by significant formation of endotoxin (acute infectious toxicosis). The resulting immune complexes (including lipopolysaccharide) are fixed in the capillaries of the mucous membrane of the large intestine, where they disrupt microcirculation, cause increased permeability of the vascular wall, platelet aggregation (DIC syndrome) with simultaneous toxic damage to the central nervous system (central nervous system) and cardiovascular systems. Shigella penetrates colonocytes, where they multiply and cause fatal destructive processes.
It should be understood that the leading damaging factor is the pronounced toxic effect of Shigella - toxins, acting on the nerve nodes of the intestine, disrupt blood and lymph circulation, cause pain and increased bowel movements. Spasm of different segments of the intestine is uneven, which leads to overflow of the upper sections and emptying of the lower ones, which also provokes pain along the intestine, a decrease in the amount of feces and tenesmus. Protein synthesis in the intestinal wall is disrupted, which leads to epithelial necrosis and the formation of mucosal defects (ulcers).
During the course of the disease, Shigella is first exposed to macrophages of the intercellular space, then natural killer cells are activated, interferons are synthesized and the number of lymphocytes increases, various classes of specific antibodies are formed, which play a decisive role in eliminating the pathogen. With immunodeficiency, complete elimination of Shigella does not occur, and a chronic course of the disease or carrier state is formed.
Classification and stages of development of dysentery
According to clinical form:
- typical;
- erased;
- subclinical;
- bacterial carriage (convalescent and transient).
By disease duration and type:
a) acute (colitic and gastrocolytic) - up to three months:
- cyclic;
- protracted;
b) chronic (more than three months):
- recurrent;
- continuous.
By severity:
- light;
- moderate;
- heavy;
- extremely heavy.
Complications of dysentery
- infectious-toxic shock (often occurs 2-3 weeks from the onset of the disease);
- infectious toxic encephalopathy;
- perforation of the large intestine (peritonitis);
Diagnosis of dysentery
Laboratory diagnostic methods include:
- general clinical blood test with leukocyte formula (neutrophilic leukocytosis with a shift of the leukocyte formula to the left, toxic granularity of neutrophils, erythrocytosis, increased ESR);
- general clinical urine analysis (proteinuria, erythrocyturia, increased density);
- biochemical blood test (increased prothrombin index, fibrinogen, ALT, amylase);
- coprogram (mucus, blood, leukocytes, etc.);
- serological diagnostics (RNHA - indirect hemagglutination reaction - with complex dysentery and salmonellosis antigens - diagnostic titers of at least 1:200/1:400 with increasing phenomena over time);
- bacteriological method (bacteriological culture of stool for dysentery group - response in 4-5 days);
- PCR diagnostics of stool, giving a quick answer about the presence or absence of Shigella without typing;
- sigmoidoscopy (for mild severity in persons of the decreed contingent);
- electrocardiography.
If complications develop, appropriate research methods are used according to the situation.
In the case of dysentery among workers in the catering, education, health and service sectors (designated groups), all of the above research methods are required.
Treatment of dysentery
Treatment of mild and moderate forms of the disease can be carried out on an outpatient basis, severe forms, as well as for persons of the decreed contingent - on an inpatient basis in the infectious diseases department.
Mode - semi-bed (depending on the severity), ward.
Diet No. 4 according to Pevzner is indicated, with a minimum of fiber, carbohydrates, excluding fatty, fried, spicy, soda, and drinking plenty of fluids.
Drug therapy begins with antibiotic therapy for any degree of severity and nature of the disease (in most cases it is ex juvantibus, that is, treatment is carried out until test results are received). The first-line drugs of choice are fluoroquinolone and cephalosporin antibiotics, usually prescribed for up to 5-7 days. Treatment should be carried out under the supervision of a physician; reduction or unauthorized changes in its composition are not allowed (to avoid the development of antibiotic resistance).
Pathogenetically, drinking plenty of saline solutions (Philips solution, rehydron, gastrolit, etc.) is indicated; in case of vomiting, parenteral administration of special solutions (Trisol, Acesol, etc.).
To relieve spasm and pain, antispasmodics are prescribed; for hemorrhagic syndrome, heparin, etc.
In the first days, the use of enterosorbents is indicated (then they lose their therapeutic function and can cause harm).
With significant fluid losses, drugs that delay increased fluid secretion into the intestinal lumen make a certain sense ( but not stopping motor skills).
In order to normalize the intestinal microflora, taking pro- and prebiotic agents and pancreatic enzymes is recommended.
Patients are discharged upon normalization of the clinical picture, general laboratory data (blood and urine) and a single negative stool test using the tank method. sowing no earlier than two days after the end of antibiotic therapy (except for decreed contingents).
Dispensary observation is carried out for three months from the tank. sowing at the end of each month and the end of the observation period.
Forecast. Prevention
The basis of prevention is compliance with sanitary and hygienic standards and rules for the production, processing (heat treatment) and consumption of food, examination of persons of the decreed contingent (if a disease is detected in them, admission to public catering facilities is denied for up to three months).
After the dysentery pathogen enters the body, the first signs of the disease appear on average after 3 days, in some cases after 7. The first symptoms of the pathology are an increase in central body temperature, usually up to 38 degrees, followed by chills and fever.
In rare cases, the temperature can reach 40 degrees, which completely eliminates home treatment. The febrile state persists for approximately 3-5 days, then the temperature begins to drop. Occasionally, dysentery occurs without an increase in temperature, but this does not mean that the disease is too mild, since the pathology can cause quite serious consequences.
The disease is characterized by intoxication of the body, so the patient may complain of headache, general weakness, and loss of appetite. These signs are observed quite early and indicate intoxication, which begins to rapidly increase.
The signs described above are symptoms that accompany the development of dysentery and are directly related to the pathological effects of the pathogen’s toxin. Signs of a different nature are associated with the effects of Shigella (the causative agent of dysentery) on the gastrointestinal tract.
Against this background, it is customary to distinguish several forms of dysentery:
- colitis;
- gastroenteritis;
- gastroenterocolitic.
Dysentery is bacterial in nature, and therefore most often occurs with damage to the large intestine, due to which colitis and gastroenterocolitic forms are mainly diagnosed.
Dysentery: characteristic symptoms
As a rule, dysentery most often occurs as a type of colitis, so it is advisable to consider its symptoms.
The main signs of this form of dysentery are abdominal pain, localized in the lower part of the small intestine. The pain is complemented by characteristic intestinal contractions and a false urge to defecate. With dysentery, bowel movements are always scanty; in mild cases, the stool is liquid and mixed with mucus; in severe cases, the discharge is insignificant and streaked with blood.
In mild cases, bowel movements can occur up to 5-10 times a day, in severe cases - up to 50. Against this background, the patient experiences significant dehydration, requiring rehydration treatment. Also, severe forms of pathology are characterized by the development of disturbances in intestinal motor activity (peristalsis), due to spasms and bloating, which often occur with dysentery.
In the case of pathology of the gastroenterocolitic and gastroenteric forms, vomiting and diarrhea of an already pronounced nature join the general signs of dysentery.
As a result, obvious symptoms of dehydration and water-electrolyte imbalance develop. The insidiousness of dysentery is its ability to imitate any other intestinal infection, so laboratory tests are an important aspect in making the correct diagnosis.
Chronic dysentery: symptoms of pathology
Incorrect or untimely treatment of dysentery provokes its transition to a chronic form. In this case, a recurrent and continuous form of the disease is distinguished.
In clinical practice, a recurrent form is more common, characterized by alternating exacerbation of dysentery and improvement of the patient's condition. Symptoms of chronic dysentery are equivalent to the symptoms of a pathology of moderate severity.
In some cases, dysentery may occur continuously. However, this phenomenon is rare and is diagnosed mainly in elderly patients. Against the background of a continuous course and the age of patients, progressive dysbiosis, disruption of the gastrointestinal tract and general exhaustion of the body are added to the standard symptoms of the pathology.
Dysentery: treatment at home
How and how to treat dysentery at home? It is immediately worth noting that treatment of dysentery at home is permitted in mild forms of the pathology. If the disease progresses and more serious symptoms develop (as discussed above), you should contact the infectious diseases department of a medical institution.
For simple forms of dysentery in adults, when symptoms are not pronounced, treatment at home is quite possible. If you notice the first symptoms of the disease, increase your fluid intake and also administer the drug Regidron. The product is used to restore acid-base balance in case of diarrhea and vomiting due to acute intestinal infections (acute intestinal infections). Please note that this disease does not require the use of antidiarrheal drugs. Further treatment is prescribed only by a doctor; it must be comprehensive and selected individually.
For mild dysentery, the following antibacterial drugs are most often prescribed:
- Furadonin;
- Nitroxoline;
- Macropen.
For moderate illness, stronger drugs are prescribed:
- Ofloxacin;
- Enterofuril.
In case of severe forms of the disease, broad-spectrum antibiotics and antibacterials are prescribed, usually 3-4 generations:
- Ofloxacin;
- Tsiprolet;
- Ceftriaxone.
In case of obvious intoxication, crystalloid solutions in the form of droppers can be added to the main treatment. Also, for any form of dysentery, enterosorbent drugs and enzyme agents (Atoxil, Pancreatin) are prescribed. Atoxil eliminates signs of intoxication and removes toxins, Pancreatin- normalizes the functioning of the intestines and pancreas.
To eliminate intestinal spasms and pain, it is prescribed Drotaverine(antispasmodic) and Nalgesin forte (painkiller). It is mandatory to appoint Regidron, to eliminate dehydration.
In addition to standard dysentery, there are other types of disease that require a special approach to therapy. Thus, Sonne and Flexner dysentery is treated with the help of a dysenteric polyvalent bacteriophage. The drug is approved for use by adults and children over 6 months.
The chronic form of the pathology also has its own characteristics. Complex treatment includes not only taking antibacterial agents and rehydrate solutions, but also a course of immunomodulating agents.
Treatment of dysentery is impossible without following a diet. As a rule, foods that provoke fermentation in the intestines are excluded: fruits, bread, some types of vegetables, smoked foods, semi-finished products.
It is mandatory to increase fluid intake (still water, dried fruit compotes) to 2-3 liters per day.
Treatment of dysentery at home: diet
To achieve the highest possible therapeutic effect, drug therapy must be accompanied by a certain diet. Prescribe gentle products, namely dietary table according to Pevzner (No. 4). During the rehabilitation period, it is recommended to follow table No. 2, on average this is about 4 weeks.
All dishes must be boiled or steamed. It is allowed to eat low-fat meat and fish, porridge with water, crackers or yesterday's bread, vegetable/meat broths, jelly, weak tea, compotes. All food should contain a minimum amount of salt and acid; the use of hot seasonings and pepper is excluded.
When treating dysentery at home, as well as during the rehabilitation period, the intake of alcoholic beverages, carbonated waters, canned food, legumes, and fresh baked goods is completely excluded.
Basically, the diet is the basis on the table for patients with exacerbation of ulcer pathology. Therefore, all meals are divided into 5-6 times, the portions are small.
Treatment with folk remedies
It is immediately worth noting that the use of traditional medicine recipes is advisable in combination with drug treatment, when both therapies enhance the therapeutic effect of each other. Treatment with folk remedies as the main therapy is not justified.
The following traditional medicine methods can be used as additional treatment methods:
- Burdock juice. Take 1 teaspoon 3-4 times a day before meals.
- Herbal collection. Consists of wild rosemary leaves, marshmallow root, oregano. All components are mixed in equal proportions and brewed. Drink 25 ml every 3 hours.
- Blueberry. Dry berries are used. For 1 liter of boiling water, 250 grams of berries, brew in a water bath and drink 50 ml 3-4 times a day.
- Herbal collection No. 2. Take in equal quantities: plantain, peppermint, fireweed, marshmallow root. The mixture is infused in a water bath at a ratio of 1 to 2. Take 100 ml 3 times a day before meals.
To reduce the severity of unpleasant symptoms, you can use an alcohol extract of propolis. The product is sold in pharmacy chains and is used at the rate of 1 teaspoon per 450 ml of water. Take 100 ml 3-5 times a day. The therapeutic course is 7-10 days. Please note that this recipe is not suitable for patients with intolerance to bee products.
If the patient does not have allergies, it is recommended to eat a small amount of natural honey during the day. This product promotes faster elimination of Shigella during bowel movements. Due to this, recovery is observed much faster.
Dysentery is a general infectious disease caused by dysentery bacteria. Most often the development of the disease is provoked by shigella . Amoebic dysentery manifests itself as a consequence of infection gnostolytic amoeba . With the development of this disease in humans, the mucous membrane of the large intestine is mainly affected.
Dysentery is most often diagnosed in children aged two to seven years. But the disease can affect people from any age group. Less commonly, signs of dysentery are recorded in infants, since in the first months the child has a strong dysentery inherited from his mother. As a rule, the disease can develop in infants if the water or food contains the causative agent of dysentery.
Symptoms of dysentery mainly appear in the summer. The infection spreads quickly, and if basic hygiene rules are not followed, the child may need treatment for dysentery. That is why disease prevention consists, first of all, in strict adherence to general hygiene standards.
Amoebic dysentery
Amoebic dysentery (amoebiasis ) is caused by a gnostolytic amoeba. Infection occurs when mature cysts of the Histolithic amoeba enter the gastrointestinal tract through the mouth. A person can become infected if they drink raw water that has been contaminated, as well as by consuming foods contaminated with the pathogen. This disease is most often diagnosed in areas where the climate is very hot.
With this form of dysentery, the incubation period can last up to 30 days. There are three forms of the disease: extraintestinal , intestinal , cutaneous amoebiasis . Intestinal amoebiasis is the most common. In turn, this form is divided into amoebic colitis And amoebic dysentery . With amoebic colitis, a person’s appetite decreases, abdominal bloating appears, and constantly alternate constipation And diarrhea . After defecation, the patient constantly experiences the feeling that the intestines have not been completely emptied. The stool has a mushy consistency and contains mucus. Sometimes blood may also be found. The temperature in an acute condition increases slightly and for a short period.
With amoebic dysentery, patients note severe aching or cramping pain, loose stools with blood and mucus, general weakness and malaise. Stool can appear up to 10 times a day. A moderately elevated body temperature persists for 3 to 5 days. There is also bloating and a coating on the tongue. Sometimes doctors also note an enlarged liver.
With both types of amebiasis, a person’s ability to work is reduced, anemia, and poor sleep. During a rectal examination, ulcers in the distal colon and mucosal ulcers are detected.
With extraintestinal amebiasis, the liver is most often affected, and amoebic hepatitis develops. Cutaneous amebiasis develops, as a rule, with the intestinal form.
As complications of amebiasis, pericolitis, intestinal, intestinal obstruction, lung abscesses, and subdiaphragmatic abscesses can develop.
The diagnosis is made based on epidemiological data. The doctor studies the medical history in detail and examines the patient. Also an informative method of research is sigmoidoscopy and parasntoscopic examination of the patient’s stool.
Treatment of amoebic dysentery involves compliance with diets , the use of pathogenetic and symptomatic drugs. Also, if necessary, patients are prescribed antihistamines and vitamins.
How is dysentery transmitted?
The causative agents of the disease are in the form of rods. They die instantly at a temperature of 100C; at a temperature of 60C they can survive for about half an hour. The pathogen dies in the stool within a few hours.
The infection spreads from patients with acute and chronic forms of the disease. Infection is also possible from bacteria excretors, which are people with a mild course of the disease. Such patients do not consult a doctor due to the mildness of their symptoms. The infection can be transmitted through food and drink, and it can also be spread by flies. Transmission of the pathogen can also occur through dirty hands.
Symptoms of dysentery
There are two forms of dysentery - acute And chronic . In the acute form of the disease, a person can be sick from 3-4 days to three months. If the disease continues longer, then we are talking about a chronic form of dysentery. The duration in both cases can vary from 18 hours to 5 days.
If the patient has a moderate course of the disease, then its symptoms are more acute. Initially, a person feels weak and unwell, and may shiver a little. Later, cramping pain appears in the left side of the lower abdomen. The stool is liquid, with blood and mucus, its frequency sometimes reaches 25 times a day. In the first two days of dysentery development, the frequency of stool increases. In addition, the patient's body temperature rises, which can reach 39 degrees, and he is bothered by a headache. The temperature subsides after 2-5 days.
For most patients, abdominal pain does not subside for a long time. Sometimes the pain does not subside even for a while. As a rule, the stomach hurts in the lower left part, but some patients note that the pain is diffuse. Often also noted. In severe forms of acute dysentery, the onset of the disease is always violent. The patient is experiencing very severe pain in the lower abdomen, which is cramping in nature. The stool is loose and very frequent, vomiting, nausea may occur, and the body temperature rapidly rises. In addition to mucus and blood, pus may be found in the stool. The patient's pulse quickens, blood pressure decreases, and... Severe dysentery can last up to 6 weeks. If the disease is not adequately treated, it can become chronic.
A child with dysentery immediately has abundant stool, but then its appearance changes, lumps of gray-green mucus appear in it. At this time, the child’s body becomes very dehydrated. If the baby has dry mucous membranes, then we are talking about a significant loss of fluid. Parents should also be aware of the fact that dehydration is more dangerous the younger the child.
In severe cases of dysentery, the baby may develop cardiovascular failure , appear convulsions ,consciousness is impaired . In this case, urgent hospitalization is important.
A sick baby with dysentery has cold limbs and constantly regurgitates. Sleep is very restless and bad.
Diagnosis of dysentery
To diagnose dysentery in a patient, bacteriological culture of stool is performed in the laboratory. To ensure the accuracy of the research result, the analysis is carried out three times. However, this method is not always suitable for diagnosis, since results appear only after a week. In order to speed up the diagnosis of dysentery, detection of the causative agent of the disease and toxins in the blood and feces is practiced.
In this case, immunological methods are used. To determine the presence of Shigella, the polymerase chain reaction method is used.
In the process of establishing a diagnosis, the patient also undergoes a stool analysis (coprogram). If the test material contains a large amount of mucus and at the same time an increased number of leukocytes and red blood cells are present, then the integrity of the intestinal mucosa is most likely compromised.
Treatment of dysentery
In the process of treating dysentery, the most important point is the destruction of the causative agents of the disease. It is also necessary to restore normal water-salt balance and ensure detoxification of the body. If the disease is severe, the patient is treated in a hospital. Mild dysentery can be treated on an outpatient basis.
Medications belonging to the group effectively combat Shigella nitrofuran series , and also quinolines , fluoroquinolones . When prescribing antibacterial drugs, the doctor must be guided by the characteristics of a particular case. After all, it is important to take into account the sensitivity of the Shigella species to the specific drug prescribed. The patient takes antibacterial drugs for 3-4 days if he is diagnosed with a moderate form of the disease. If we are talking about a severe form of the disease, then antibacterial agents are prescribed for 5 days.
During this period, the patient's general condition gradually improves, the temperature returns to normal, the nature and frequency of stool also normalize. After the course of antibiotic therapy ends, the patient still experiences mild intestinal dysfunction for several days. The stool remains liquid, its frequency is no more than three times a day. But at this time there is no longer any need to take antibiotics.
If a patient is diagnosed with a mild degree of the disease, then he is advised to drink plenty of fluids. The fact is that in the process of vomiting and diarrhea, the body loses fluid and salts. The most optimal drink would be water with the addition of soda, salt and sugar. You can also add a special preparation to the water rehydron . You need to drink in small portions and often. In severely ill patients, special solutions are administered intravenously in order to restore the water-salt balance.
In order to remove toxins from the body when treating dysentery, a course of treatment with enzyme preparations is prescribed. Patients take calcium supplements . In addition, enterosorbents are used for treatment: activated carbon , enterosorb , . They help remove toxins from the patient’s intestines. The course of treatment also includes high doses of vitamins.
If there is a need to relieve a severe pain attack, then other drugs that relieve spasms are used for this purpose.
When treating this disease, the correct approach to nutrition is important. You should not eat foods that enhance fermentation processes in the intestines. These are milk, legumes, black bread, cucumbers, beets, cabbage.
When treating children, special attention must be paid to nutrition. If a child categorically refuses to eat, then force-feeding him is not recommended. During the period when the child feels better and has an appetite, it is advisable to reduce the amount of food by half and increase it gradually. This will prevent overloading the recovering baby’s body. But the child should drink as much as possible. Compotes and fruit drinks are ideal for this.
Some traditional methods of treating dysentery are also practiced. However, they can only be used after the approval of the attending physician. You can prepare an infusion of oak bark, a decoction of honeysuckle flowers, an infusion of yarrow flowers. An effective remedy for the treatment of dysentery is burnet root, from which an infusion is also prepared. Also used are decoctions and infusions of plantain herb, the fruits of bird cherry, blueberry, and blackberry leaves.
Doctors
Medicines
To prevent the disease, it is very important to comply with all sanitary and hygienic standards. In order to prevent mass infection of the population, strict sanitary supervision is carried out over enterprises that produce food products and provide public catering. It is equally important to control the water supply. All these measures are aimed at preventing the massive spread of intestinal infections.
Personal prevention measures include, first of all, regular and thorough hand washing. In addition, it is important to promptly get rid of flies indoors and prevent them from coming into contact with food. Parents should make every effort to protect their child from infection by pathogens. You should not only ensure that the child washes his hands after using the toilet and walking, but also avoid eating unwashed fruits and vegetables.
Diet, nutrition for dysentery
List of sources
- Shuvalova E.P. "Infectious diseases". - M.: Medicine. - 2001;
- Pokrovsky, V.I. Bacterial dysentery / V.I. Pokrovsky, N.D. Yushchuk. - M.: Medicine, 1994;
- Shakhmardanov M.Z., Luchshev V.I., Kornilova I.I., Sokolova L.V., Onukhova M.P. Flexner's shigellosis (clinic, diagnosis, treatment). Methodological recommendations of the Ministry of Health of the Russian Federation. M: Publishing house "Hermes-MTK". 2000;
- Yushchuk N. D., Brodov L. E. Acute intestinal infections: diagnosis and treatment. - M., 2001.
