Dysentery: symptoms and treatment, prevention

Dysentery - acute bacterial intestinal infection, is characterized mainly by the damage of the colonic mucosa membrane.

The disease becomes kind of Shigella bacteria, Gram-negative rods still not forming spores, fine breeding in nutrient media, but extremely low resistance to external factors. In particular, Shigella instantly killed by boiling and for 10 minutes at a temperature above 60 degrees.

The main source of the disease is asymptomatic carriers or sick person. Special epidemiological risk patients carry with erased or mild dysentery, as well as people working in the catering establishments and the food industry.

What it is?

Dysentery - a contagious general disease that causes dysentery bacteria.

Most often provoke the development of disease Shigella. Amoebic dysentery seen as a consequence of infection gnstoliticheskoy amoeba. With the development of this disease in humans mainly affects the mucous membrane of the colon.

As the disease develops

Dysentery damaged the lower large intestine - the sigmoid colon and rectum, and her sphincter.

1. With food, water or through the patient's everyday objects Shigella initially enter the stomach, where there are few hours (rarely days). Some of them are killed. Thus endotoxins are allocated.
2. Further pathogens enter the small intestine, where the stick with isolated enterocytes and enterotoxic exotoxin, under whose influence a lumen intensively secreted fluid and electrolytes.
3. Hemolysin Shigella, located in their outer membrane, facilitates the penetration of pathogens in epithelial cells (preferably the ileum), where they begin to proliferate. Enterocytes damaged. The inflammation of the intestinal wall. Heighten damage the gut wall immune complexes, which include an endotoxin. They are fixed in the capillaries of the mucous membrane of the colon and disrupt microcirculation.
4. Sensitized eosinophils and mast cells to secrete toxic substances. Enhanced the cytotoxic effect of leukocytes. All this contributes to the development of DIC from the 2nd week of the onset of the disease. Developing thrombosis mesenteric vessels, including vessels of the lungs and brain.
5. Intoxication causes flow of endotoxin dead Shigella in patient blood. On admission of bacteria in the blood develops bacteremia.

Shigella toxins affect the central and autonomic nervous system, cardiovascular and digestive system, adrenal glands. In chronic dysentery comes to the fore not intoxication, as a violation of the gastrointestinal tract.

When curing the body is completely free of infection. When the immune system is not the recovery is delayed up to a month or more. Some of the patients become carriers of infection. In some patients, the disease becomes chronic.

The causative agent of dysentery

The causative agent is a bacterium Shigella - fixed coli genus Shigella. Are 4 kinds of bacteria, each of which is able to cause dysentery in man: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

A feature of Shigella is their ability to rapidly acquire resistance to antibiotics. All the more common bacteria that are resistant to conventional treatment. In addition, the bacteria are extremely stable in the environment - under the right conditions can maintain its pathogenic properties to a few months, including in food.

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

endotoxin	toxin, which is part of most of the bacterial cells. It is the cause of intoxication symptoms - fever, feeling of weakness, pain in muscles and joints.
invasin	proteins providing invasion - penetration of bacterial cells in the intestinal mucosa. Most often the bacteria affects the lower large intestine.
exotoxin	toxin which is produced by bacteria and vybrazyvaetsya in blood. Most pathogenic toxin is serovar Shigella dysenteriae 1 (Shiga-shigella Grigoriev) called Shiga-toxin. Exotoxin is a cause of diarrhea.

Mechanism dysentery infection - fecal-oral, i.e. bacteria of the intestine gets sick person in the gastrointestinal tract of healthy humans.

There are a number of transmission paths. It is contact-household way - through unwashed hands under poor personal hygiene; food - in contact with bacteria in food products; and water - at the use of the infected water. In addition, infection is possible when swimming in polluted waters.

symptoms of dysentery

Manifest the first symptoms of dysentery begin 2-3 days after infection, when the food the way, this time can be reduced to hours, contact-household path can be extended to 7 days. In most cases, the disease begins acutely, can sometimes be a prodrome of malaise, chilling or headache. Severity distinguish mild, moderate, severe and very severe.

The most characteristic features of the disease in the embodiment dysentery with lesions of the colon.

The disease usually begins with the appearance of pain in the stomach, followed by the frustration of a chair is attached. Dysentery may begin with a general manifestations - weakness, lethargy, temperature elevation, headache, etc... The most severe manifestations of the disease was achieved on the 2-3rd day of illness. For this form of dysentery characterized by the predominance of local phenomena.

The most complete dysentery presented with moderate forms of the disease. Characterized by the acute onset, fever and chills (up to 38-39 ° C) which lasts 2-3 days. Concerned about the weakness, headache, decreased appetite. Intestinal disorders occur in the first 2-3 hours after the onset of illness and manifested by discomfort in the abdomen, rumbling, periodic, cramping abdominal pain, stool frequency ranges from 10 to 20 times day. The chair has a first fecal character, then there is an admixture of mucus, blood and pus, reduces the amount of feces, they can acquire the kind of spit - mucus and blood.

There have been sharp urge to defecate. The skin becomes pale, the tongue is covered with a thick brown bloom. Cardio-vascular system marked palpitation, reduction in blood pressure. The most characteristic symptoms are cramps and pain on palpation of the left iliac region.

The duration of intoxication at moderate form of dysentery is 4-5 days. The chair is normalized to the 8-10 th day of the disease, but the disease can be delayed up to 3-4 weeks.

severe form

Heavy for dysentery is characterized by a very rapid development of the disease, pronounced intoxication, deep disorders of the cardiovascular system.

The disease starts very quickly. Body temperature rises rapidly to chill to 40 ° C and above, patients complain of severe headache, general sharp weakness, increased sensitivity to cold, especially in the extremities, dizziness when standing up from the bed, the complete absence appetite.

Often have nausea, vomiting, hiccups. Patients concerned about abdominal pain accompanied by frequent urge to defecate and urinate. Chair more than 20 times a day, the number of bowel movements is often difficult to count ( "a chair without an account"). The height of the disease lasts 5-10 days. Recovery is slow, up to 3-4 weeks, the full normalization of the intestinal mucosa takes place in 2 months or more.

chronic dysentery diagnosis is established if the condition continues for more than 3 months.

moderate form

Increased body temperature (to 39 ° C) is accompanied by chills and can last from a few hours up to 4 days. Intoxication symptoms are expressed. Stool frequency up to 20 times a day. In the stool blood and mucus streaks. Cramping abdominal pain.

Recorded symptoms of the cardiovascular system: the small filling pulse, tachycardia, systolic blood pressure dropped to 100 mm. Hg. Art., heart sounds are muffled. Tongue dry, thickly coated with white bloom. When sigmoidoscopy recorded catarrhal-erosive changes. Seen multiple hemorrhages, often ulcers. In the blood, increased levels of neutrophils to 109 / L. Symptoms of intoxication and diarrhea lasts 2 - 5 days. Recovery mucosa and normalization of the organism occur within 1 - 1.5 months.

A mild form of dysentery

In less severe disease fever is short, from a few hours to 1-2 days, the body temperature usually rises to 38 ° C. Patients are disturbed by moderate abdominal pain, mainly to act stool.

The stools are pasty or semi-liquid consistency, bowel movement frequency and 10 times a day, the admixture of mucus and blood is not visible. Intoxication diarrhea and stored for 1-3 days. Full recovery occurs in 2-3 weeks.

bacteriocarrier Shigella

If the patient is in the recovery stage Shigella stand out for 3 months, then talk about rekonvalistsentnom of bacteria. If practically healthy person, who has never been sick with dysentery and had no bowel dysfunction within the last three months was noted once the selection of bacteria Shigella, then talk about transient of bacteria.

Diagnostics

To diagnose a patient dysentery, in the laboratory conduct bacteriological stool cultures. For the accuracy of the results of research analysis was performed three times. However, this method is suitable for the diagnosis is not always, as the results come in a week. To accelerate the determination of diagnosis practiced dysentery antigens to pathogens and toxins in the blood and feces.

In this case, we used immunological methods. To determine the presence of shigella method is used the polymerase chain reaction.

In the process of the diagnosis to the patient is also made feces analysis (coprogram). If the test material has a large amount of mucus and thus increase the number of leukocytes and erythrocytes are present, it is most likely disrupted the integrity of the intestinal mucosa.

differential diagnosis

An important object of diagnosis is the exclusion of other enteric diseases or bacterial infectious nature. Parasitism often many species of microorganisms in the intestine causes identical symptoms. It is possible to identify the main symptoms similar with the flow of the disease, but with characteristic differences of dysentery:

1. Salmonellosis. When the feces has salmonellosis hue marsh slime, light or dark green color.
2. Poisoning products. If this condition is not severe cramping pain in the ileum of the peritoneum due to lack of lesions of the colon. And no urge to defecate.
3. Cholera. The disease is not accompanied by pronounced signs of colitis begins with severe diarrhea, vomiting, and stool color reminds congee. No false urges to defecation.
4. Amoebiasis. The disease is not accompanied by fever, febrile syndrome. Fecal include blood and mucous components that resemble jelly crimson. The main causative agent - the amoeba.
5. Intestinal colitis. If colitis infectious nature, that often it is caused by a toxic lesions of the organism in uremic syndrome, the pathological development of the small intestine, cholecystitis, gastritis different nature. Usually the disease does not have seasonality and special foregoing factors against the general health of the patient.
6. Typhoid fever. There are no signs of the disease-specific colitis, but there is a pink rash, severe hyperthermia, the cavity is affected colon.
7. Oncogenic education. colon cancer accompanied by severe diarrhea with blood. The character of the regular chair. Present symptoms of intoxication, but the rapid nature of the disease, as in dysentery, no.
8. Hemorrhoids. When inflammation of hemorrhoids and the hemorrhoids when running after the act of defecation may be noted the appearance of bleeding inclusions in the stool. The disease occurs without obvious inflammatory lesions in the rectum.

Timely definition of dysentery and the type of pathogen it allows to make the necessary treatment plan, accelerate the recovery of the patient, eliminate risks of disease complications.

complications

Consequences of dysentery doctors are divided into two large groups. Actually intestinal complications:

• bleeding due to ulceration of the mucous membranes;
• prolapse of the rectum - is particularly common in children;
• peritonitis as a result of perforation of the intestinal wall;
• megacolon - stretching of the colon;
• intestinal dysfunction, persists for a long time after treatment.

Extraintestinal complications:

• pneumonia;
• pyelonephritis, severe renal insufficiency;
• polyarthritis;
• myocarditis;
• otitis;
• bacteremia with symptoms of severe intoxication, when dysentery bacillus through the bloodstream to penetrate in all the cells - often a critical state ends in death.

dysentery treatment

Adult patients can be treated in a hospital or at home, depending on the severity of infection, the age and condition of the patient, or when it is impossible to treat and care for patients at home.

The main treatment of dysentery is to appoint the following drugs:

1. When selecting antimicrobial agents: mild forms are treated with furazolidone, moderate and severe preferably ftorhinologny or cephalosporins, aminoglycosides (kanamycin).
2. Children from the earliest days of illness should be given glyukozosolevye and saline solutions - "Glyukosolan", "Oral", "Regidron". One bag of the drug should be diluted in a liter of water and to give the baby every 5 minutes. The daily dose should be 110 ml per 1 kg of weight of the child.
3. Eubiotics - bifidobakterin, Baktisubtil, Bifiform, Rioflora immune, Bifikol, Primadofilyus, Lactobacterin, Linex and others. Since antibacterial drugs aggravate the symptoms of intestinal dysbiosis, necessarily shown eubiotics, who are appointed by the course of at least 3-4 weeks (see. full list of analogues Linex).
4. According to the testimony of the doctor may prescribe immunomodulators, vitamins, as well as astringent and antispasmodic.
5. After transferring the acute process to accelerate the recovery of the body it is recommended to use microclysters with herbal decoctions, rose hips and sea buckthorn oils, chamomile, eucalyptus, Vinylinum.
6. Adsorbents chelators - smectite Polyphepanum, POLYSORB, Filtrum STI (Usage intsruktsiyami), activated carbon and so forth.
7. Enzyme complex preparations - Festal, Creon, Panzinorm, Mezim.
8. In chronic dysentery, antibiotics less effective, however appointed physiotherapy, eubiotiki, therapeutic micro enema.

Also assigned light diet - mashed potatoes, rice porridge without salt and rice water, slimy soup.

Force-feed any adult or child should not be the main condition is a sufficient amount of liquid. You can drink milk whey, water, diluted, unsweetened tea. From the diet should exclude cheeses, sausages, smoked meats, prepared foods, convenience foods, coffee, sugar, meat, baking. Only 5 day diet can gradually add yogurt, omelettes, meatballs, boiled fish.

After two weeks you can go on a balanced diet, but it must be balanced dietetically.

Quarantine

Quarantine dysentery declared for 7 days, which corresponds to the incubation period of the disease. The main purpose of quarantine is a sick person limit contact with healthy people. Specific measures under the quarantine depends on the type of institution and epidemiological situation in the country.

The reason for the declaration of quarantine dysentery can be:

1. Identify repeated cases of dysentery in the band for 7 days. In this case, preventive measures are as described above.
2. Identification of dysentery symptoms of two or more persons in the same village, who do not work / do not learn in the same institution. In this case, the probability is high that an infection is present at a local reservoir or public dining. Suspicious institutions and bodies of water at the same time closed and water samples and food are sent to a laboratory for detailed study. All residents of the village and it is recommended to observe good personal hygiene, and to use only well-treated (heat), food and boiled water.
3. The simultaneous appearance of clinical signs of dysentery among two or more persons in the same group (in the kindergarten, in the classroom, and so on). In this case, the group is declared to quarantine. Within 7 days, none of the children can not be transferred to another group. All in contact with the patient must undergo bacteriological testing and start accepting dysentery bacteriophage in prophylactic doses.

Vaccination with dysentery

Immunity (immunity) recovering from dysentery is produced only by the sub-species of the pathogen that caused the disease in a given individual. Immunity persists for a maximum of one year. In other words, if a person is infected with one of the varieties of Shigella dysentery, it can easily infect other Shigella, and in a year may be re-infected with the same pathogen.

Based on the foregoing, it follows that to develop an effective vaccine that could protect people from becoming infected with dysentery for a long time, almost impossible. That's why major importance in the prevention of this disease is given hygienic measures aimed at preventing the contact of a healthy person with an infectious agent.

Nevertheless, vaccination of people against some agents of dysentery (in particular against Shigella sonnei, which are considered the most common) can be carried out under certain conditions.

Vaccination against Shigella sonnei shows:

1. Employees of infectious hospitals.
2. Employees bacteriological laboratories.
3. Individuals traveling to epidemiologically dangerous regions (where there is a high incidence of dysentery sonnei).
4. Children attending kindergartens (when unfavorable epidemiological situation in the country or region).

After administration of the vaccine in human body produces specific antibodies which circulate in the blood and prevent infection Shigella sonnei for 9 - 12 months.

Vaccination is contraindicated for children under three years, pregnant women, and people who recover Sonne dysentery during the last year (if the diagnosis was confirmed by laboratory).

Prevention of dysentery

For the prevention of dysentery developed and implemented a set of measures, the purpose of which are as follows:

1. Sanitary education of the population (hand washing, the use of boiled water, wash before eating fruits and vegetables with boiled water to help avoid illness).
2. Improving the health status of people living areas and improved living conditions of the population.
3. Prevention of infection of food (the fight with the flies).
4. Strict compliance with food hygiene rules (compliance with food storage conditions of products and deadlines for their implementation).
5. Treatment of HIV infected.