Dysentery – an infectious disease characterized by lesions of the gastrointestinal tract, mainly the colon.
The disease is caused by Shigella spp. With the destruction of microbes, a toxin is released, which plays a large role in the development of the disease and causes its manifestations.
Dysentery pathogens are characterized by high survival in the environment. Depending on the temperature and humidity conditions, they persist from 3-4 days to 1-2 months, and in some cases up to 3-4 months or even more. Under favorable conditions, shigella are capable of reproduction in food products (salads, vinaigrettes, boiled meat, minced meat, boiled fish, milk and dairy products, compotes and jelly).
Dysentery is transmitted only from a person through food contaminated with faeces, water, and also upon contact.
The source of the causative agent of infection in dysentery are patients, as well as bacterial carriers, which secrete shigella into the external environment with feces. Patients with dysentery are infectious since the onset of the disease. The duration of the isolation of the pathogen by patients, as a rule, does not exceed a week, but can be delayed up to 2-3 weeks.
Most susceptible to infection in individuals with blood group A (II).
The leading factor in the development of the disease is the entry of bacteria into the bloodstream. First of all, the nervous and the cardiovascular system, adrenal glands and digestive organs are affected.
Shigella can be in the stomach from several hours to several days (in rare cases). Overcoming the acidic barrier of the stomach, shigella enter the intestine. In the small intestine, they attach to intestinal cells and release a toxin, which causes an increased secretion of fluid and salts into the intestinal lumen. Shigella actively move, causing an inflammatory process in the small intestine, which is supported and aggravated by the action of the toxin produced by shigella. Shigella Toxin, enters the bloodstream and causes the development of intoxication.
In the large intestine Shigella get a little later, but massive. This leads to a more significant effect of toxins.
Recovery from dysentery is usually accompanied by the release of the body from the pathogen. However, when the immune system is insufficient, cleansing the body from the pathogen is delayed up to 1 month or more. Carriage is formed, and in some of those who have been ill, the disease becomes chronic.
After suffering the disease formed a short immunity.
The incubation period is 1-7 (on average 2-3) days, but can be reduced to 2-12 hours.
The form, variant and severity of dysentery depend on the ways and methods of infection, the number of microbes in the body, the level of body immunity.
The disease begins quickly. In the beginning, a general intoxication syndrome develops, characterized by fever, chills, fever, weakness, loss of appetite, headache, and lower blood pressure.
The defeat of the gastrointestinal tract is manifested by abdominal pain, initially dull, diffuse throughout the abdomen, having a permanent character. Then they become sharper, cramping, localized in the lower abdomen, often to the left. Pain is usually worse before bowel movements.
Mild form of dysentery
With a mild course of the disease, fever is short-lived, from several hours to 1-2 days, the body temperature, as a rule, rises to 38 ° C.
Patients are concerned about moderate abdominal pain, mainly before the act of emptying the bowel.
The feces have a pasty or semi-fluid consistency, the frequency of bowel movements up to 10 times a day, an admixture of mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs in 2-3 weeks.
The onset of this form of dysentery quick The body temperature with chills rises to 38 ~ 39 ° C and stays at this level from several hours to 2-4 days.
Patients are worried about general weakness, headache, dizziness, lack of appetite. Intestinal disorders usually join in the next 2-3 hours from the onset of the disease.
Patients appear periodic cramping pain in the lower abdomen, frequent false urge to defecate, a feeling of incompleteness of the act of defecation. Stool frequency reaches 10-20 times per day. The feces are scanty, often composed of a single mucus with streaks of blood.
There is irritability, pallor of the skin. Tongue covered with thick white bloom, dryish. Intoxication and diarrhea last from 2 to 4-5 days. Full healing of the mucous membrane of the intestine and the normalization of all body functions occur no earlier than 1-1.5 months.
Severe dysentery is characterized by a very rapid development of the disease, pronounced intoxication, and deep disturbances in the activity of the cardiovascular system.
The disease begins extremely quickly. The body temperature with chills quickly rises to 40 ° C and higher, patients complain of severe headache, severe general weakness, increased chilliness, especially in the limbs, dizziness when rising from bed, a complete lack of appetite.
Often, nausea, vomiting, hiccups. Patients suffer from abdominal pain, accompanied by frequent urge to defecate and urination. A chair more than 20 times a day, often the number of bowel movements is difficult to count (“chair without an account”). The height of the illness lasts 5-10 days.Recovery occurs slowly, up to 3-4 weeks, the full normalization of the intestinal mucosa occurs after 2 months or more.
The diagnosis of chronic dysentery is established if the disease lasts more than 3 months.
Among the complications of the disease, the most frequent are:
- infectious toxic shock,
- infectious-toxic damage to the nervous system,
Diagnosis based on the results of the examination of the patient. Of great diagnostic importance is the examination of feces, which can detect the admixture of mucus with streaks of blood.
Laboratory confirmation of dysentery is carried out by bacteriological and serological methods. The bacteriological method (seeding shigella from stool) with a 3-fold study provides confirmation of the diagnosis in 40-60% of patients.
Accelerated diagnosis of acute intestinal diarrheal infections can be carried out by detecting pathogens’ antigens and their toxins in biosubstrates — saliva, urine, feces, and blood. For this purpose, use immunological methods with high sensitivity and specificity: -fermentny immunosorbentassay (ELISA), latex agglutination reaction (RAL), the reaction koagglyutinatsii (PKA), immunofluorescence (IFA), polymerase chain reaction (PCR).
Treatment of patients with dysentery should be comprehensive and strictly individualized. Bed rest is necessary, as a rule, only for patients with severe forms of the disease. Patients with moderate forms are allowed to go to the toilet. Patients with mild forms of ward prescribed and physical therapy.
One of the most important components in the complex therapy of intestinal patients is medical nutrition. In the acute period with significant intestinal disorders appoint table number 4; with an improvement in the condition, a decrease in intestinal dysfunction and the appetite of patients, they are transferred to table No. 2, and 2-3 days before discharge from the hospital – to the common table.
It is necessary to prescribe an antibacterial drug to a patient, taking into account information about the “territorial landscape of drug resistance”, i.e. Shigella sensitivity to it , allocated from patients in the area in recent times. Combinations of two or more antibiotics (chemotherapy drugs) are prescribed only in severe cases.
The duration of the course of treatment of dysentery is determined by the improvement of the patient’s condition, the normalization of body temperature, the decrease in intestinal disorders.
In moderately severe dysentery, the course of therapy may be limited to 3–4 days, and in severe, 4–5 days. Mild intestinal dysfunction (pasty stools up to 2–3 times a day, moderate phenomena flatulence ) should not be a reason for the continuation of antibacterial treatment.
Patients with mild dysentery in the midst of a disease that occurs with an admixture of mucus and blood in the feces are prescribed one of the following drugs:
- nitrofurans ( furazolidone, furadonin 0.1 g 4 times a day,
- ersefuril ( nifuroxazide) 0.2 g 4 times a day),
- cotrimoxazole, 2 tablets, 2 times a day,
- hydroxyquinoline (nitroksolin 0.1 g 4 times a day, intetriks 1-2 tablets three times a day).
With moderate dysentery, fluoroquinolone drugs are prescribed: ofloxacin , 0.2 g, 2 times a day, or ciprofloxacin, 0.25 g, 2 times a day;
- cotrimoxazole, 2 tablets, 2 times a day;
- Intrix 2 tablets 3 times a day.
With severe dysentery prescribed
- Ofloxacin, 0.4 g, 2 times a day, or ciprofloxacin, 0.5 g, 2 times a day;
- fluoroquinolones in combination with aminoglycosides;
- aminoglycosides in combination with cephalosporins.
In Flexner and Zonne dysentery, polyvalent dysenteric bacteriophage is prescribed. The drug is available in liquid form and in tablets with an acid-resistant coating. Take for 1 hour before meals inside 30-40 ml 3 times a day or 2-3 tablets 3 times a day.
With mild dysentery Compensation for fluid loss is carried out by one of the ready-made compositions ( cytoglucosalan, rehydron, touring, etc.). These solutions give to drink in small portions. The amount of fluid consumed should be 1.5 times its loss with feces and urine.
Patients with moderate diarrhea are advised to drink plenty of sweet tea or 5% glucose solution, or one of the ready-made solutions ( citroglucous salane, rehydron, touring , etc.) up to 2–4 l / day.
For severe intoxication, intravenous drip infusion of 10% albumin, hemodez and other crystalloid solutions ( trisol , lactasol , acesol , chlorol ), 5-10% glucose solution with insulin is indicated . In most cases, the introduction of 1000-1500 ml of one or two of these solutions is enough to achieve a significant improvement in the patient’s condition.
To bind and remove toxin from the intestine, one of the enterosorbents is prescribed – polyphepan 1 tablespoon 3 times a day, activated carbon 15-20 g 3 times a day, enterodez 5 g 3 times a day, Polysorb MP 3 g 3 times per day, smecta 1 sachet 3 times a day or others.
Enzyme preparations are used for the neutralization of toxins: pancreatin, panzinorm in combination with calcium preparations.
In the acute period of diarrhea to eliminate spasm of the colon shows the use of:
- Drotaverine hydrochloride (no-spa) to 0.04 g, 3 times a day,
- papaverine hydrochloride, 0.02 g, 3 times a day.
With significant pain syndrome prescribed no-silos in 2 ml of a 2% solution intramuscularly or 1-2 ml of a 0.2% solution of platifillin Hydrotartrate subcutaneously.
During the entire period of treatment, patients are prescribed a complex of vitamins.
In order to correct the intestinal biocenosis, biosporin, baktisporin, baktisubtil, flivivin- BS are prescribed in 2 doses, 2 times a day for 5-7 days. When choosing a drug preference should be given a modern complex preparations -. Linex, bifidumbacterin -Fort, vitaflor and other drugs are administered in the standard dose. With good tolerability shown in convalescence period fermented therapeutic and dietetic bifidus – lactate and products which have a high therapeutic efficiency.
Treatment of patients with chronic dysentery (recurrent and continuous) is carried out in an infectious diseases hospital. Treatment includes:
- fluoroquinolones ciprofloxacin 0.5 g 2 times a day or ofloxacin 0.2 g 2 times a day for 7 days;
- immunotherapy depending on the state of immunity – thymalin, timogen, levamisole, dibazol, etc .;
- Panzinorm , Festal , Pancreatin, Pepsin, etc .;
- increased daily doses of vitamins;
- treatment of associated diseases, helminthic and protozoal intestinal invasions;
- to restore intestinal biocenosis prescribed biosporin, baktisporin, lineks, bifidumbakterin -Fort, vitaflor, lacto bacterin; These drugs are prescribed in a standard dosage for 2 weeks after etiotropic therapy simultaneously with pathogenetic agents.
The prognosis for treating patients with dysentery is usually favorable.
Those who have had acute dysentery are discharged from the hospital no earlier than 3 days after clinical recovery (normalization of body temperature, stool, disappearance of signs of intoxication, abdominal pain, spasm and bowel pain) in the absence of pathological changes in laboratory tests. Chemoprophylaxis in contact with patients is not carried out.