Dysentery is an infectious lesion of the gastrointestinal tract, the source of which is localized mainly in the colon.
The disease has a bacterial etiology, and microorganisms of the Shigella genus are its causative agent. With the destruction of pathogenic microorganisms, toxins, toxins are released into the blood and determine the course and manifestation of pathology.
Shigella long retain their livelihoods in the external environment. Also, under favorable conditions, these bacteria can multiply in food products - salads, meat, minced meat, boiled fish, dairy products, etc. For this reason, the storage of such products should be taken seriously.
Causative agent of dysentery
Dysentery, or shigellosis is a pathology, the causative agent of which are bacteria belonging to the genus Shigella. These pathogens are divided into 4 groups:
- Shigella dysenteriae;
- Shigella flexneri;
- Shigella boydii;
- Shigella sonnei.
Each of these species can provoke the development of dysentery in humans.
The main feature of Shigella is that they are capable of producing resistance to the antimicrobial drugs used in a short time. In addition, these microorganisms are characterized by stability in the external environment. With favorable conditions, these bacteria can retain pathogenic properties for several months. And this concerns not only the external environment as such, but also food.
The provocation of the development of the disease occurs due to the presence of specific pathogenic properties in Shigella. It:
- Invasins are protein structures that ensure the penetration (invasion) of bacteria into the intestinal wall. Most often, Shigella is exposed to the lower part of the colon.
- Endotoxin. This is a toxic substance contained in the composition of the bacterial cell. It is under his influence that the symptoms of intoxication characteristic of dysentery, hyperthermia, weakness, lethargy, general malaise, etc., occur.
- Exotoxins are substances that are produced by the Shigella itself, and flow directly into the blood. The most dangerous are toxins secreted by microorganisms of the Shigella dysenteria group.
How can you get infected?
Dysentery is transmitted mainly by the fecal-oral route. That is, the pathogenic microorganisms, standing out from the body during bowel movements, wilt in the digestive tract, causing infection. The source of infection can be people who:
- At the moment, suffer from dysentery. This may be a patient with both an acute form of the pathology and a pronounced clinical picture, or a patient with a chronic course of the pathology.
- They are in the recovery phase. So, a person who has just started to recover, still for a certain time continues to excrete shigella, thereby infecting others.
- They are carriers of bacteria. In such a patient, Shigella is present in the digestive tract, but does not cause any ailment. However, this person is a source of infection (bacteria carrier) to others.
Shigella can be transmitted in several ways:
- Food. In this case, Shigella is transmitted through poorly processed, washed, cooked food. In this way, Shigella Zonne is most commonly infected.
- Water. When drinking dirty or inadequately filtered water, a person is often infected with Flexner's Shigella.
- Contact-household. This transmission method involves the contact of human skin with household items on which Shigella spp. Bacteria are found. If after that, without having washed his hands, he is taken for food, then infection becomes almost inevitable. This route of infection is most common among children.
Forms of dysentery
Dysentery can occur in several forms:
- Spicy. Some clinical picture appears only a few days after infection. If untreated, the disease can last for quite a long time, but with timely intervention it retreats after 5 to 7 days. Acute dysentery of the disease can occur in 3 forms: mild (up to 3 bowel movements per day, not too intense stomach pain, slight hyperthermia), moderate and severe form. For the latter, characteristic symptoms are frequent and profuse diarrhea with the release of mucus alone, intense gastralgia and stomach cramps, vomiting, and a significant increase in body temperature.
- Chronic. This form of dysentery is discussed when the pathological process lasts longer than 3 months. At the same time, patients do not notice any ailments, only the nature of feces changes - it becomes pastous or soft. However, sometimes there are periods of exacerbation of the disease, alternating phases of remission.
- Asymptomatic. This is one of the rarest, but at the same time, the most dangerous forms of dysentery. It does not give itself out at all, so a person may not even know that he is a carrier of the disease. At the same time, the feces remain normal, or become a bit softer. Only a coprogram (laboratory examination of feces) and a sigmoidoscopy - endoscopic diagnostic manipulation, during which the intestine is examined by means of access through the anus, helps to identify the disease.
There is another form of the disease - carriage. In this case, neither the patient himself, nor the sigmoidoscopy does not mark any changes in the body. And only thanks to the coprogram it is possible to detect the secretion of shigella with feces.
The incubation period for dysentery is 48 - 72 hours, but sometimes the disease can occur within a few hours after a person is infected. The pathological process is accompanied by the following symptoms:
- liquid, slimy stools mixed with blood;
- false urges to defecate;
- nausea and vomiting;
- cephalgia (headache);
- lack of appetite;
- general malaise;
- dehydration of the body;
The onset of dysentery is acute. The patient feels chills and loss of appetite, after which he has cramps and abdominal pain, which are also joined by signs of intoxication of different intensity of manifestation. Diarrhea can occur 2 - 3 times a day, or else it becomes incessant. Against this background, patients develop dehydration - dehydration.
In children, the disease manifests itself somewhat differently. So, in newborn babies, dysentery usually is asymptomatic. But at the same time it is characterized by a protracted course. If the wrong approach to diet therapy and general treatment is irrational, in the future this will be the cause of the development of dystrophy.
Older children are more likely to have enterocolitic form of dysentery. Symptoms of the disease are typical, and continue for 7 to 8 days. Bacteria can be detected in stool only by bacteriological examination of feces.
Degrees of severity
Given the course of the pathological process and the intensity of symptoms, dysentery is divided into:
- Easy This form is the most favorable for the course and prognosis for recovery. It is characterized by a mild course of intoxication and a quick cure. Recovery occurs after about 4 to 6 days.
- Moderate severity. It is characterized by a pronounced manifestation of intoxication with a parallel lesion of the central nervous system. Timely initiated therapy helps to ensure that recovery occurs after 14 days.
- Heavy. This form of dysentery is accompanied by severe symptoms of intoxication, which, in the absence of timely medical care, can be fatal. This form of the disease requires long-term treatment. Recovery occurs in about 3 to 6 weeks.
To confirm the preliminary diagnosis is necessary to:
- bacteriological test;
- serological test (RNA);
- enzyme immunoassay;
- polymerase chain reaction.
In addition, it is important to:
- Coprograms. In the patient’s feces, mucus, blood, as well as shigella, leukocytes, and altered epithelium cells are detected.
- Oak. An increase in ESR and leukocyte levels is detected in the blood, which indicates the presence of inflammation in the body.
- Rectoromanoscopy. During the manipulation, inflammation is noted — hyperemia and edema — of the mucous membrane of the large intestine. In parallel, recorded intestinal spasm.
In children and adults, the treatment of dysentery requires an integrated and strictly individual approach. Bed rest is indicated only for severe course of the disease. With a moderate course of the disease, the patient is allowed only to go to the toilet, and with a mild degree - to observe the ward regime and engage in therapeutic exercises.
Diet is also of great importance. In case of intensive disorder, the patient is prescribed table No. 4, and after stabilization of the state - No. 2. Shortly before discharge (for 2 - 3 days) the patient is transferred to the common table.
Antibiotics are prescribed exclusively after bacteriological examination and the results of the antibiogram. It is important to understand exactly what antimicrobial agents the Shigella species identified in the patient’s feces is sensitive to. In severe cases, a comprehensive anti-bacterial therapy.
The duration of the therapeutic course depends on the general condition of the patient, body temperature and the rate of disappearance of other symptoms. With moderate form of dysentery, recovery is observed after 3 to 4 days. In severe cases, the treatment lasts 4 to 5 days. Within a few days, minor intestinal disorders may still occur, which, however, are not grounds for prolongation of antibiotic therapy.
With mild dysentery, accompanied by the appearance of bloody and mucous impurities in the feces, antimicrobials may be prescribed:
- Nitrofuran groups. Preference is given to drugs Furadonin and Furazolidone. They are prescribed in a dose of 100 mg 4 times a day.
- Ersefuril and its analogues. The drug Nifuroksazid prescribed in a dosage of 200 mg 4 times a day.
- Cotrimoxazole. It is taken 2 tablets 2 times a day.
- Group oxyquinolines. The most commonly prescribed drugs are Nitroxolin (100 mg 4 times a day) and Intetrix (1 to 2 tab. 3 times a day).
In moderate cases, medications from the fluoroquinolone group are prescribed, and not only:
- Ofloxacin - 200 mg twice a day.
- Ciprofloxacin (instead of Ofloxacin instead): 250 mg 2 times / day.
- Cotrimoxazole: 2 tab. 2 times a day.
- Intrix: 2 tab. 3 times a day.
For the treatment of severe forms of the disease resort to the appointment:
- Ofloxacin 400 mg twice a day, or Ciprofloxacin 500 mg twice a day.
- Fluoroquinolone antibiotics in combination with aminoglycosides.
- Cephalosporins in combination with aminoglycosides.
For the treatment of dysentery, Sonne and Flexner have resorted to the use of a special polyvalent dysenteric bacteriophage. The medicine is released in the form of a mixture, as well as in the form of tablets coated with an acid-resistant coating. The drug must be taken an hour before meals, 30 - 40 ml, or 2 - 3 tab. 3 times a day.
- In the case of a mild form of dysentery, fluid deficiency should be replenished by the use of rehydration agents — Gastrolit, Rehydron, Ionica, Normohydron, Orsol, etc. The prepared solution is taken in small portions during the day. The volume of fluid consumed should be one and a half times the loss of water along with feces and urine.
- In case of moderate form of the disease, it is recommended to use sweet tea, 5% glucose solution or previously reviewed rehydrants. The daily volume of fluid consumed should range from 2 to 4 liters.
- Severe intoxication in dysentery is treated with the help of intravenous drip infusions of albumin, Trisol, Chlosol, etc., or 5-10% of the insulin-glucose solution. Usually, to stabilize the patient's condition, it is enough to enter 1 - 1.5 liters of medicine prescribed by the doctor.
Enterosorbents are mandatory - White Coal, Atoxyl, Polyphepan, activated carbon, etc. Enzyme agents such as Pancreatin or Panzinorm help to neutralize toxins in the patient's body. They are recommended to be combined with calcium preparations.
In acute diarrhea, medication is prescribed to the patient to eliminate intestinal spasm. It may be Papaverine, Drotaverine (or No-Shpa).
With intensive pain syndrome, a 2% solution of No-Shpy is administered in the form of intramuscular injections. It is administered at a dose of 2 ml for 1 time. Instead, the drug can be applied 0.2% solution of platyphylline hydrotartrate in the amount of 1 to 2 ml. This medicine is intended for subcutaneous administration.
Throughout the continuation of treatment is mandatory taking vitamins.
For the correction of intestinal eubiosis (biocenosis) of the intestine, the patient is prescribed the following preparations:
- Bifidumbacterin-Forte, etc.
Usually drugs take 2 doses 2 times a day. The duration of therapy is 5 to 7 days.
When the patient's condition stabilizes slightly, he is prescribed lacto-and bifidobacteria. It can be both drugs and specially selected food.
The treatment of patients with chronic exacerbated dysentery is carried out in the hospital of the infectious diseases department. Therapy is based on the use of:
- Fluoroquinolones. Usually prescribed drug Ciprofloxacin at a dose of 500 mg twice a day. Ofloxacin 200 mg 2 times a day can also be applied. Reception course - a week.
- Immunostimulants - Timalin, Timogen, Levamisole, Dibazol, etc.
- Enzyme Drugs - Pepsin, Pancreatin, Mezim, Festal, etc.
- Vitamins in high doses.
At the same time, the treatment of associated diseases, especially intestinal diseases, if any, is carried out.
After the end of treatment, probiotics are prescribed to fully restore the intestinal microflora - Linex, Acidolac, Laktovit, Bifidumbakterin-Forte, Bifiform, etc. The prognosis of dysentery treatment is usually favorable for all patients, if it was started on time.
To prevent the development of dysentery, it is necessary to carefully monitor the quality of consumed food products and water. All products intended for use in raw form (vegetables, fruits, berries, etc.) should be well washed, meat, fish, etc. - should be fully heat-treated.
An important role is also played by hygiene by the person himself. Regular and thorough hand washing is one of the main pillars to prevent shigella from entering the body.
In order to prevent infecting a child, it is important not only to wash his hands after visiting the toilet, or after the street, but also to ensure that he does not eat unwashed fruits, vegetables, or berries.