Dysentery - an infectious disease characterized by lesions of the gastrointestinal tract, especially the colon.
Dysentery causing bacteria of the genus Shigella. With the destruction of microbes
It released a toxin that plays an important role in the development of the disease and
It causes its manifestation.
dysentery Pathogens have high survival rates in
environment. Depending on the temperature and humidity conditions, they
saved from 3-4 days to 1-2 months, and in some cases up to 3-4
months and even more. Under favorable conditions, capable of Shigella
multiply in foods (salads, vinaigrettes, cooked meats,
beef, boiled fish, milk and dairy products, fruit and kissels).
Shigellosis is transmitted only from a person via contaminated feces of food, water, as well as in contact.
The source of the infectious agent in dysentery are patients, and
also bacillicarriers that produce Shigella into the environment with
faeces. Sick with dysentery, infectious disease onset. duration
pathogen isolation patients, usually not more than a week, but
may be delayed up to 2-3 weeks.
The highest susceptibility to infection in patients with blood group A (II).
The leading factor in the development of the disease is the intake of poisons bacteria
in blood. Primarily affects the nervous system, as well as
cardiovascular system, adrenal glands and digestive organs.
Shigella may be in the stomach for several hours to
a few days (in rare cases). Overcoming the acidic barrier
stomach, Shigella reach the intestine. In the small intestine they are attached
to intestinal cells and secrete a toxin that causes increased
and salts fluid secretion into the lumen. shigella actively
move, causing inflammation in the small intestine, which
maintained and exacerbated by the action produced by Shigella
toxin. Shigella toxin enters the bloodstream and causes the development of
In colon Shigella come later, but massive. This leads to a more significant effect shigella toxin.
Recovery for dysentery is usually accompanied by the release of
organism from the pathogen. However, if failure of the immune system
cleansing the body of the pathogen is delayed up to 1 month or more.
Formed carriage, and on the part becomes ill with a disease
After this illness is formed short-lived immunity.
The incubation period of 1-7 (average 2-3) days, but can be reduced to 2-12 hours.
Form, variant and severity of dysentery depend on the ways and means
infection, the number of microbes caught in the body, the level of immunity
As shown dysentery
The disease begins
fast. At the beginning of developing the syndrome of general intoxication,
characterized by fever, chills, feeling of heat,
weakness, decreased appetite, headache, decreased blood
Involvement of the gastrointestinal tract is manifested by pain in
stomach, first blunt, diffuse throughout the abdomen, have a permanent
character. Then they become more acute, cramping,
are localized in the lower abdomen, often left. Pain is usually
worse before a bowel movement.
In less severe disease fever is short-term, from
few hours to 1-2 days, body temperature, usually
It rises to 38 ° C. Patients are disturbed by moderate abdominal pain, in
mainly before the act of defecation. The stools are
pasty or semi-liquid consistency, frequency of defecation up to 10 times
per day, the admixture of mucus and blood is not visible. Intoxication and diarrhea
stored for 1-3 days. Full recovery occurs through
Moderate course of the disease - the rapid onset of the disease.
The body temperature with cold fits raises to 38 ~ 39 ° C and kept at this
a level of from a few hours to 2-4 days. Patients concerned about the overall
weakness, headache, dizziness, lack of appetite. intestinal
disorders usually joined in 2-3 hours from
onset of the disease. Patients appear periodic cramping
in the lower abdomen, frequent false urge to defecate, feeling
incomplete defecation. stool frequency up to 10-20 times
day. The stools are scarce, often consist of a mucus-streaked
blood. There is increased irritability, pale skin. Language
covered with a thick white coating, dryish. Intoxication and diarrhea
2 to extend from 4-5 days. Complete healing mucosa
ulcers and the normalization of all body functions occur not earlier than 1-1,5
Severe dysentery is characterized by a very fast
the development of the disease, pronounced intoxication, deep
disorders of the cardiovascular system. Disease
It begins very quickly. The body temperature rises rapidly chills
up to 40 ° C and above, patients complain of severe headache, sharp overall
weakness, increased sensitivity to cold, especially in the extremities, dizziness
getting out of bed, a complete lack of appetite. often appear
nausea, vomiting, hiccups. Patients concerned about pain in the abdomen,
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 ( "chair
without an account "). During the height of the disease lasts 5-10 days.
Recovery is slow, up to 3-4 weeks, full normalization
intestinal mucosa after 2 months or more.
Diagnosis is chronic dysentery when the disease continues more than 3 months.
Among the complications of the disease
It is the most common: toxic shock,
infectious and toxic damage of the nervous system, peritonitis,
How is the diagnosis of dysentery
based on the results of the patient survey. great
diagnostic value has inspection of feces, in which you can
detect an admixture of mucus streaked with blood. Laboratory confirmation
dysentery conducted bacteriological and serological methods.
Bacteriological method (seeding Shigella from feces), with 3-fold
study provides confirmation of the diagnosis in 40-60% of patients.
Rapid diagnosis of acute intestinal diarrheal infections can
carried out for the detection of antigens of pathogens and their toxins in
biosubstrates - saliva, urine, feces, blood. For this purpose, use
Immunological methods are highly sensitive and
Specificity: enzyme-linked immunosorbent assay (ELISA), agglutination reaction
latex (RAL), koagglyutinatsii reaction (RSA), immunofluorescence (RIF)
Polymerase chain reaction (PCR).
How is the treatment of dysentery
Treatment of patients
dysentery should be comprehensive and strictly individualized.
Bed rest is required, usually only for patients with severe
forms of the disease. Patients with moderate forms allowed to go
the toilet. Patients with milder forms of treatment prescribed and medical ward
One of the most important components in the treatment of intestinal
patients is a health food. In the acute period with significant
intestinal disorders designate table №4; with improved condition
a decrease in bowel dysfunction and the emergence of appetite patients
converted on the table №2, and for 2-3 days before discharge from the hospital - in the
Given to patients with an antibacterial drug should be
taking into account information about the "territorial landscape of drug resistance"
those. sensitivity to Shigella allocated from the patients in the
areas recently. Combinations of two or more antibiotics
(Chemotherapeutic agents) are assigned only in severe cases.
The duration of treatment is determined by dysentery
improving the patient's condition, normalization of body temperature,
reduction of intestinal disorders. In moderate form of dysentery
course of therapy may be limited to 3-4 days, with heavy - 4-5 days.
Continuing in the early recovery period, mild dysfunction
intestine (mushy stools 2-3 times a day, moderate events
flatulence) should not serve as a pretext for continuing
Patients with mild dysentery at the height of the disease,
flowing with mucus and blood in the stool, appoint 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 on
0.1 g 4 times a day, intetriks 1-2 tablets three times a day).
When to moderate dysentery prescribe drugs
the group fluoroquinolones: ofloxacin 0.2 g 2 times a day, or
Ciprofloxacin 0.25 g 2 times a day; cotrimoxazole 2 tablets 2
times a day; intetriks 2 tablets three times a day.
In severe dysentery prescribe ofloxacin 0.4 g
2 times daily or ciprofloxacin 0.5 g 2 times a day; fluoroquinolones
in combination with an aminoglycoside; aminoglycosides in combination with
When dysentery Flexner and Sonne appoint a polyvalent
dysentery bacteriophage. The drug is available in liquid form and
tablets with acid-resistant coating. Take 1 hour before meals
into 30-40 ml three times a day, or 2-3 tablets three times a day.
In less severe disease fluid loss compensation
carried out by one of the ready-made formulations (tsitroglyukosalan,
rehydron, tours, etc.). These solutions allow to drink in small portions.
The amount of fluid you drink should be 1.5 times the loss it with
feces and urine.
Patients with moderate form of diarrhea is recommended
excessive drinking sweet tea, or 5% glucose solution, or one of
ready-made solutions (tsitroglyukosalan, rehydron, tours, etc.) to 2-4
l / day.
In severe intoxication shown intravenous drip
10% albumin infusion solution gemodeza and other crystalloid
solutions (Trisol, laktasol, Acesol, Chlosol), 5-10% glucose solution
with insulin. In most cases, administration of 1000-1500 ml
one or two of these solutions, to achieve a significant
improve the patient's condition.
For binding and excretion of intestinal toxin administered
one of enterosorbents - Polyphepanum 1 tablespoon 3 times a day,
activated carbon 15-20 grams 3 times per day to 5 g Enterodesum 3 times
per day, polysorb MP 3 grams 3 times per day, smectite 1 sachet 3 times
day or so.
For neutralization of the toxins used enzyme preparations: pancreatin, panzinorm in combination with calcium supplementation.
In the acute phase of diarrhea to eliminate the spasm of colon shown
Application: Drotaverinum hydrochloride (no-spa) at 0.04 g 3 times a day,
papaverine hydrochloride 0.02 g of 3 times a day. With a significant
pain syndrome appoint Nospanum 2 mL of 2% solution intramuscularly or
1-2 ml of 0.2% solution of hydrogen tartrate platifillina subcutaneously.
Throughout the treatment period, the patient is prescribed a complex vitamins.
To correct intestinal biocenosis appoint biosporin, baktisporin,
baktisubtil, flonivin BS-2 dose 2 times a day for 5-7 days.
When choosing a medication should be preferred date
complex preparations - Linex, bifidumbakterin forte, vitaflor and others.
The drugs are administered in the standard dose. With good endurance
during the recovery period, showing dairy therapeutic diet
bifidobacteria and laktosoderzhaschie foods that have a high therapeutic
Treatment of patients with chronic dysentery (recurrent and
continuous) carried out in an infectious diseases hospital.
- fluoroquinolones ciprofloxacin 0.5 g of 2 times a day or ofloxacin 0.2 g of 2 times a day for 7 days;
- immunotherapy according to the state of immunity - timalin, timogen, levamisole, dibasol, etc .;
- panzinorm, Festal, pancreatin, pepsin, etc .;
- higher daily doses of vitamins;
- treatment of opportunistic diseases, helminth and protozoan intestinal infestations;
for the restoration of intestinal biocenosis appoint biosporin,
baktisporin, Linex, bifidumbakterin forte, vitaflor, lacto-bacterin;
these drugs are administered in unit dosage for 2 weeks
after causal therapy simultaneously with pathogenic agents.
The prognosis for the treatment of patients with dysentery, is generally favorable.
than 3 days after clinical recovery (normalization
Body temperature chair disappearance intoxication symptoms, pain
stomach, gut spasm and pain) in the absence of
pathological changes in laboratory studies.
Chemoprevention in contact with a sick individual is not carried out.