Dysentery: diagnosis and treatment


  • Dysentery
  • As shown dysentery
  • How is the diagnosis of dysentery
  • How is the treatment of dysentery

  • Dysentery

    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.

    Dysentery: diagnosis and treatment
    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
    chronic course.

    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
    2-3 weeks.

    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

    Diagnosing 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
    physical Culture.

    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
    common table.

    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
    antibacterial treatment.

    Dysentery: diagnosis and treatment
    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.

    It comprises:

    • 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.

    Recover from acute dysentery discharged from hospital at the earliest
    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.

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