Dysentery. Causes, types, symptoms and signs. Shigellosis (bacterial dysentery): symptoms, diagnosis, treatment 1 dysentery

The causative agents of dysentery are in the form of rods and are relatively little resistant to the effects of the external environment. At a temperature of 100C they die instantly, at 60C - within half an hour, in feces - after a few hours. When exposed to a 1% solution of phenol (carbolic acid) and direct sunlight, dysentery pathogens die within 30 minutes.

The source of infection are patients with acute and chronic dysentery, as well as bacteria excretors. Of these, the greatest danger is posed by patients with an acute form of dysentery with a mild course of the disease, who are not treated in medical institutions (apparently, infection from such patients occurs much more often than is recorded, since the bulk of them are detected only during active examinations).

Methods of transmission of dysentery

Transmission factors include food, drinking water and flies. Pathogens can also be transmitted through dirty hands.

Types of dysentery, symptoms

Dysentery is usually divided into acute and chronic. Acute dysentery lasts from several days to three months; a disease with a longer course is considered chronic.

Most often, the disease occurs in an acute form and is currently characterized by a relatively mild course and very low mortality.

The mild form of acute dysentery is characterized by a typical, although pronounced, clinical picture. The incubation (latent) period, as with other forms of dysentery, traditionally lasts 2-5 days, but can be shortened to 18-24 hours.

The disease most often begins suddenly. Patients experience moderate pain in the lower abdomen, mainly on the left; there may be nagging pain in the rectal area. Stools are frequent, from 3-5 to 10 times a day, mixed with mucus and sometimes blood. Body temperature is normal or slightly high.

The symptoms (signs) of dysentery are more clearly expressed in moderate cases of the disease.

Typically, acutely or after a short period of malaise, weakness, chills, and an unpleasant feeling in the abdomen, characteristic signs of the disease are detected.

In the majority of cases, cramping pain appears first in the lower abdomen, mainly on the left. The frequency of stools (painful, liquid, mixed with mucus and blood) ranges from 10-15 to 25 times a day and can increase during the first 2 days.

At the same time, a headache appears and the temperature rises, which lasts for 2-5 days, reaching 38-39C. The duration of the increase in body temperature is no more than 2-3 days.

In approximately 80% of patients, cramping abdominal pain lasts a long time. In some patients they may be permanent. Usually the pain is in the lower half of the abdomen, sometimes mainly on the left. In 30% of patients, the pain is diffuse, in 5-7% - in the epigastric region or within the umbilical region. It is not uncommon to experience bloating with gases.

The severe form of acute dysentery is characterized by the presence of an acute clinical picture. The disease begins rapidly, patients mainly complain of severe cramping pain in the abdomen, frequent loose stools, weakness, high body temperature, and sometimes nausea and vomiting. Stools are very frequent, mixed with mucus, blood, and sometimes pus. The pulse increases sharply, shortness of breath is observed, and blood pressure is reduced. The disease can last up to 6 weeks and, if the course is unfavorable, becomes chronic.

Treatment of dysentery

Treatment is carried out in an inpatient infectious diseases hospital.

Prevention of dysentery

Prevention of dysentery is primarily associated with sanitary and hygienic measures. Sanitary supervision of food industrial enterprises, dairy farms, public catering establishments. Control of sanitary improvement of children's preschool institutions, public and residential institutions. Sanitary supervision of drinking water supply and nutrition of the population. The purpose of all these measures is to prevent the transmission of all intestinal infections. In this regard, great importance is attached to sanitary educational work. Personal prevention comes down to careful adherence to the rules of personal hygiene. In a word, dysentery is a disease of dirty hands! Wash your hands often with soap and kill flies!

Articles from the forum on the topic “ Dysentery»

Dysentery, what is it? Cause of the disease? Symptoms and complications? Cause of the disease? Symptoms and complications?

Dysentery is an intestinal infectious disease caused by protozoa (dysenteric amoeba). It is transmitted through dirty food, unboiled water, dirty hands, etc. nails through the gastric - intestinal tract. Loose stools, maybe with blood. Weakness, dehydration... You can catch in the Asian CIS countries, at a resort (for example in India) if you try, and in Russia. Run to the doctor for antibiotics!!!

. Shigella dysentery

The causative agent of bacterial dysentery in humans. Dysentery occurs as an acute infectious disease, the main source of which is a person who is acutely or chronically ill, as well as carrier bacteria that secrete pathogens in feces. Infection occurs through consumption of contaminated food, water and, very often, milk. The disease consists of acute inflammation of the colon and is accompanied by general intoxication, frequent bowel movements, and painful spasms of the rectum.

An infectious disease caused by the dysentery bacillus. Symptoms: diarrhea, vomiting, fever. Complications - dehydration. If left untreated, it will be fatal.

Dysentery (report - 6th grade) very urgent please!

Dysentery (shigellosis) is an infectious disease characterized by a syndrome of general infectious intoxication and a syndrome of damage to the gastrointestinal tract, mainly the distal colon.

Dysentery is caused by bacteria of the genus Shigella, which includes more than 40 serologically and biochemically differentiated variants. Shigella grows well on regular nutrient media; When microbial cells are destroyed, endotoxin is released, which plays a large role in the pathogenesis of the disease and causes clinical manifestations. In addition, Shigella produces several types of exotoxin: cytotoxin, which damages the membranes of epithelial cells; enterotoxins that increase the secretion of fluid and salts into the intestinal lumen; a neurotoxin found mainly in Grigoriev-Shiga bacteria (Sh. dysenteriae serovar 1). In modern conditions, Shigella Flexner and Sonne are the most widespread.

The pathogenicity of Shigella is determined by 4 main factors: the ability of adhesion, invasion, toxin formation and intracellular reproduction. It is most pronounced in Grigoriev-Shiga bacteria (Sh. dysenteriae serovar 1), somewhat less pronounced in Shigella Flexner and even less in other species.

An important property of Shigella is their ability to quickly change their sensitivity to various antibacterial agents, depending on the frequency of their use in a particular region. In most cases, drug resistance is transmitted to Shigella from gastrointestinal bacteria by genes of transmissible resistance plasmids. Pronounced virulence (for example, Shigella Flexner 2a), the presence of transmissible drug resistance in individual strains, especially multiple ones, largely determines the ability of these microorganisms to cause mass diseases in the form of large epidemics, characterized by severe disease. Mortality during the epidemic period can reach 2-7%.

The causative agents of dysentery, especially Shigella Sonne, are characterized by high survival rates in the external environment. Depending on temperature and humidity conditions, they retain their biological properties from 3-4 days to 1-2 months, and in some cases up to 3-4 months or even more. Under favorable conditions, Shigella is capable of reproducing in food products (salads, vinaigrettes, boiled meat, minced meat, boiled fish, milk and dairy products, compotes and jelly), especially Shigella Sonne.

The content of the article

Historical data of dysentery

Etiology of dysentery

Epidemiology of dysentery

Pathogenesis and pathomorphology of dysentery

Dysentery Clinic

Chronic dysentery

Diagnosis of dysentery

Specific diagnosis of dysentery

Differential diagnosis of dysentery

Treatment of dysentery

Prevention of dysentery

Content

It is not without reason that this infectious disease is called the “disease of dirty hands.” The main causative agents of Shigella dysentery easily pass from the skin to food, water, drinks, affecting the intestinal tract and poisoning the entire body. The disease is dangerous with severe complications, so it is important to recognize it in time.

Symptoms of dysentery in adults

The infection very rarely manifests itself without causing fever. This is more common among older people. Much more often, the course of dysentery (in common parlance - red diarrhea) is sudden and acute. The main causative agents of the disease are the following types of Shigella:

• Sonne;
• Flexner;
• Grigorieva-Shiga.

There are four stages in the development of the disease. This:

• initial;
• acute;
• the climax and decline of the disease;
• final recovery.

The very first signs of dysentery in adults:

• slight chills;
• stomach ache;
• diarrhea;
• rise in temperature.

At the same time, signs of damage to nerve cells appear:

• headache;
• pressure surges;
• arrhythmia;
• loss of strength, feeling of weakness;
• depressed mood.

Classic signs of dysentery infection are high fever and diarrhea. I am tormented by frequent urge to stool, sometimes up to 20-30 times a day. In this case, the patient is exhausted by cutting pain in the abdomen, which has the nature of contractions. Very little feces are excreted. The stool is liquid, with mucus, and some time later tests show the presence of blood and pus. The temperature during diarrhea in an adult can rise to 30-40 degrees. The acute period of dysentery development can last from 2-3 to 10 days.

Afterwards, the symptoms of the disease subside. The temperature with diarrhea in adults quickly becomes normal, but final recovery may require another 2, and sometimes 3 weeks. Often people mistake diarrhea for food poisoning and practice self-medication. In such cases, due to inadequate treatment, the disease becomes chronic and can last for more than one month. Recently, dysentery often occurs in a mild form. Shigella Grigoriev-Shiga is becoming less and less common, and Sonne and Flexner bacilli are less aggressive.

Sonne dysentery

The disease begins acutely, with severe spasms of the large intestine. Signs of dysentery in adults include fever and vomiting. The insidiousness of this type of disease is that it can easily be mistaken for food poisoning or an attack of appendicitis. Stool with Sonne dysentery is also frequent and liquid. All these signs and features should be taken into account in order to prevent a medical error when determining the diagnosis.

Flexner's dysentery

Grigoriev-Shiga dysentery

Bacteria of this type are distinguished by the fact that they produce toxins that are especially poisonous to the human body. In addition, they are resistant to many drugs. Such pathogens are rare. In addition, this pathogenic flora does not tolerate heat and cold and quickly dies from disinfection solutions containing chlorine. However, at a comfortable room temperature, Grigoriev-Shiga bacteria actively multiply while in the feces, on the skin, and underwear of the patient.

How does dysentery manifest in adults?

This disease can occur in completely different ways in two patients of the same age, health status, and gender. Sometimes the differences in the signs of the disease are simply striking. Much depends on the form of the pathology. Acute dysentery can occur in the following ways:

• colitic, when the large intestine is affected;
• gastroenteritis, if the stomach is also affected;
• gastroenterocolitic, in which the entire gastrointestinal tract suffers.

Among the typical signs of dysentery in adults who are acutely ill:

• frequent urge to stool and profuse diarrhea with fever;
• cutting cramps in the abdomen, rectal pain;
• feverish condition;
• nausea turning into vomiting.

Signs of dysentery in adults with chronic infection:

• diarrhea also occurs, but not as frequent and debilitating;
• in the analysis of stool there is little mucus and no traces of blood at all;
• the temperature does not rise above 38 degrees;
• no vomiting;
• general health is much better.

What is the danger of acute and chronic dysentery?

Many people who have recovered from this disease continue to experience signs of exhaustion, anemia, loss of strength, and lack of appetite for a long time. Often the reason for this lies in dysbiosis due to antibiotics. However, anemia is the most surmountable consequence of the disease. It is not so difficult to restore beneficial intestinal microflora with the help of pro- and prebiotics. The threat of dehydration is also easy to avoid thanks to drinking plenty of fluids and taking Regidron. What is much more dangerous is that this pathology can be complicated by severe damage to many organs.

Doctors divide the consequences of dysentery into two large groups. Actually intestinal complications:

• bleeding due to ulceration of the mucous membranes;
• rectal prolapse – especially common in children;
• peritonitis as a result of perforation of the intestinal wall;
• megacolon - distension of the colon;
• intestinal dysfunction that persists for a long time after treatment.

Extraintestinal complications:

• Pneumonia;
• pyelonephritis, severe renal failure;
• polyarthritis;
• myocarditis;
• otitis;
• bacteremia with symptoms of severe intoxication, when dysentery bacilli penetrate all cells through the bloodstream - often such a critical condition ends in death.

Video: diarrhea and fever in an adult - what to do

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

You can catch any disease anywhere, even without leaving home. This article will discuss a disease such as dysentery. Treatment, diagnosis of the disease, symptoms and effective preventive measures - I would like to talk about all this.

About the disease

At the very beginning, you need to understand the concepts. So, what is dysentery? This is an infectious disease that affects the gastrointestinal tract, namely the final section of the large intestine. Dysentery is caused by various microorganisms. Depending on this, the nature of this disease is:

1. Amoebic. This disease is typical for countries with tropical and subtropical climates. Thus, this microorganism causes a disease such as amoebiasis.
2. Bacterial, when dysentery is caused by bacteria from the genus Shigella.

About pathogens

I would like to say a few words about the causative agents of dysentery, which are common in our area. As mentioned above, it is caused by the bacterium Shigella, which at normal temperature and humidity can live from several days to a couple of months. In some cases, under the most convenient conditions for it, this bacterium can exist even for up to 4 months. Particularly suitable conditions for its reproduction are in food products (boiled meat, salads, boiled fish, minced meat, milk and dairy products, as well as compotes and jelly), as well as various types of sewage.

Types of dysentery

If a person is diagnosed with dysentery, treatment will be prescribed depending on what kind of shigellosis the patient has. So, it is worth saying that it comes in two types (in our homeland):

1. Sonne dysentery. This disease is the most common today. Pathogenicity of the bacterium: 10 million cells. The main route of transmission is food.
2. Flexner's dysentery. It began to spread actively in the 60s of the last century. Pathogenicity: about 100 microbial bodies. Main route of transmission: water.

In world medical practice, Grigoriev-Shiga dysentery is also distinguished. However, it was most widespread at the beginning of the last century in America, as well as in Asian countries.

Spread of infection

Dysentery spreads like other intestinal diseases. Shigella can enter the body through the mouth. In this case, not only food, but also water can be contaminated. You can also become infected due to dirty hands, if the bacteria that may be on them enter the patient’s esophagus (this method of infection is most often characteristic of children). Scientifically speaking, in medical practice there are two main routes of transmission of this disease:

1. Fecal-oral (food or water).
2. Contact household (dirty hands, household items).

Shigella bacteria enter the human body through the mouth, pass through the entire gastrointestinal tract (gastrointestinal tract) and only then become attached to the mucous membrane of certain organs (most often the sigmoid colon). Also, these bacteria begin to actively multiply, while releasing a dangerous toxin that tends to affect all human tissues. It especially affects the patient’s nervous system. An important point: the cause of everything that happens to the human body after the infection process is precisely these toxins. Next comes damage to the mucous membrane, its inflammation, and the appearance of ulcers. These symptoms are how the disease is determined. Then follows the process of treatment, removal of Shigella from the body, and healing of the resulting wounds.

Time periods

Doctors of the so-called old guard say that dysentery is a disease of dirty hands. And this is absolutely true. In children this is how infection most often occurs. The peak of the disease in children is the summer months, i.e. July August. As for infants, they most often get sick in September. Adults can be affected by dysentery at any time of the year.

Course of the disease

Now we need to consider how the disease itself proceeds and what signs of dysentery can be identified in an adult. The incubation period ranges from 1 day to 1 week (most often it is 2-3 days). The disease itself begins with a rather acute reaction of the body to the pathogen. At this time there may be:

1. Chills.
2. Temperature increase.
3. Lack or decreased appetite.
4. Headache (with low toxicity) or spasms and convulsions (with high toxicity).

A little later you may feel abdominal pain. At the very beginning they will be stupid. Over time, the nature of the pain will change. The pain will be cramping and sharp. It will also be possible to determine in more detail the location of its localization: the lower abdomen, mainly on the left (less often on the right). Before defecation (i.e. going to the toilet), pain may intensify. In this case, false urges (tenesmus) may occur, and dehydration may also occur. Dysentery can last from several days (in its mildest form) to a week, or even more (in severe form).

Patient examination

In order for the diagnosis of dysentery to be correctly made, the diagnosis of the disease must take place exclusively within the walls of a medical institution. Self-medication and self-diagnosis can lead to irreversible consequences and serious development of the disease. So, the doctor’s first actions: collecting anamnesis and examining the patient. In this case, palpating the abdomen is very important. In this case, the patient will experience spasms and pain in the colon. The doctor will also ask about the nature of the patient's stool. So, feces may be mixed with mucus and blood. The frequency will depend on the disease itself (its degree of toxicity) and can range from several times a day to 12-15 trips to the toilet. The nature of defecation is the so-called rectal spitting. And, of course, in the diagnosis of this disease, bacteriological examination of stool is of particular importance. A stool test for dysentery will also be prescribed to the patient after recovery in order to ensure the complete absence of Shigella in the human body.

Infants

In young children, this disease can develop in completely different ways. There may be no obvious symptoms. Moreover, this disease is very similar at this age to enterocolitis. The severity of the disease will depend on dehydration, and, of course, on the degree of toxicity. Blood in the stool most often appears later than in adults and older children. Getting rid of the disease may be delayed. With improper treatment and non-compliance with the diet, children may develop dystrophy.

Children over 1 year old

In such children, enterocolitic dysentery most often occurs, the cause of which is dirty hands. At the same time, the disease itself begins quite acutely. Babies may vomit at its initial stage. Serious intoxication can result in dehydration. For the first few days, children's stools are very copious and watery. Further, its volume decreases, but streaks of blood and mucus may appear.

Mild course of the disease

I would also like to consider the various signs of dysentery in an adult. So, what symptoms will be characteristic of a patient with a mild course:

1. Short-term fever (from several hours to a couple of days). The temperature will rise to 38°C.
2. The pain is moderate, intensifying only before defecation.
3. The stool is liquid or mushy. In this case, streaks of blood or mucus will not be visible. Frequency of going to the toilet: no more than 10 times a day.

With this course of the disease, intoxication, as well as diarrhea, persist for a couple of days. Full recovery of the patient occurs in 2-3 weeks.

Moderate course of the disease

What symptoms can be observed in a patient with a moderate course of this disease?

1. Chills, body temperature within 38-39°C (duration: from several hours to a maximum of 4 days).
2. Weakness, dizziness, headache, lack of appetite.
3. The pain is cramping, periodic, localized in the lower abdomen.
4. Tenesmus and false urge to defecate are common.
5. Stool frequency: up to 20 times a day. Character: scanty stools, streaked with blood and mucus.
6. The skin becomes pale. Irritability appears.
7. The tongue may become covered with a white coating. You may also feel dry mouth.

In this case, the disease and intoxication last from 2 to 5 days. Complete recovery (intestinal healing) occurs within one and a half months.

Severe course of the disease

What symptoms will be observed in a patient with severe dysentery?

1. Rapid development of the disease, pronounced intoxication.
2. Significant disorders of the cardiovascular system.
3. Chills, fever up to 40C.
4. Severe headache, weakness.
5. There may be nausea, vomiting, hiccups.
6. Stomach ache.
7. Frequent urge to defecate.
8. Bowel movements more often than 20 times a day.

In this case, the duration of the disease is 5-12 days. The recovery process is protracted, treatment lasts 3-4 weeks. A person becomes completely healthy only after 2 months, when the intestinal mucosa has completely healed.

Treatment

If a patient is diagnosed with dysentery, treatment will most often be carried out at home, i.e. outpatient. The following patients are subject to hospitalization:

1. Those who have a severe form of the disease.
2. Old men.
3. Children under one year of age.

In all these cases, treatment is protracted and often requires supervision by specialists.

How to treat?

So, dysentery. Treatment of the patient will primarily depend on how exactly his disease progresses. However, the most commonly prescribed drugs are:

1. Acute dysentery. To cope with the pathogen, the patient will be prescribed antibiotics. For dysentery, they will be tetracycline or fluoroquinolone.
2. Detoxification treatment. These are drugs such as Metadoxil (administered intravenously or intramuscularly), Zorex (capsules).
3. Enzyme agents for correcting problems in the body. These can be drugs such as Festal, Panzinorm, Mezim-Forte.
4. Microclysters. Since an acute intestinal infection affects the large intestine, to improve its condition, the patient is prescribed microenemas with chamomile infusion, as well as various oils: sea buckthorn, eucalyptus, rose hips.
5. If there is dehydration, the patient will need to take drugs such as Oralit or Regidron, which restore the water-salt balance in the body.

Depending on the symptoms, antispasmodics can also be prescribed, which effectively relieve pain (for example, the drug “Spazmalgon”). Enterosorbents (the drug “Enterosgel”) can also be prescribed.

Nutrition

Diet for dysentery is also very important. How to eat properly with this disease?

1. In the first couple of days of illness, with severe intoxication, the patient is prescribed diet No. 0a. Food should be liquid or jelly-like (decoctions, juices, jelly, broth).
2. As intoxication decreases, the diet will change to No. 4. Eggs, kefir, crackers, and fish are included in the diet.
3. To stop the inflammatory process and after getting rid of toxins, diet No. 13 is prescribed.
4. Next comes diet number 2.
5. For some time after recovery, the patient is recommended to “sit” on diet No. 15.

At the same time, the duration of each patient’s stay on the diet is not strictly indicated. It all depends on the course of the disease and the rate of recovery.

A few more words about nutrition

If a patient has an acute intestinal infection, he must follow a certain diet. So what is the correct way to eat in this case?

1. Drink plenty of fluids. Since there is a risk of dehydration, the patient should drink as much as possible.
2. You need to eat in small portions about 7 times a day.
3. Fasting is prohibited; it can lead to exhaustion of the body.
4. Food must undergo heat treatment. Dishes must be warm.
5. Taking vitamins will also be mandatory. Vitamin C is especially useful in this case (it can even be prescribed intravenously), as well as B vitamins.

Folk remedies

It is also possible to treat dysentery at home. In this case, you can use one of the following tools, which are also great at helping to cope with this problem:

1. Plantain. You need to take some plantain seeds and grind them thoroughly. This medicine should be taken 4 times a day, 1 hour before meals, 1 gram.
2. Infusion. To prepare it, you need to take 50 g of nettle leaves, plantain, angustifolia fireweed, the same amount of chamomile flowers, 30 g of aspen bark. It all gets mixed up. To prepare the medicine you need to take 3 tbsp. This mixture of herbs, pour 3 cups of boiling water, place everything in a thermos and leave for an hour and a half. After this, everything is filtered. This is the daily dose of the medicine. It should be taken approximately 4 times a day before main meals, half an hour before. The duration of treatment is two weeks.
3. Aloe. Aloe juice works great against dysentery. It should be taken orally 2 teaspoons 20 minutes before meals three times a day.
4. Honey. Along with medications, it is good for the patient to also take honey. The maximum daily dose is 100 grams. It should be divided into three doses a couple of tens of minutes before meals. As for children, their daily dose is 30-50 grams.
5. Blueberry. This is an excellent anti-dysenteric remedy. You just need to prepare an infusion from its dry berries.
6. Oak. Oak bark, which has an astringent effect, will also help cope with this problem perfectly. To prepare the medicine, you need to pour 1 teaspoon of crushed oak bark into a glass of cool boiled water and leave for a day. Next, the medicine is filtered. It should be taken in equal sips throughout the day. Attention! This remedy should not be prepared for use in children.
7. Rowan. As a medicine, you can take 100 grams of these berries every day three times a day, half an hour before meals. Rowan juice also helps with dysentery. You should drink a quarter glass three times a day 30 minutes before main meals.
8. Cocklebur. A decoction of the root and seeds of a herb such as cocklebur will also help to cope with the problem. To prepare the medicine, you need to take 1 tbsp of raw material, add a glass of water and boil everything for 10 minutes. Then everything is infused. The medicine is taken warm 3 times a day before meals along with honey (which is added to taste).
9. Propolis. This is an excellent antibacterial agent. Take it in its pure form, 3-5 grams one and a half hours before meals, chewing thoroughly.
10. Alcohol infusion. You can also prepare an infusion that will help cope with this problem in a short time. So, to prepare the medicine you need to take 20% alcohol tincture of propolis (30 drops) and a tablespoon of bird cherry fruit. The fruits are poured with a glass of boiling water and boiled for some time. Next, an alcohol infusion is added there. Take half a glass half an hour before main meals.

Prevention

In order not to look for an effective cure for dysentery and avoid this disease, it is best to adhere to certain preventive measures. What you need to remember in this case:

1. In everyday life and during food preparation, all sanitary and hygienic standards must be observed.
2. You should drink water only from proven sources.
3. Eat as little as possible in public catering establishments. Also completely eliminate the consumption of fast food.
4. And, of course, you should always keep your hands clean.

Dysentery is an infectious disease characterized by damage to the gastrointestinal tract, mainly the colon.

The disease is caused by bacteria of the genus Shigella. When microbes are destroyed, a toxin is released, which plays a large role in the development of the disease and causes its manifestations.

The causative agents of dysentery have a high survival rate in the external environment. Depending on temperature and humidity conditions, they last from 3-4 days to 1-2 months, and in some cases up to 3-4 months or even more. Under favorable conditions, Shigella is capable of reproducing in food products (salads, vinaigrettes, boiled meat, minced meat, boiled fish, milk and dairy products, compotes and jelly).

Causes

Dysentery is transmitted only from humans through food, water contaminated with feces, and also by contact.

The source of the causative agent of infection in dysentery is patients, as well as bacteria carriers who release Shigella into the external environment with feces. Patients with dysentery are contagious from the onset of the disease. The duration of isolation of the pathogen by patients, as a rule, does not exceed a week, but can last up to 2-3 weeks.

The greatest sensitivity to infection is in people with blood group A (II).

The leading factor in the development of the disease is the entry of bacterial poisons into the blood. The nervous system, as well as the cardiovascular system, adrenal glands and digestive organs are primarily affected.

Shigella can remain in the stomach from several hours to several days (in rare cases). Having overcome the acid barrier of the stomach, Shigella enters the intestines. In the small intestine, they attach to intestinal cells and release a toxin that causes increased secretion of fluid and salts into the intestinal lumen. Shigella actively moves, causing an inflammatory process in the small intestine, which is maintained and aggravated by the action of the toxin produced by Shigella. Shigella toxin enters the bloodstream and causes the development of intoxication.

Shigella enters the large intestine somewhat later, but in large numbers. This leads to greater exposure to toxins.

Recovery from dysentery is usually accompanied by the body being freed from the pathogen. However, if the immune system is insufficient, cleansing the body of the pathogen is delayed for up to 1 month or more. A carrier state is formed, and in some of those who have recovered, the disease becomes chronic.

After an illness, short-term immunity is formed.

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 routes and methods of infection, the number of microbes that have entered the body, and the level of the body's immunity.

Manifestations of dysentery

The disease begins quickly. At the beginning, a syndrome of general intoxication develops, characterized by an increase in body temperature, chills, a feeling of heat, weakness, loss of appetite, headache, and a decrease in blood pressure.

Damage to the gastrointestinal tract is manifested by abdominal pain, initially dull, spread throughout the abdomen, and of a constant nature. Then they become more acute, cramping, and are localized in the lower abdomen, often on the left. The pain usually intensifies before bowel movement.

Mild form of dysentery

In mild cases of the disease, the fever is short-lived, from several hours to 1-2 days; body temperature, as a rule, rises to 38°C.

Patients are bothered by moderate abdominal pain, mainly before bowel movement.

The stool has a pasty or semi-liquid consistency, the frequency of bowel movements is up to 10 times a day, the admixture of mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs in 2-3 weeks.

Moderate form

The onset of this form of dysentery is rapid. Body temperature with chills rises to 38~39°C and remains at this level from several hours to 2-4 days.

Patients are concerned about general weakness, headache, dizziness, and lack of appetite. Intestinal disorders, as a rule, occur within the next 2-3 hours from the onset of the disease.

Patients experience periodic cramping pain in the lower abdomen, frequent false urge to defecate, and a feeling of incomplete defecation. The frequency of stool reaches 10-20 times a day. The stool is scanty and often consists of mucus streaked with blood.

There is increased irritability and pale skin. The tongue is covered with a thick white coating and is dry. Intoxication and diarrhea last from 2 to 4-5 days. Complete healing of the intestinal mucosa and normalization of all body functions occurs no earlier than 1-1.5 months.

Severe form

Severe dysentery is characterized by a very rapid development of the disease, pronounced intoxication, and profound impairment of the cardiovascular system.

The disease begins extremely quickly. Body temperature with chills quickly rises to 40°C and above, patients complain of severe headache, severe general weakness, increased chilliness, especially in the extremities, dizziness when getting out of bed, and a complete lack of appetite.

Nausea, vomiting, and hiccups often appear. Patients are bothered by abdominal pain, accompanied by a frequent urge to defecate and urinate. Stool more than 20 times a day, often the number of bowel movements is difficult to count (“stool without counting”). The peak period of the disease lasts 5-10 days. Recovery occurs slowly, up to 3-4 weeks; complete 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.

Complications

Among the complications of the disease, the most common are:

• infectious-toxic shock,
• infectious-toxic damage to the nervous system,

Diagnostics

The diagnosis is based on the results of examination of the patient. Examination of stool is of great diagnostic importance, during which an admixture of mucus streaked with blood can be detected.

Laboratory confirmation of dysentery is carried out by bacteriological and serological methods. The bacteriological method (seeding Shigella from feces) 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 pathogen antigens and their toxins in biosubstrates - saliva, urine, feces, blood. For this purpose, immunological methods are used that have high sensitivity and specificity: enzyme-linked immunosorbent assay (ELISA), latex agglutination reaction (RAL), coagglutination reaction (PCA), immunofluorescence (RIF), polymerase chain reaction (PCR).

Treatment of dysentery

Treatment of patients with dysentery should be comprehensive and strictly individualized. Bed rest is usually necessary only for patients with severe forms of the disease. Patients with moderate forms are allowed to go to the toilet. Patients with mild forms are prescribed ward conditions and physical therapy.

One of the most important components in the complex therapy of intestinal patients is nutritional therapy. In the acute period, with significant intestinal disorders, table No. 4 is prescribed; with improvement of condition, decrease in intestinal dysfunction and appearance of appetite, patients are transferred to table No. 2, and 2-3 days before discharge from the hospital - to the general 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. sensitivity to it of Shigella isolated from patients in the area recently. Combinations of two or more antibiotics (chemo drugs) are prescribed only in severe cases.

The duration of the course of treatment for dysentery is determined by the improvement of the patient's condition, normalization of body temperature, and reduction of intestinal disorders.

For moderate forms of dysentery, the course of therapy can be limited to 3-4 days, for severe ones - 4-5 days. Mild intestinal dysfunction that persists during the early recovery period (mushy stools up to 2-3 times a day, moderate flatulence) should not serve as a reason to continue antibacterial treatment.

Patients with mild dysentery at the height of the disease, which occurs with an admixture of mucus and blood in the stool, 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,
• hydroxyquinolines (nitroxoline 0.1 g 4 times a day, intetrix 1-2 tablets 3 times a day).

For moderate dysentery, drugs from the fluoroquinolone group 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;
• intetrix 2 tablets 3 times a day.

For severe dysentery, it is 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.

For Flexner and Sonne dysentery, a polyvalent dysentery bacteriophage is prescribed. The drug is available in liquid form and in acid-resistant tablets. Take 30-40 ml orally 3 times a day 1 hour before meals or 2-3 tablets 3 times a day.

In case of mild dysentery, compensation for fluid losses is carried out using one of the ready-made formulations (citroglucosalan, rehydron, gastrolit, etc.). These solutions are given to drink in small portions. The amount of liquid drunk should be 1.5 times greater than lost through feces and urine.

In case of severe intoxication, intravenous drip infusion of 10% albumin solution, hemodez and other crystalloid solutions (Trisol, Laktasol, Acesol, Chlosol), 5-10% glucose solution with insulin is indicated. In most cases, it is enough to administer 1000-1500 ml of one or two of these solutions to achieve a significant improvement in the patient's condition.

To bind and remove toxin from the intestines, one of the enterosorbents is prescribed - polyphepan 1 tablespoon 3 times a day, activated carbon 15-20 g 3 times a day, enterodesis 5 g 3 times a day, polysorb MP 3 g 3 times per day, smecta 1 sachet 3 times a day or others.

To neutralize toxins, enzyme preparations are used: pancreatin, panzinorm in combination with calcium preparations.

In the acute period of diarrhea, to eliminate spasm of the colon, the use of:

• drotaverine hydrochloride (no-spa) 0.04 g 3 times a day,
• papaverine hydrochloride 0.02 g 3 times a day.

In case of significant pain syndrome, no-shpa is prescribed 2 ml of a 2% solution intramuscularly or 1-2 ml of a 0.2% solution of platyphylline hydrotartrate subcutaneously.

During the entire period of treatment, patients are prescribed a complex of vitamins.

In order to correct the intestinal biocenosis, biosporin, bactisporin, bactisubtil, flonivin-BS are prescribed, 2 doses 2 times a day for 5-7 days. When choosing a drug, preference should be given to modern complex drugs - Linex, Bifidumbacterin-Forte, Vitaflor, etc. The drugs are prescribed in a standard dosage. If tolerated well, during the recovery period fermented milk therapeutic and dietary bifido- and lactose-containing products are indicated, which have high therapeutic effectiveness.

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, thymogen, levamisole, dibazole, etc.;
• panzinorm, festal, pancreatin, pepsin, etc.;
• increased daily doses of vitamins;
• treatment of concomitant diseases, helminthic and protozoal intestinal invasions;
• to restore the intestinal biocenosis, biosporin, bactisporin, linex, bifidumbacterin-forte, vitaflor, lactobacterin are prescribed; These drugs are prescribed in a standard dosage for 2 weeks after etiotropic therapy simultaneously with pathogenetic agents.

The prognosis for the treatment of patients with dysentery is usually favorable.

Prevention

Those who have recovered from 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, spasms and soreness of the intestines), in the absence of pathological changes in laboratory tests. Chemoprophylaxis is not carried out for persons in contact with the patient.