Dysentery - an infectious disease characterized by lesions of the gastrointestinal tract, primarily large intestine.
Dysentery caused by the bacterium genus Shigella. When you destroy microbes are allocated toxin, which plays a major role in the development of the disease and hence its manifestations.
Activators of dysentery have high survival in the external environment. Depending on the temperature and humidity conditions, they are saved from 3-4 days to 1-2 months and in some cases up to 3-4 months or even longer. Under favorable conditions shigelly capable of reproduction in foods (salads, salad, cooked meat, minced, cooked fish, milk and milk products, mix and Kysela).
Dysentery is transmitted only through contaminated with human faeces food, water, as well as in contact.
The source of the causal agent of infection with dysentery are sick, as well as bakterionositeli that provide shigelly the outside environment with faeces. Patients dysentery contagious disease from the beginning. Running time allocation of the causal agent of patients, usually no more than a week, but it may linger until 2-3 weeks.
The greatest vulnerability to the disease in persons with blood group A (II).
The leading factor in the development of the disease is the flow of poisons bacteria in the blood. The first porazhaetsya nervous system and the cardiovascular system, adrenal and digestive organs.
Shigelly may be in the stomach from several hours to several days (in rare cases). Having overcome the barrier of stomach acid, shigelly fall into the intestines. In the small intestine they are attached to cells intestine and emit toxin, which causes increased secretion of fluid and salts in the colon lumen. Shigelly to move, causing inflammation process in the small intestine, which is maintained and compounded by the effect produced shigellami toxin. Shigell toxin, enters the blood and hence the development of intoxication.
In colon shigelly come somewhat later, but massively. This leads to a significant step toxins shigell.
Recovery with dysentery usually accompanied by the release of the body of the causal agent. However, the insufficiency of the immune system, cleansing the body of the cause delays up to 1 month or more. A carrier, as part of the perebolevshih disease becomes chronic over.
After carry the disease formed a short immunity.
The incubation period is 1-7 (average 2-3) days, but can be reduced to 2-12 hours.
The form and severity of the current version of dysentery depend on the ways and means of infection, the number caught in the body of microbes, the level of immunity of the body.
Symptoms of dysentery
Dysentery caused by the bacterium genus Shigella. When you destroy microbes are allocated toxin, which plays a major role in the development of the disease and hence its manifestations.
Activators of dysentery have high survival in the external environment. Depending on the temperature and humidity conditions, they are saved from 3-4 days to 1-2 months and in some cases up to 3-4 months or even longer. Under favorable conditions shigelly capable of reproduction in foods (salads, salad, cooked meat, minced, cooked fish, milk and milk products, mix and Kysela).
Dysentery is transmitted only through contaminated with human faeces food, water, as well as in contact.
The source of the causal agent of infection with dysentery are sick, as well as bakterionositeli that provide shigelly the outside environment with faeces. Patients dysentery contagious disease from the beginning. Running time allocation of the causal agent of patients, usually no more than a week, but it may linger until 2-3 weeks.
The greatest vulnerability to the disease in persons with blood group A (II).
The leading factor in the development of the disease is the flow of poisons bacteria in the blood. The first porazhaetsya nervous system and the cardiovascular system, adrenal and digestive organs.
Shigelly may be in the stomach from several hours to several days (in rare cases). Having overcome the barrier of stomach acid, shigelly fall into the intestines. In the small intestine they are attached to cells intestine and emit toxin, which causes increased secretion of fluid and salts in the colon lumen. Shigelly to move, causing inflammation process in the small intestine, which is maintained and compounded by the effect produced shigellami toxin. Shigell toxin, enters the blood and hence the development of intoxication.
In colon shigelly come somewhat later, but massively. This leads to a significant step toxins shigell.
Recovery with dysentery usually accompanied by the release of the body of the causal agent. However, the insufficiency of the immune system, cleansing the body of the cause delays up to 1 month or more. A carrier, as part of the perebolevshih disease becomes chronic over.
After carry the disease formed a short immunity.
The incubation period is 1-7 (average 2-3) days, but can be reduced to 2-12 hours.
The form and severity of the current version of dysentery depend on the ways and means of infection, the number caught in the body of microbes, the level of immunity of the body.
Symptoms of dysentery
The disease starts quickly. At the beginning of developing a common intoxication syndrome, characterized by increased body temperature, chills, feeling the heat, divided, declining appetite, headache, lower blood pressure.
The defeat of the gastrointestinal tract apparent pain in the abdomen, initially blunt instruments spilled across the stomach, are permanent in nature. Then they become more acute, shvatkoobraznymi, localized in the lower divisions of the stomach, often on the left. Pain is usually exacerbated before oporozhneniem intestine.
In light during rush short illness, from several hours to 1-2 days, body temperature, typically rises to 38 ° C. Sick concern to moderate abdominal pain, mainly in the act of emptying the bowels. Excreta are pappy or semiliquid consistency, frequency of bowel movement up to 10 times a day, impurity mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs within 2-3 weeks.
During the mid disease - the beginning of the disease quickly. The temperature of the body with chills rises to 38 ~ 39 ° C and kept at this level from several hours to 2-4 days. Sick concerned about the general weakness, headache, dizziness, lack of appetite. Intestinal disorders tend to align in the next 2-3 hours from the beginning of the disease. Patients appear periodically Cramping in the lower abdomen, frequent false urge for a bowel movement, a sense of unfinished act of defecation. The frequency of stool reaches 10-20 times a day. Excrement scarce, often composed of a mucus with blood veins. Present increased irritability, paleness of skin. Language is covered with thick white bloom, dryish. Intoxication and diarrhea going from 2 to 4-5 days. Complete healing of mucosal intestine and the normalization of all bodily functions occur no earlier 1-1,5 months.
The difficult period of dysentery characterized by very rapid development of the disease, has expressed intoxication, profound disruption of the cardiovascular system. The disease begins very quickly. The temperature of the body to chill quickly rises to 40 ° C and above, patients complain of severe headache, severe general weakness, increased zyabkost, particularly in the limbs, dizziness when standing from the bed, complete lack of appetite. Often there are nausea, vomiting, hiccup. Sick concerned about abdominal pain, accompanied by frequent urge to defecation and urination. A chair for more than 20 times a day, often difficult to count the number of bowel movement ( «chair without accounts»). During the height of disease continues 5-10 days. Recovery is slow, up to 3-4 weeks, the full normalization of mucosal ulcers occur in 2 months or more.
The diagnosis of chronic dysentery determined if the disease continues more than 3 months.
Complications of dysentery
Among the most frequent complications of the disease are: infectious-toxic shock, infectious-toxic defeat of the nervous system, peritonitis, pneumonia.
Diagnosis of dysentery
Diagnosis of dysentery is based on a survey of the patient. Much importance is the diagnostic examination of stool, which can be found smack mucus from the blood veins. Laboratory confirmation of dysentery conducted bacteriological and serologicheskim methods. Bacteriological method (Sowing shigell of excreta) in 3-multiplying the study provides confirmation of diagnosis from 40-60% of patients. Rapid diagnosis of acute intestinal diarrheal infections can be carried out to detect antigens pathogens and toxins biosubstratah - saliva, urine, Kale, blood. For this purpose, using immunological methods with high sensitivity and specificity: immuno-enzymatic analysis (IFA), the reaction of latex agglutination test (RAL), the reaction koagglyutinatsii (RSA), immunofluorestsentsii (RIF), polymerase chain reaction (PCR).
Treatment of dysentery
Treatment of patients with dysentery must be comprehensive and strictly individualized. Bed rest is needed, usually only for patients with severe disease. Patients with intermediate forms are allowed to go to the toilet. Patients mild appoint ward treatment and medical fitness.
One of the most important ingredient in the complex therapy intestinal patients is therapeutic feeding. In the acute period, with large intestinal disorders designate a table number 4, with improvements, reduced bowel dysfunction and the emergence of appetite patients are transferred to the table number 2, and for 2-3 days before an extract of the hospital - at the table.
Appoint a patient antibacterial drugs should be given the details of «territorial landscape resistance», ie sensitivity to it shigell available from patients in the area recently. Combinations of two or more antibiotics (CHEMOTHERAPEUTICS) appointed only in severe cases.
The duration of treatment of dysentery is determined improvement of the patient, normalization of body temperature, decrease in intestinal disorders. In the mid form of dysentery therapy may be limited to 3-4 days, with heavy - 4-5 days. The continued during the early recovery easy bowel dysfunction (pappy a chair up to 2-3 times a day, moderate phenomenon flatulence) should not be used as a pretext for the continuation of antibacterial treatment.
Patients light dysentery in the midst of disease, running with some mucus and blood in the faeces, appoint one of the following products: nitrofurany (furazolidon, furadonin of 0.1 g 4 times a day, ersefuril (nifuroksazid) 0.2 g 4 times a day) , Kotrimoksazol 2 tablets, 2 times a day, oksihinoliny (nitroksolin of 0.1 g 4 times a day, intetriks 1-2 tablets 3 times a day).
In mid dysentery during the prescribers group FLUOROQUINOLONE: ofloxacin to 0.2 g, 2 times a day or ciprofloxacin at 0.25 g 2 times a day; kotrimoksazol 2 tablets, 2 times a day; intetriks 2 tablets 3 times a day.
With heavy flow of dysentery appoint ofloxacin to 0.4 g, 2 times a day or ciprofloxacin at 0.5 g, 2 times a day; fluoroquinolone, in combination with aminoglicoside; aminoglicoside in combination with tsefalosporinami.
In dysentery and Fleksnera Zonne appoint polyvalent dysenteric Bacteriophage. The drug is available in liquid form and tablets with acid-resistant coating. Take for 1 hour before meals inside of 30-40 ml 3 times a day or 2-3 tablets 3 times a day.
In light during illness compensation for loss of liquid is carried out by one of the finished formulations (tsitroglyukosalan, regidron, tours, etc.). These solutions offer drink small amounts. Number vypitoy fluid should exceed 1.5 times the loss it isprazhneniyami and urine.
Patients with mid form of diarrhea is recommended abundant drink sweet tea or 5% glucose solution, or a ready solution (tsitroglyukosalan, regidron, tours, etc.) to 2-4 liters per day.
In severe intoxication shown intravenous drip infusion of 10% albumin solution, gemodeza and other kristalloidnyh solutions (trisol, laktasol, atsesol, hlosol), 5-10% solution of glucose with insulin. In most cases, quite imposing 1000-1500 ml of one or two of these solutions to achieve significant improvement of the patient.
For the binding and removal of toxins from the bowels appoint one of enterosorbent - polyphepane to 1 tablespoon 3 times a day, activated carbon to 15-20 g 3 times a day, enterodez to 5 g 3 times a day, polisorb MP to 3 g 3 times a day smekta to 1 bag 3 times a day or so
For the removal of toxins using enzymatic preparations: pankreatin, panzinorm in combination with calcium products.
In the acute period of diarrhea to eliminate spasm colon shows application: drotaverina hydrochloride (but-shpa) of 0.04 g 3 times a day, papaverine hydrochloride to 0.02 g 3 times a day. When the pain syndrome designate no-shpu to 2 ml 2% solution intramuscularly or 1-2 ml of 0.2% solution platifillina gidrotartrata subcutaneously.
Throughout the treatment of patients designate a complex vitamins.
In order to correct biocenosis bowel appoint biosporin, baktisporin, baktisubtil, flonivin-BS-2 dose 2 times a day for 5-7 days. In selecting the drug preference should be given a modern complex drugs - lineks, bifidumbakterin-forte, vitaflor and other drugs appoint, in a standard dosage. With good portability in a period of recovery shown Starch treatment and dietary bifido and laktosoderzhaschie products which have high therapeutic effectiveness.
Treatment of patients with chronic dysentery (recrudescent and continuing) is infektsionnom hospital. Treatment includes:
fluoroquinolone ciprofloxacin to 0.5 g, 2 times a day or ofloxacin of 0.2 g, 2 times a day, 7 days;
immunotherapy depending on the state immunity - timalin, timogen, levamizol, dibazol etc.;
panzinorm, festal, pankreatin, pepsin, etc.;
increased daily dose of vitamins;
treatment of opportunistic diseases, and glistnyh protozoynyh intestinal invasions;
to restore kishechnogo biocenosis appoint biosporin, baktisporin, lineks, bifidumbakterin-forte, vitaflor, lakto-bakterin; these drugs designate the standard dose for 2 weeks after etiotropnoy therapy in conjunction with the pathogenetic means.
Forecast with dysentery
The forecast for treating patients with dysentery, usually favorable.
Prevention of dysentery
One of the most important ingredient in the complex therapy intestinal patients is therapeutic feeding. In the acute period, with large intestinal disorders designate a table number 4, with improvements, reduced bowel dysfunction and the emergence of appetite patients are transferred to the table number 2, and for 2-3 days before an extract of the hospital - at the table.
Appoint a patient antibacterial drugs should be given the details of «territorial landscape resistance», ie sensitivity to it shigell available from patients in the area recently. Combinations of two or more antibiotics (CHEMOTHERAPEUTICS) appointed only in severe cases.
The duration of treatment of dysentery is determined improvement of the patient, normalization of body temperature, decrease in intestinal disorders. In the mid form of dysentery therapy may be limited to 3-4 days, with heavy - 4-5 days. The continued during the early recovery easy bowel dysfunction (pappy a chair up to 2-3 times a day, moderate phenomenon flatulence) should not be used as a pretext for the continuation of antibacterial treatment.
Patients light dysentery in the midst of disease, running with some mucus and blood in the faeces, appoint one of the following products: nitrofurany (furazolidon, furadonin of 0.1 g 4 times a day, ersefuril (nifuroksazid) 0.2 g 4 times a day) , Kotrimoksazol 2 tablets, 2 times a day, oksihinoliny (nitroksolin of 0.1 g 4 times a day, intetriks 1-2 tablets 3 times a day).
In mid dysentery during the prescribers group FLUOROQUINOLONE: ofloxacin to 0.2 g, 2 times a day or ciprofloxacin at 0.25 g 2 times a day; kotrimoksazol 2 tablets, 2 times a day; intetriks 2 tablets 3 times a day.
With heavy flow of dysentery appoint ofloxacin to 0.4 g, 2 times a day or ciprofloxacin at 0.5 g, 2 times a day; fluoroquinolone, in combination with aminoglicoside; aminoglicoside in combination with tsefalosporinami.
In dysentery and Fleksnera Zonne appoint polyvalent dysenteric Bacteriophage. The drug is available in liquid form and tablets with acid-resistant coating. Take for 1 hour before meals inside of 30-40 ml 3 times a day or 2-3 tablets 3 times a day.
In light during illness compensation for loss of liquid is carried out by one of the finished formulations (tsitroglyukosalan, regidron, tours, etc.). These solutions offer drink small amounts. Number vypitoy fluid should exceed 1.5 times the loss it isprazhneniyami and urine.
Patients with mid form of diarrhea is recommended abundant drink sweet tea or 5% glucose solution, or a ready solution (tsitroglyukosalan, regidron, tours, etc.) to 2-4 liters per day.
In severe intoxication shown intravenous drip infusion of 10% albumin solution, gemodeza and other kristalloidnyh solutions (trisol, laktasol, atsesol, hlosol), 5-10% solution of glucose with insulin. In most cases, quite imposing 1000-1500 ml of one or two of these solutions to achieve significant improvement of the patient.
For the binding and removal of toxins from the bowels appoint one of enterosorbent - polyphepane to 1 tablespoon 3 times a day, activated carbon to 15-20 g 3 times a day, enterodez to 5 g 3 times a day, polisorb MP to 3 g 3 times a day smekta to 1 bag 3 times a day or so
For the removal of toxins using enzymatic preparations: pankreatin, panzinorm in combination with calcium products.
In the acute period of diarrhea to eliminate spasm colon shows application: drotaverina hydrochloride (but-shpa) of 0.04 g 3 times a day, papaverine hydrochloride to 0.02 g 3 times a day. When the pain syndrome designate no-shpu to 2 ml 2% solution intramuscularly or 1-2 ml of 0.2% solution platifillina gidrotartrata subcutaneously.
Throughout the treatment of patients designate a complex vitamins.
In order to correct biocenosis bowel appoint biosporin, baktisporin, baktisubtil, flonivin-BS-2 dose 2 times a day for 5-7 days. In selecting the drug preference should be given a modern complex drugs - lineks, bifidumbakterin-forte, vitaflor and other drugs appoint, in a standard dosage. With good portability in a period of recovery shown Starch treatment and dietary bifido and laktosoderzhaschie products which have high therapeutic effectiveness.
Treatment of patients with chronic dysentery (recrudescent and continuing) is infektsionnom hospital. Treatment includes:
fluoroquinolone ciprofloxacin to 0.5 g, 2 times a day or ofloxacin of 0.2 g, 2 times a day, 7 days;
immunotherapy depending on the state immunity - timalin, timogen, levamizol, dibazol etc.;
panzinorm, festal, pankreatin, pepsin, etc.;
increased daily dose of vitamins;
treatment of opportunistic diseases, and glistnyh protozoynyh intestinal invasions;
to restore kishechnogo biocenosis appoint biosporin, baktisporin, lineks, bifidumbakterin-forte, vitaflor, lakto-bakterin; these drugs designate the standard dose for 2 weeks after etiotropnoy therapy in conjunction with the pathogenetic means.
Forecast with dysentery
The forecast for treating patients with dysentery, usually favorable.
Prevention of dysentery
Perebolevshie acute dysentery discharged from hospital not earlier than 3 days after clinical recovery (normalization of body temperature, chairs, the disappearance of signs of intoxication, pain in the stomach, intestine spasm and pain), in the absence of pathological changes in laboratory studies. Chemoprophylaxis from contact with sick people do not.
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