Bacillary dysentery
Introduction
Introduction to bacterial dysentery Bacterial dysentery (bacillarydysentery) is a common acute intestinal infectious disease caused by dysentery bacilli. It is characterized by colonic suppurative inflammation, with symptoms of systemic poisoning, abdominal pain, diarrhea, urgency, and pus and bloody stools. Shigella bacillus invades the intestinal mucosa epithelium and has a layer and multiplies in it, causing inflammation of the intestinal mucosa. The lamina propria has capillary and venous congestion, and there is exudation and infiltration of cells and plasma, and even the lamina propria can be small. Vascular circulatory failure, resulting in degeneration or even necrosis of epithelial cells, necrotic epithelial cells can form small and superficial ulcers, resulting in abdominal pain, diarrhea, pus and bloody stools. Prevention should start from three aspects: controlling the source of infection, cutting off the route of transmission, and improving the body's resistance. Early detection of patients and carriers, timely isolation and thorough treatment is an important measure to control bacterial diseases. Those who work in the catering industry, conservation and water plants need to conduct a longer-term follow-up and temporarily transfer them from work if necessary. basic knowledge Sickness ratio: 2% Susceptible people: no specific population Mode of infection: digestive tract spread Complications: abortion, malnutrition, Reiter syndrome, angular keratitis
Cause
Bacterial sputum
Route of transmission (25%):
The dysentery bacilli are discharged by the patient or the faeces of the carrier, and are transmitted through contaminated hands, food, water or life contact, or indirect ways such as flies and cockroaches, and finally pass through the digestive tract to allow the susceptible person to be tendered.
Susceptibility to the population (25%):
The population is generally susceptible to dysentery bacilli, preschool children are more ill, and are associated with poor health habits. Adult patients are associated with decreased body resistance and exposure to infection, and there is no consolidation of immunity after the same type of bacillary dysentery. And there is no cross-immunization between different serotypes of dysentery bacilli, which causes repeated infection or re-infection and repeated onset.
Source of infection (25%):
Sources of infection include patients and carriers. Acute non-acute typical bacillary dysentery and chronic occult sputum sputum are important sources of infection.
Prevention
Bacterial dysentery prevention
It should start from three aspects: controlling the source of infection, cutting off the route of transmission and enhancing the body's resistance:
(1) Early detection of patients and carriers, timely isolation and thorough treatment are important measures to control bacterial diseases. Those engaged in catering, conservation and waterworks work need to be traced in a longer period of time, and temporarily removed from work if necessary.
(2) Cut off the route of transmission: do a good job of "three tubes and one extinguish", that is, control the water, manure and diet, and eliminate flies), develop the habit of washing before and after meals, and regularly check the status of the bacteria in the catering industry and children's institutions. If a carrier is found, it should be treated immediately and removed from work.
(3) Protecting susceptible populations can be orally administered with E. coli strains. The bacteria are not pathogenic, but have protective effects. The protection rate is 85% to 100%. Domestically produced multivalent dysentery vaccines.
Complication
Bacterial dysentery complications Complications, abortion, dystrophy, Reiter syndrome, angular keratitis
1. In the recovery period or acute phase, occasionally, exudative arthritis, joint redness and swelling, self-resolved within a few weeks.
2. Severe pregnant women can cause miscarriage or premature birth.
3. Chronic bacillary dysentery with ulcerative colon disease, can be complicated by malnutrition, anemia, vitamin deficiency and neurosis.
4. Can lead to hemolytic uremic syndrome, Reiter syndrome, leukemia-like reactions, etc., children with otitis media, angular cheilitis, rectal prolapse.
5. Concomitant sepsis is rare, with double manifestations of bacillary dysentery and sepsis, but the condition is more dangerous, the mortality rate is high, and the baby is older within 1 year of age.
Symptom
Bacterial dysentery symptoms Common symptoms Dysentery, mucus, thin stool, diarrhea, mucus, dehydration, stool, soreness, abdominal pain, paroxysmal abdominal pain, nausea
Because of the different types of bacillary bacilli entering the human body, the number and the resistance of each person are different, so the symptoms are also different, so the clinical dysentery is divided into acute and chronic.
First, acute dysentery
According to the symptoms, acute dysentery is divided into four types: light, normal, heavy and poisonous. In the poisoning type, it is divided into shock type and brain type according to the condition. Although parents do not have to strictly classify the child's condition, they should Understand the basic symptoms of dysentery and the outcome of changes in the condition.
Light dysentery
This is the lightest type of dysentery, usually only mild abdominal pain, diarrhea, stool 2-4 times a day, watery or mushy, no pus and blood, sometimes mixed mucus, relieve abdominal pain after dissolution, most do not heat or Only low fever, due to atypical symptoms, is often misdiagnosed as general enteritis.
2. Ordinary type
This type has more typical symptoms of dysentery, fever, body temperature can be as high as 39 ° C, individual children can be as high as 40 ° C or more, can start without abdominal pain, diarrhea, only nausea, vomiting, headache and other symptoms, therefore, often misdiagnosed as A bad cold, a few hours later began to appear paroxysmal abdominal pain, diarrhea, began to be loose stools, followed by pus and blood, because the intestinal mucosa has ulcers and necrosis, so there is a clear sense of falling.
Heavy
The severe dysentery is acute, with high fever. The daily stool frequency can reach 20-30 times. The stool is pus-like blood, the amount is small, the abdominal pain is severe, the falling is heavier, and even the toilet is not wanted to leave, the limbs are cold, and dehydration occurs soon. Some can have disturbances of consciousness.
4. Poisoning type
Poisoning dysentery is more common in children aged 2-7 years, often sudden onset, only high fever at the beginning, body temperature can reach 40 ° C, mental wilting, complexion gray, lips and nails blue, skin often appears pattern, breathing shallow and weak, can appear repeatedly Convulsion, most children do not have abdominal pain, diarrhea and vomiting, a small number of children only have mild abdominal pain, diarrhea, no pus and blood in the stool, in addition to the above symptoms, if the shock symptoms are called shock type, the performance is weak pulse, blood pressure is down or not measured Out, oliguria or no urine, dyspnea, hemoptysis, death due to heart failure, if the brain symptoms are called brain type, the main manifestations of brain type are irritability, lethargy, normal or elevated blood pressure, there are Severe headache, frequent vomiting, rapid breathing, sometimes apnea, sigh-like breathing or double inhalation, and soon into a coma, and the size of the lateral pupils are not equal or suddenly, often due to respiratory failure.
Second, chronic dysentery
Those who have a disease duration of more than 2 months are called chronic dysentery. Most of them are caused by incomplete treatment of mild dysentery or children with malnutrition, rickets, anemia, parasites and other diseases. High fever, sometimes abdominal pain, diarrhea, vomiting and low fever, stool 3-5 times a day, may have normal and mucus and pus and blood will alternate, children with chronic dysentery, due to long-term malnutrition, poor resistance, Easy to combine with other bacterial infections, such as pneumonia, tuberculosis, etc.
Although there are many types of dysentery, only heavy and poisonous types are harmful to children's lives. If it is in summer and autumn, the child suddenly has a fever, repeated vomiting, pale, cold limbs, with or without abdominal pain and diarrhea. The possibility of poisoning dysentery, emergency hospitals for rescue treatment.
Examine
Bacterial dysentery
(1) Blood: In the acute cases, the total number of white blood cells and neutrophils are moderately elevated, and chronic patients may have mild anemia.
(2) Fecal examination: There is no fecal matter in the dysentery of typical dysentery, the amount is small, it is bright red and sticky, no odor, a large number of pus cells and red blood cells can be seen by microscopic examination, and macrophages are found, and pathogenic bacteria can be detected by culture. If the sample is not properly sampled, the specimen has been left for too long, or the patient has received antibacterial therapy, the culture results are often unsatisfactory. The commonly used identification medium is SS agar and MacConkey agar.
(3) Other examinations: Fluorescent antibody staining technology is one of the rapid examination methods, which is more sensitive than cell culture. The method of immunofluorescence microsphere is adopted in China. The method is simple, sensitive and specific, and can be diagnosed 8 hours after sampling. The bacteria can continue to be cultured and tested for drug susceptibility. Sigmoidoscopy can reveal diffuse hyperemia of the intestinal mucosa in the acute phase, edema, massive exudation, superficial ulcers, and sometimes pseudomembrane formation. The intestinal mucosa in the chronic phase is granular. Ulcer or polyp formation, scraping secretions from the lesion for culture, can increase the detection rate, in addition, X-ray barium examination in the chronic phase, visible intestinal fistula, dynamic changes, bag shape disappear, intestinal lumen stenosis, intestine The mucosa is thickened or segmented. In recent years, staphylococcal synergistic agglutination test has been used as a rapid diagnostic method for bacillary dysentery, which has good sensitivity and specificity.
Diagnosis
Diagnosis and diagnosis of bacterial dysentery
diagnosis
In the epidemic season, abdominal pain, diarrhea and pus and bloody stools should consider the possibility of bacillary dysentery. Patients in the acute phase often have fever, and most of them appear before the gastrointestinal symptoms. The history of the past episodes of patients in the chronic phase is very important. Stool smear Detection and bacterial culture contribute to the establishment of diagnosis, sigmoidoscopy and X-ray barium examination, which have certain value for the identification of chronic bacillary dysentery and other intestinal diseases. In the season of bacillary dysentery, sudden fever, convulsions and no other symptoms Children must take into account the possibility of poisoning bacillary dysentery, should be taken soon or later with anal test specimens or saline broth for smear microscopy and bacterial culture.
Differential diagnosis
(1) Amoebic dysentery: the onset is generally slow, with few symptoms of toxemia, the sensation is less severe, the stool frequency is less, the abdominal pain is mostly on the right side, the typical feces are jam-like, rancid, and the microscopic examination only sees a little White blood cells, red blood cells condensation group, often with Charcot-Ryden's crystal, can find amoeba trophozoites, sigmoidoscopy, see most of the mucosa normal, scattered ulcers, the disease is easy to have liver abscess.
(2) Epidemic encephalitis B: The performance and epidemic season of this disease is similar to that of bacillary dysentery (heavy or poisoned). The latter is more acute, rapid progress, and easy to have shock. It can be warmed by saline enema and microscopic examination. Bacterial culture, in addition, the disease should be associated with Salmonella infection, Vibrio parahaemolyticus food poisoning, Escherichia coli diarrhea, Campylobacter jejuni enteritis, viral enteritis, chronic bacillary dysentery and chronic schistosomiasis, rectal cancer, non-specific Identification of ulcerative colitis.
