dysentery
Introduction
Violent introduction Irritable, also known as acute bacterial dysentery (acutebacillary dysentery), referred to as bacillary dysentery, is an acute intestinal infectious disease caused by Shigella (genus Shigellae). There are scattered epidemics throughout the year, which are common in summer and autumn, and are generally susceptible to children. It is often found in summer and autumn, because the weather is hot and the temperature is high, which is suitable for the growth and reproduction of Shigella. In summer and autumn, fresh melons and fruits are on the market. People like to eat melons and vegetables, but they don't pay attention to cleaning and disinfection or self-cultivation. They don't wash their hands and eat them, so that germs enter the gastrointestinal tract with food. In the summer and autumn, the human body needs to dissipate more heat through the skin to maintain body temperature balance; the skin blood vessels are often in an expanded state, while the gastrointestinal blood vessels are relatively contracted, the blood flow is relatively reduced, and the body's resistance to gastrointestinal infectious diseases is also It weakens. In addition, cold, excessive fatigue, overeating, and suffering from a variety of acute and chronic diseases, when the body's resistance is reduced, it is easy to induce dysentery. basic knowledge Sickness ratio: 0.05% Susceptible people: more common in children Mode of infection: non-infectious Complications: dehydration, abdominal pain, bloating
Cause
Illness
Shigella gram-negative Shigella spp., divided into 4 groups (A, B, C, D), 37 types, namely group A (Shigella dysenteriae) 12 types, B group (Fu Laizhi There are 6 types of Heshi), 18 types of C group (Shigella serrata), and 1 type of D group (Shigella sonnei). It is most common with F. faecalis and S. sinensis. The bacterium has strong resistance to the external environment, can survive for about 10 days on fruits and vegetables, and can survive for up to 3 months in river water at a suitable temperature. Can also be multiplied. Not resistant to high temperatures, sensitive to a variety of chemical disinfectants. The main pathogenic factors of Shigella bacilli are invasiveness and toxins. After entering the digestive tract, the invasive dysentery bacillus invades the colonic mucosal epithelium and multiplies within the cell, causing inflammation. Shigella can produce Shiga toxin (SHT) and Shiga toxin (SLT). SHT has cytotoxic, enterotoxin and neurotoxic effects.
It is often found in summer and autumn, because the weather is hot and the temperature is high, which is suitable for the growth and reproduction of Shigella. In summer and autumn, fresh melons and fruits are on the market. People like to eat melons and vegetables, but they don't pay attention to cleaning and disinfection or self-cultivation. They don't wash their hands and eat them, so that germs enter the gastrointestinal tract with food. In the summer and autumn, the human body needs to dissipate more heat through the skin to maintain body temperature balance; the skin blood vessels are often in an expanded state, while the gastrointestinal blood vessels are relatively contracted, the blood flow is relatively reduced, and the body's resistance to gastrointestinal infectious diseases is also It weakens. In addition, cold, excessive fatigue, overeating, and suffering from a variety of acute and chronic diseases, when the body's resistance is reduced, it is easy to induce dysentery.
The pathogenesis of toxic bacillary dysentery is mainly due to the body's abnormally strong reaction to bacterial toxins, causing a series of pathophysiological disorders such as acute microcirculatory disorders. The lesion of the plaque affects the entire colon and even the ileum, with the sigmoid colon and rectum being the most serious. According to the course of the disease can be divided into acute and chronic two phases. After the dysentery bacillus enters the digestive tract, it can be quickly eliminated by normal people's gastric juice, and a small amount of netted people will be further inhibited or rejected by the intestinal tract. Once the body's defense function is weakened, the dysentery bacillus will take advantage of it, causing chills and fever, often accompanied by headache and fatigue. Abdominal pain and diarrhea occur in a short period of time, and the stool begins to be watery. It quickly turns into mucus pus or pus and blood, and the amount of feces. Less, more times, more important after the urgency, severe toxic shock can occur, life-threatening. Children under the age of 7 are prone to toxic bacillary dysentery in summer and autumn. The main symptoms are sudden high fever, convulsions, coma, etc., and should not be taken lightly.
Prevention
Violent prevention
To prevent irritability, there are mainly the following aspects:
(1) Do a good job in environmental sanitation, strengthen the management of toilets and manure, eliminate the breeding grounds of flies, and mobilize the masses to eliminate flies;
(2) Strengthening food hygiene and water source management, especially for individuals and food vendors;
(3) The cooks and caregivers of the collective units and child care institutions should regularly check the stool and do bacterial culture;
(4) Strengthen health education. Everyone should wash their hands before and after meals, do not drink raw water, do not eat spoilage and rotten food, and do not eat food that has been contaminated by flies. Do not overeating, so as not to reduce the resistance of the gastrointestinal tract.
Complication
Violent complications Complications, dehydration, abdominal pain, bloating
1. Acute bacillary dysentery is often accompanied by varying degrees of dehydration acidosis and electrolyte imbalance;
2. Chronic dysentery has abdominal pain, bloating and other symptoms. There are many stools, obvious mucus, but the symptoms of systemic poisoning are not obvious;
3. A small number of patients developed joint swelling and pain at 1-2 weeks after onset, which was non-suppurative and migratory. If accompanied by fever, urethritis, and membranous inflammation, it is called Reiter syndrome, which is related to the immune response induced by infection.
Symptom
Illness symptoms common symptoms diarrhea, abdominal pain, urgency, dysentery, dyspnea, high fever, nausea, coma, coma
1. The acute incubation period of acute bacillary dysentery varies from several hours to seven days, most of which are 1-2d; generally can be divided into the following three types:
(1) Acute poisoning bacillary dysentery is more common in children aged 2-7 years, and occasionally occurs in adults. Generally, the onset is rapid, the development is fast, the symptoms of poisoning are heavy, and the symptoms of the digestive tract are not necessarily heavy. High fever, occasionally the body temperature does not rise. According to the location of the microcirculation obstacles, the type 4 is different:
1) The brain type accounts for most of the drug mites. Early irritability, lethargy, pale, increased muscle tone, with convulsions, normal or slightly higher blood pressure, late coma, and even cerebral palsy;
2) The lung type is mainly the microcirculatory disorder of the lung, also known as shock lung. The incidence is low, the mortality rate is high, often occurs in the course of the disease 16-24h, manifested as progressive dyspnea, hypoxemia, general oxygen can not be alleviated;
3) Shock-type adults are more common, limbs or limbs with cyanosis, cold, fine pulse, low blood pressure, small pulse pressure difference, and reduced urine output. A few are high-row and low-resistance types;
(2) Acute common type bacteria are called acute typical bacteria, and the symptoms are mainly acute onset, chills, fever, nausea, vomiting, abdominal pain at the same time or several hours later, first seen in the umbilical cord or the whole abdomen, then turned into In the left lower abdomen, physical examination often has tenderness in the lower left abdomen. Frequent diarrhea, initially yellow loose stools, followed by mucus and pus and blood, the amount is small, accompanied by urgency and heavy;
(3) Mixed type bacteria above type 3, any two types exist simultaneously or sequentially, and the incidence rate is low.
2. Chronic bacillary dysentery is caused by chronic bacillary dysentery due to incomplete treatment or self-remission of acute bacillary dysentery. The course of disease is more than 2 months. There is loss of appetite, abnormal stool, dry time and rare mucus. Generally, there is no abdominal pain. Only in the lower abdomen, there is pain or intestinal cramps before defecation, and abdominal pain disappears after defecation. Some patients may have symptoms such as insomnia, multiple dreams, forgetfulness, and neurasthenia.
Examine
Illness check
1. Immunofluorescence ball method is positive;
2. Fecal examination showed more red blood cells and white blood cells under the microscope, and a few had phagocytic cells. Fecal culture of Shigella is positive;
3. Peripheral blood leukocyte count and neutrophil increase in the acute phase of blood.
Diagnosis
Violent diagnosis
Diagnosis is based on clinical performance and examination.
1. The common type of acute bacillary dysentery should be differentiated from infectious diarrhea, including Salmonella enteritis, Campylobacter jejuni enteritis, pathogenic Escherichia coli enteritis, etc., and the corresponding pathogenic bacteria should be present in stool culture;
2. Acute poisoning bacteria should be differentiated from febrile seizures, Japanese encephalitis and water-induced shock;
3. Chronic bacillary dysentery should be differentiated from chronic non-specific ulcerative colitis, chronic amoebic dysentery and colon cancer; amoebic dysentery generally has mild symptoms of systemic poisoning, feces are dark red jam-like, and amoebic nourishment can be seen by microscopic examination. Body or inclusion body for identification.
