Toxic bacillary dysentery
Introduction
Introduction to toxic bacterial dysentery Poisonous bacterial dysentery is a critical condition for acute bacterial dysentery. Sudden onset, sudden high fever, severe illness, rapid deterioration and convulsions, coma and shock. This type is more common in children aged 2-7 years, and the mortality rate is high. Poisonous bacterial dysentery is a critical condition for acute bacterial dysentery. Sudden onset, sudden high fever, repeated convulsions, lethargy, rapid shock, coma, this type is more common in 2-7 years old and strong children, high mortality, must be actively rescued. basic knowledge The proportion of illness: 0.03% Susceptible people: more common in 2-7 years old and healthy children Mode of infection: digestive tract spread Complications: Diffuse intravascular coagulation Acute respiratory distress syndrome Acute cardiac insufficiency
Cause
Toxic bacterial sputum
The pathogen is Shigella bacillus, Shigella belonging to Enterobacter, and divided into four groups A, B, C, and D (Shigella, Fusarium, Baus, and S.). More common. In recent years, the resistance of dysentery bacilli to various drugs has gradually increased. The same strain of dysentery bacilli can be resistant to various antibiotics, and its drug resistance is mainly caused by the transmission of drug resistance factor (R factor). Shigella Oral into the gastrointestinal tract, relying on a group of polypeptide toxins encoded by its virulence plasmid to invade the colonic epithelial cells, and grow and multiply, the bacteria lysate to produce a large amount of endotoxin and a small amount of exotoxin. The mechanism of the occurrence of poisoning dysentery is not very clear, and may have an abnormal allergic reaction to the bacterial toxin (systemic inflammatory response syndrome). The endotoxin of Shigella is absorbed into the blood from the intestinal wall, causing fever and toxemia. Acute microcirculatory disorders. Endotoxin acts on the adrenal medulla and excites the sympathetic nervous system to release epinephrine, norepinephrine, etc., causing spasm contraction of small arteries and venules. Endotoxin acts directly or by stimulating the reticuloendothelial system to dehistify histidine Increased enzyme activity, or release by lysosomes, causes a large number of blood vessels to dilate blood and aggravate microcirculatory disorders. The above-mentioned lesions of toxic bacillary dysentery are most prominent in brain tissue. It can cause cerebral edema and even cerebral palsy, coma, convulsions and respiratory failure, which are the main causes of toxic bacillary death.
Prevention
Toxic bacterial dysentery prevention
1. Do a good job in environmental sanitation, strengthen toilet and manure management, eliminate flies and breeding grounds, and mobilize people to eliminate flies.
2, wash hands before and after meals, do not lead to water, do not eat spoiled and rotten food, do not eat food contaminated by flies.
3, do not overeating, so as not to reduce the resistance of the gastrointestinal tract.
4, cooling down and stop alarm, prevention and treatment of cerebral edema and respiratory failure, in order to quickly control infection, prevention and treatment of circulatory failure, should use strong broad-spectrum antibacterial drugs.
Complication
Toxic bacterial dysentery complications Complications, diffuse intravascular coagulation, acute respiratory distress syndrome, acute cardiac insufficiency
In addition to incidental sepsis, toxic bacteria can also be found in disseminated intravascular coagulation (DIC), acute respiratory distress syndrome, acute hemolytic uremic syndrome, cardiac insufficiency and toxic myocarditis.
Symptom
Symptoms of toxic bacillary dysentery Common symptoms Blood pressure drops limbs wet cold feces pus blood around the nose and mouth high fever high heat chills diarrhea shock nail bed hair blisters shortness of breath
The incubation period is mostly 1-2 days. The short period is several hours. The onset and development are fast. The high fever can be >40 °C (a few are not high). Rapid respiratory failure, shock or coma, intestinal symptoms are not obvious or even abdominal pain and diarrhea. There are also poisoning types that develop from 2-3 days after fever and pus and bloody stools. According to its main performance, it can be divided into the following three types.
1, shock type (skin visceral microcirculatory disorder type)
Mainly manifested as septic shock, early microcirculatory disorders, visible wilting, pale gray limbs cold, rapid pulse, shortness of breath, normal or low blood pressure, small pulse pressure, late microcirculation blood stasis, hypoxia, Lips and nail bed blemishes, skin spots, blood pressure drop or can not be measured, may be associated with heart, lung, blood, kidney and other multi-system dysfunction.
2, brain type (brain microcirculatory disorder type)
Repeated convulsions, coma and respiratory failure due to cerebral hypoxia and edema. Early sleepiness, vomiting, headache, high blood pressure, and relatively slow heart rate. As the disease progresses, it quickly enters a coma, frequent or persistent convulsions. The size of the pupils is not equal, the light reflection disappears, the breathing is shallow and uneven, the rhythm is not complete, and even the breathing stops. This type is more serious and has a high mortality rate.
3, lung type (pulmonary microcirculatory disorder type)
Also known as respiratory distress syndrome, mainly due to pulmonary microcirculation disturbance, often developed on the basis of brain-type or shock-type dysentery dysentery, the condition is critical and the mortality rate is high.
4, mixed type
The above two types or three types appear at the same time or successively, which is the most dangerous type, and the mortality rate is very high.
Examine
Examination of toxic bacterial dysentery
1, stool routine
The disease can be normal at the beginning, and there will be pus and mucus in the future, and there will be piles of pus cells, red blood cells and phagocytic cells.
1, stool culture
Shigella is a bacterium of the genus Shigella.
2, peripheral blood
The total number of white blood cells increased to (10-20)×109/L or more, neutrophils were dominant, and the nucleus of the nucleus was left-shifted. When DIC was present, platelets were significantly reduced.
3. Immunological testing
At present, the specific multivalent antibody of dysentery bacillus with fluorescent substance labeling has been used to detect pathogenic bacteria in stool specimens, and the methods are different, but the specificity needs to be further improved.
4, specific nucleic acid detection
The use of nucleic acid hybridization or PCR can directly check the dysentery bacillus nucleic acid in the feces, which has the advantages of high sensitivity, strong specificity, quick and simple, and low requirements for specimens, and is a promising method. Healthy children aged 2-7 years, with high fever in summer and autumn, accompanied by repeated seizures, encephalopathy and/or shock performance, should consider poisonous bacillary dysentery. Anal swab or enema can be used to take a large amount of pus cells or red blood cells. Initial diagnosis. The disease should be distinguished from high fever convulsions, epidemic encephalitis and other diseases. High fever convulsions are more common in 6 months - 3 years old children, often recurrent sensation of sudden increase in body temperature, convulsions, short convulsions, general after a shock, no other symptoms of infection. One more convulsion occurred in one course of the disease, which was normal. Epidemic encephalitis season, high fever, convulsions and the disease are similar, but coma occurs more than 2-3 days, more often does not appear circulatory failure, cerebrospinal fluid examination can be abnormal and stool examination is normal, and other invasion of intestinal mucosal bacteria The identification of enteritis and colitis is mainly based on the diagnosis of stool pathogenic bacteria.
Diagnosis
Diagnosis and diagnosis of toxic bacterial dysentery
1, stool routine
The disease can be normal at the beginning, and there will be pus and mucus in the future, and there will be piles of pus cells, red blood cells and phagocytic cells.
1, stool culture
Shigella is a bacterium of the genus Shigella.
2, peripheral blood
The total number of white blood cells increased to (10-20)×109/L or more, neutrophils were dominant, and the nucleus of the nucleus was left-shifted. When DIC was present, platelets were significantly reduced.
3. Immunological testing
At present, the specific multivalent antibody of dysentery bacillus with fluorescent substance labeling has been used to detect pathogenic bacteria in stool specimens, and the methods are different, but the specificity needs to be further improved.
4, specific nucleic acid detection
The use of nucleic acid hybridization or PCR can directly check the dysentery bacillus nucleic acid in the feces, which has the advantages of high sensitivity, strong specificity, quick and simple, and low requirements for specimens, and is a promising method. 2-7 years old children, high fever in summer and autumn, accompanied by repeated seizures, encephalopathy and (or) shock performance, should consider poisonous bacteria, can be used for anal swab or enema to take a large number of pus cells or red blood cells. Initial diagnosis. The disease should be distinguished from high fever convulsions, epidemic encephalitis and other diseases. High fever convulsions are more common in 6 months - 3 years old children, often recurrent sensation of sudden increase in body temperature, convulsions, short convulsions, general after a shock, no other symptoms of infection. One more convulsion occurred in one course of the disease, which was normal. Epidemic encephalitis season, high fever, convulsions and the disease are similar, but coma occurs more than 2-3 days, more often does not appear circulatory failure, cerebrospinal fluid examination can be abnormal and stool examination is normal, and other invasion of intestinal mucosal bacteria The identification of enteritis and colitis is mainly based on the diagnosis of stool pathogenic bacteria.
