Dysentery is ... Dysentery (shigellosis) is an infectious disease. Causes, Symptoms and Treatment
Few people find it difficult to answer the question of what dysentery is. "This is diarrhea, abdominal pain, fever," many of us will list the brightest symptoms. There are people who believe that dysentery is caused by unripe fruits, such as green apricots. This is because some consider dyssentery to be an upset stomach. In fact, dysentery is a disease caused solely by bacteria, microscopic unicellular creatures that can send light to both children and adults. Just imagine, 700 thousand people die of dysentery every year, and about 80 million get sick! And these are only registered cases. But to avoid the disease is not difficult. You just need to be clear about what you are dealing with.
Shigellosis? What is it?
If almost everyone knows or has heard about dysentery, then the question “what is shigellosis?” Will confuse many. In fact, it is all the same dysentery. The causes of its occurrence in most cases are infection by bacteria of the Shigella genus, hence the tricky second name for the disease.These bacteria are microscopically small (up to 3 μm), have a rod-shaped body, do not need oxygen for active life, that is, they feel great in the internal organs of a person. To date, there are 4 known types of Shigella - Boyd, Sonne, Flexner and dysentery. Microbiologists in each of them distinguish several serotypes that differ in a number of features and abilities to adapt to the environmental conditions surrounding them. Every single danger to humans. Precisely because the disease is caused by bacteria, it is called "bacterial dysentery." There is another - amoebic dysentery, or amebiasis. It is caused by another microscopic protozoan parasite, Entamoeba histolytica amoeba.
What do Shigella do with us?
Once in the stomach, the bacteria do not linger there (they do not like the gastric juice, the epithelium cells do not fit), but move into the intestine.Having reached the right place, Shigella begin to secrete mucin, or cytotoxin, an enzyme that destroys cell membranes. This gives them the opportunity to penetrate into the intestinal epithelium and multiply there. Thus, bacterial dysentery develops very quickly. That's not all. Living Shigella produce:
1. Enterotoxin, which causes increased secretion of water from the body into the intestine. This is precisely the cause of diarrhea.
2. Neurotoxin, which poison the nervous system of the patient and causes headache, general weakness, fever.
The original (maternal) Shigella does not live long, up to 14 days, therefore they constantly replenish their ranks. But even when they die, the bacteria continue to harm, releasing endotoxin into the host intestine. This poison not only brings a lot of trouble to the digestive tract, but also enters the bloodstream, causing serious general intoxication.
The result of all of the above: dysentery is the most serious infectious disease that develops in the intestine and causes intoxication of the whole organism.
As a result of vigorous shigella activity, the patient is disturbed by the balance of bacteria that are useful to the intestines, resulting in dysbacteriosis.In addition, bacteria cause inflammation of the intestinal mucous layer, which causes bleeding ulcers (hence so much mucus and blood in the feces of dysentery).
How can I catch infection
Transmission pathways for dysentery are as follows:
1.From patient to healthy in all forms of contact.Bacteria are able to live up to several days on items used by an infected person on door handles, linen, towels, and dishes. To avoid this possibility of infection is easy. Virtually all types of shigella die within a couple of minutes under the action of antibacterial agents, so furniture, handles, and the like must be carefully processed. Boiling bacteria can withstand just an instant, so everything that can be subjected to high temperatures (dishes, linens, household items), you need to boil. Even heating to 60 degrees Shigella tolerate only 20 minutes. This means that everything that cannot be boiled (for example, soft toys) should be subjected to heat treatment (steam). Sunlight for these bacteria is also deadly. They endure its impact for half an hour. A UV lamp kills them in 10 minutes. Therefore, where the elementary rules of hygiene are observed, dysentery infection is minimal.By the way, the cold Shigella does not scare, so the removal of food and things in the cold or placing them in the freezer from dysentery does not save.
2.Insects. Carriers of infection are often flies, who love to crawl (and that we all know) in feces. On the legs of these insects, Shigella live up to 3 days, during which they manage to safely move to new, undeveloped areas, such as food, household items. Control measures - the destruction of flies and again the same hygiene. At least shigella is tolerated by cockroaches and ants, although this route of infection also occurs.
3.Products. The requirement to wash fruits and vegetables before eating has long been, as they say, a classic of the genre. But for some reason, many people neglect them. Meanwhile, bacteria, fruits and berries and vegetables are easier to get from the soil thanks to numerous insects. In addition, Shigella feels great in dairy products, salads, cold side dishes and snacks. This particularly applies to Shigella Flexner.
- washing all that is bought on the market and torn in the garden;
- cleanliness and freshness of cooked dishes.
4.Reservoirs. It is the most common source of dysentery.Bacteria enter the rivers, ponds and lakes with feces and water. In the aquatic environment, they live up to a month, and in feces and in cesspools - twice as long. Most of the water in the water "likes" to inhabit the bacteria Zonne. Measures to combat contagion in this case are in the regular epidemiological monitoring of water bodies of the relevant services.
In winter, dysentery does not get sick!
Those who think so are deeply mistaken. Dysentery infection affects and kills year-round. But the peak of the disease, and especially mass epidemics, are really observed in the warm season. Causes:
- bathing in reservoirs in which they do anything, but not analyzes of bacterial contamination;
- flocks of flies, diving on food after walks, it is not known where;
- The temptations to eat straight from the bush an appetizing berry or fruit.
In winter and all year round, you can get dysentery like this:
- At public catering points where sanitation is not observed, especially if there are sick and self-healing employees.
- In any public places where you can cross with a carrier of dysentery bacteria (transport, schools, shops, etc.), if you do not wash your hands upon returning home or before eating.By the way, an excellent carrier of infection is money that constantly wanders from one owner to another.
- Another way to get dysentery all year round - through the water supply system in case of accidents at sewage treatment plants. This is rare, but cases have occurred.
Everyone who "swallowed" the bacteria gets sick, but some who have a strong body tolerate dysentery easily.
Is there a vaccination for dysentery?
Unfortunately no. Those who are already ill, get immunity for a short time, sometimes just for three months, sometimes for 2 years, but more often for a year. It only works with the kind of bacteria that a person has had. That is, after dysentery with Shigella Flexner, you can immediately pick up dysentery with bacteria Sonne. Plus, there are a half dozen serotypes in each population. So, we can say that there is no immunity as such after dysentery, and vaccinations are not being developed.
Types of shigellosis. Easy form
Dysentery is a multifaceted and insidious disease. Some of them are knocked down right away, while others live with him for years, drink “something from diarrhea” and do not realize what danger they pose to others.In order to somehow classify the manifestations and the course of the disease and develop the most appropriate treatment methods for each case, physicians have conditionally identified what form dysentery can have. It:
3. Acute, heavy.
The mild form of dysentery is registered in about 80% of all cases. It is characterized by the following symptoms:
- Temperature up to 37.8-38 degrees Celsius;
- mushy stools;
- mucus and blood in the stool is not observed;
- The number of urges per day to 10;
- abdominal pain (moderate).
Hospitalization and bed rest in this case is not required. For treatment apply:
- drugs from the nitrofuran series;
- “Regidron” or “Enterodez” for detoxification;
- prebiotics, restoring microflora in the intestine;
- diet food;
- drink plenty of liquids to avoid dehydration.
Such a course of the disease is noted in 25% of all people who have picked up Shigella bacteria. Symptoms of dysentery in adults with moderate form are as follows:
- temperature up to 39 degrees Celsius;
- abdominal pains undulating, moderate to severe;
- liquid stools;
- possible the presence of blood and mucus;
- urges more than 10 times a day;
- General weakness, sometimes a headache;
- false desires, not accompanied by emptying.
With a moderate form of the patient is hospitalized. Bed rest is required.
- drink plenty of liquids, glucose solutions can be prescribed;
- “Gastrolit”, “Orsol” for detoxification;
- antibiotics of the fluoroquinolone group;
- probiotics, prebiotics, vitamins.
In this state, about 5% of all patients suffer from the disease. Symptoms of dysentery in adults with severe are as follows:
- severe weakness;
- temperature above 40 degrees Celsius or so;
- The stool is similar to bloody mucus interspersed with pus;
- urges more than 30 times a day;
- high intoxication;
- chills or fever;
- apathy, loss of appetite;
- headaches, aching bones;
- pain in the abdomen almost never ending, sharp, painful.
In severe form of dysentery, severe dysbiosis is observed - a problem of the gastrointestinal tract, caused by ulceration of the intestinal walls, inflammation of the rectum.
The treatment of dysentery in adults with this form is as follows:
- hospitalization, bed rest;
- plenty of drink, even through force; Often the patient is given a dropper with saline, glucose (mixed with insulin) or other means of dehydration;
- detoxification of the body, for which they use intravenous "Albumin"; with its help not only the reserve of the lost fluid is replenished, but also the tissues are provided with protein;
- intravenous "Hemodez", "Acesol" and "Lactasol" (these drugs bind toxins and remove them from the body);
- perhaps the appointment of "Prednisolone";
- antibiotics of the cephalosporin group;
- anti-fungal drugs;
- probiotics, prebiotics, a wide range of vitamins;
- sometimes plasmapheresis is performed (plasma purification);
- strict diet.
For all forms and types of dysentery, antispasmodics and binders are prescribed - Papaverin, Atropine, No-shpa. Useful broths of blueberries, oak bark, chamomile, St. John's wort. Microclysters also give a good effect (100 ml with a fluid temperature not higher than +37 degrees Celsius) with chamomile, sea buckthorn or rosehip oil. They especially help with the ulcerative process in the colon.
By the nature of the onset of the disease and the rate of its development, there are such types of dysentery:
Acute is characteristic of severe and moderate forms. Her symptoms are:
- a sharp deterioration in health;
- weakness, chills;
- temperature rise to critical levels;
- sharp, painful, cramping abdominal pain;
- sometimes vomiting;
- frequent and painful urge to defecate.
Acute dysentery can begin as early as the first day after infection and torment a person from 3-5 days to 3 months. She, in turn, is divided into three subgroups:
These hard-to-pronounce definitions are easy to understand and remember. The name colitis is derived from the word colitis, meaning that the disease develops in the large intestine. This type of dysentery is observed in most patients (90%) and is characterized by severe pain with cramping in the abdomen, urge to defecate more than 30 times a day, loose stools mixed with blood, mucus, pus, symptoms of general intoxication (nausea, weakness, headache ).In severe cases, fainting and loss of connectivity in speech are recorded. In addition, the severe form of colic dysentery can complicate the position of a patient with high tachycardia, shortness of breath, hypotension (up to collapse). The incubation (hidden) period sometimes lasts only a day, and sometimes several days, which is especially dangerous, since during this time the colonies of bacteria have grown considerably.
Gastroenteric dysentery, symptoms, the treatment of which is slightly different from the colitis, is no less unpleasant. The word "gastroenteritis" means the stomach ("gastro") and intestines (in Greek, "eder"). Thus, gastroenteric dysentery is a disease of the stomach and at the same time the small intestine. Most often it is observed in young children and means that the bacteria are ingested with food. The incubation period in this case is very small. Symptomatology resembles toxic poisoning and is characterized by nausea, vomiting, sharp abdominal pain, diarrhea (first without blood and mucus), general weakness, fever, and the symptoms of enterocolitis are usually basic. This makes it difficult to diagnose correctly.in which it is necessary to conduct laboratory tests.
Zonne's bacteria most commonly cause gastroenterocolitic dysentery. The disease covers the entire gastrointestinal tract (stomach plus all parts of the intestine). It starts rapidly and is manifested by high fever, sharp pains in the abdomen, diarrhea, frequent and painful acts of defecation. Intoxication and dehydration also follow almost immediately after the first signs.
Chronic dysentery. Symptoms, treatment
If the disease lasts 3 months or more, it is classified as chronic. Characteristics:
- phases of recurrence and remission, up to the complete disappearance of symptoms;
- forms of the disease only mild and moderate;
- Sometimes chronic dysentery lasts all the time, but evenly, without interruptions and sudden changes. It usually proceeds in a mild form.
Relapses can occur when the diet is disturbed and have standard symptoms of dysentery:
- temperature increase to medium-high marks;
- stomach ache;
- general weakness.
If dysentery flows without interruption, patients usually have anemia, vitamin deficiencies, dysbacteriosis lasting for years, irritability, headaches, and sleep disorders.
Treatment of dysentery in adults should be carried out in combination, depending on the associated diseases. In case of relapses, medications are prescribed the same as in conventional dysentery, plus a strict diet, digestive enzymes, eubiotics, astringents. Antibiotics are attributed with great caution, as bacteria develop addiction to them. Alcohol, of course, excluded from the diet. Most often it is the chronic patients who are bacteria carriers.
Sad but true: a doctor is consulted only when acute dysentery occurs in severe and moderate forms. In mild form, most citizens try to cope with unpleasant symptoms on their own, which leads to the transition of the disease to the chronic form. At the reception, the doctor must:
- carefully examine the patient, inquire about the symptoms, clarify how, according to the patient's assumption, the disease could occur (infection after contact with dysentery patients or other reasons).
- make a contact inspection by examining the abdomen.
- to measure the pressure (it is, as a rule, low, and the pulse is quickened);
- to examine the mucous membranes of the oral cavity (dry tongue with white bloom is an indirect sign of the disease).
On the basis of these data, a medical history is compiled. Dysentery is reliably diagnosed only by the results of laboratory tests. The patient is prescribed to pass feces on bakposev. Also take for research vomit and smear from the rectum. Colonies of bacteria are diagnosed on the 4th day. If it is fundamentally important to establish the type of shigella, agglutination is performed with sera that are different for each kind of bacteria. Scalological feces tests are also performed (under a microscope) to help determine whether or not there is inflammation in the intestine.
For early diagnosis, perform the following tests:
- immunofluorescent (much more accurate bacteriological, but also much more expensive);
- immunoassay (determines shigella antigens in the blood);
- PCR (polymerase chain reaction that detects the DNA of bacteria in any patient's sample - it is blood, urine, feces);
- reaction to coal agglomeration:
- serological methods.
In addition, a sigmoidoscopy is performed instrumentally, especially in cases where dysentery proceeds without typical symptoms.
Complications of Dysentery
Shigellosis is a dangerous complication that occurs during and after treatment. By localization they are divided into intestinal and extraintestinal.
For intestinal include:
- dysbacteriosis (normal intestinal microflora is disturbed);
- pericolitis (inflammation of the peritoneum and the entire colon; sometimes it is combined with peritonitis;
- intestinal bleeding;
- post-dysteric dysfunction (characterized by discomfort in the gastrointestinal tract after recovery);
- prolapse of the rectum (occurs with frequent urge to defecate)
Extraintestinal complications include:
- dehydration or shock hypovolemic (arterial and venous pressure falls, the functions of organs are disturbed);
- shock infectious-toxic (fatal complication);
- Catarrhal pneumonia;
- renal failure;
- bacteremia (Shigella get into the bloodstream and spread throughout the body);
- otitis media;
- other infectious diseases;
- weakness, exhaustion, depression.
As you can see, dysentery is a very serious disease. Nevertheless, it is easy to protect yourself from it. The method is extremely simple - cleanliness and once again cleanliness.To do this, just need:
- wash hands before meals and in general more often;
- wash vegetables and fruits;
- observe hygiene when cooking;
- Do not swim in questionable waters.
Sanitary and epidemiological station employees are required to carry out epidemiological control in the territories entrusted to them.
Catering workers are obliged to undergo medical examination on time, and at the first signs of dysentery they go not to work, but to a doctor.