The causative agent of dysentery. Shigellosis (bacterial dysentery): symptoms, diagnosis, treatment

Dysentery is an acute bacterial intestinal infection characterized by primary damage to the mucous membrane of the large intestine.

The causative agents of the disease are bacteria of the genus Shigella, immobile gram-negative rods that do not form spores, reproduce well in nutrient media, but are extremely low-resistant to external factors. In particular, Shigella die instantly when boiled, and within 10 minutes at temperatures exceeding 60 degrees.

The main source of the disease is an asymptomatic carrier or a sick person. A particular epidemiological danger is posed by patients with erased or mild forms of dysentery, as well as people employed in institutions Catering and at food industry enterprises.

What it is?

Dysentery is infectious disease of a general nature, which is caused by dysentery bacteria.

The most common cause of the disease is Shigella. Amoebic dysentery manifests itself as a consequence of infection with gnostolytic amoeba. With the development of this disease in humans, the mucous membrane of the large intestine is mainly affected.

How the disease develops

With dysentery, the lower part of the large intestine is damaged - the sigmoid and rectum and its sphincter.

1. With food, water or through household items, Shigella first enters the stomach, where it remains for several hours (rarely days). Some of them die. This releases endotoxins.
2. Next, the pathogens enter the small intestine, where they adhere to enterocytes and release an enterotoxic exotoxin, under the influence of which fluid and electrolytes are intensively secreted into the intestinal lumen.
3. Shigella hemolysin, found in their outer membrane, promotes the penetration of pathogens into epithelial cells (mainly ileum), where they begin to multiply intensively. Enterocytes are damaged. Inflammation of the intestinal wall develops. Immune complexes, which include endotoxin, increase damage to the intestinal wall. They become fixed in the capillaries of the colon mucosa and disrupt microcirculation.
4. Sensitized eosinophils and mast cells begin to secrete toxic substances. The cytotoxic effect of leukocytes is enhanced. All this contributes to the development of DIC syndrome from the 2nd week from the onset of the disease. Thrombosis of mesenteric vessels develops, including those of the lungs and brain.
5. Intoxication of the body is caused by the entry of endotoxin from dead Shigella into the patient’s blood. When bacteria enter the blood, bacteremia develops.

Shigella toxins affect the central and autonomic nervous systems, cardiovascular and digestive system, adrenal glands. In the chronic course of dysentery, it is not intoxication that comes to the fore, but disruption of the gastrointestinal tract.

When cured, the body is completely freed from infection. If the immune system is not functioning properly, recovery may take up to one month or more. Some patients become carriers of the infection. In some patients the disease becomes chronic.

The causative agent of dysentery

The causative agent of shigellosis is a bacterium - a non-motile bacillus of the genus Shigella. There are 4 types of this bacterium, each of which is capable of causing dysentery in humans: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

A special feature of Shigella is its ability to quickly acquire resistance to antibacterial drugs. Bacteria resistant to traditional treatment are becoming increasingly common. In addition, the bacteria are extremely resistant to external environment- at favorable conditions can retain their pathogenic properties for up to several months, including in food products.

Shigella have a number of properties that make them pathogenic for humans, i.e. ability to cause disease.

The mechanism of infection for dysentery is fecal-oral, i.e. bacteria from the intestines of a sick person enters the gastrointestinal tract healthy person.

There are several routes of transmission of the pathogen. This is a contact and household route - through unwashed hands and failure to comply with personal hygiene rules; food – when bacteria get into food; and also water - when drinking infected water. In addition, infection is possible by swimming in polluted waters.

Symptoms of dysentery

The first symptoms of dysentery begin to appear 2-3 days after infection; with the food route, this time can be reduced to hours, with contact and household path can extend up to 7 days. In most cases, the disease begins acutely; sometimes there may be a prodrome in the form of malaise, chills or headache. Based on the degree of severity, there are mild, moderate, severe and very severe forms.

The most characteristic signs of the disease in the variant of dysentery affecting the large intestine.

The disease, as a rule, begins with the appearance of abdominal pain, followed by stool disorder. Dysentery can begin with general manifestations - weakness, lethargy, fever, headache, etc. The manifestations of the disease reach their greatest severity on the 2-3rd day of the disease. This form of dysentery is characterized by a predominance of local phenomena.

The most complete signs of dysentery are presented in the moderate form of the disease. Characterized by an acute onset, increased temperature with chills (up to 38-39 ° C), which lasts 2-3 days. Worried about weakness, headache, loss of appetite. Intestinal disorders occur in the first 2-3 hours from the onset of the disease and are manifested by discomfort in the lower abdomen, rumbling, periodic, cramping pain in the lower abdomen, the frequency of stool varies from 10 to 20 times a day. The stool initially has a fecal character, then an admixture of mucus, blood and pus appears, the volume decreases feces, they can take on the appearance of spit - mucus and blood.

There is an acute urge to defecate. The skin becomes pale, the tongue becomes covered with a thick brown coating. From the outside of cardio-vascular system increased heart rate and decreased blood pressure are observed. The most characteristic features are spasm and pain when palpating the left iliac region.

The duration of intoxication for moderate forms of dysentery is 4-5 days. The stool returns to normal by the 8-10th day of illness, but the disease can drag on for up to 3-4 weeks.

Severe form

Severe dysentery is characterized by a very rapid development of the disease, pronounced intoxication, and profound impairment of the cardiovascular system.

The disease begins extremely quickly. Body temperature with chills quickly rises to 40°C and above, patients complain of severe headache, severe general weakness, increased chilliness, especially in the extremities, dizziness when getting out of bed, complete absence appetite.

Nausea, vomiting, and hiccups often appear. Patients are bothered by abdominal pain accompanied by frequent urges for defecation and urination. Stool more than 20 times a day, often the number of bowel movements is difficult to count (“stool without counting”). The peak period of the disease lasts 5-10 days. Recovery occurs slowly, up to 3-4 weeks; complete normalization of the intestinal mucosa occurs after 2 months or more.

The diagnosis of chronic dysentery is established if the disease lasts more than 3 months.

Moderate form

Elevated body temperature (up to 39 ° C) is accompanied by chills and can last from several hours to 4 days. Symptoms of intoxication are pronounced. The frequency of stools reaches 20 times a day. The stool is streaked with blood and mucus. The pain in the lower abdomen is cramping.

Symptoms of damage to the cardiovascular system are recorded: small pulse, tachycardia, systolic pressure drops to 100 mm. rt. Art., heart sounds are muffled. The tongue is dry, thickly coated with white coating. During sigmoidoscopy, catarrhal-erosive changes are recorded. Multiple hemorrhages and often ulcerative defects are visible. The level of neutrophil leukocytes in the blood increases to 109/l. The symptoms of intoxication and diarrhea last 2 - 5 days. Restoration of the mucous membrane and normalization of the body's functioning occurs after 1 - 1.5 months.

Mild form of dysentery

With a mild course of the disease, the fever is short-lived, from several hours to 1-2 days, the body temperature, as a rule, rises to 38°C. Patients are bothered by moderate abdominal pain, mainly before bowel movement.

The stool has a pasty or semi-liquid consistency, the frequency of bowel movements is up to 10 times a day, the admixture of mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs in 2-3 weeks.

Shigella bacteria carriage

If a patient in the recovery stage produces Shigella for 3 months, then they speak of convalescent carriage of the bacteria. If a practically healthy person who has never had dysentery and has not had intestinal dysfunction over the past three months has had a single release of Shigella bacteria, then they speak of transient bacterial carriage.

Diagnostics

To diagnose dysentery in a patient, bacteriological culture of stool is performed in the laboratory. To ensure the accuracy of the research result, the analysis is carried out three times. However, this method is not always suitable for diagnosis, since results appear only after a week. In order to speed up the diagnosis of dysentery, the determination of antigens to the causative agent of the disease and toxins in the blood and feces is practiced.

In this case, immunological methods are used. To determine the presence of Shigella, the polymerase chain reaction method is used.

In the process of establishing a diagnosis, the patient also undergoes a stool analysis (coprogram). If the material under study contains a large number of mucus and at the same time the number of leukocytes is increased and red blood cells are present, then, most likely, the integrity of the intestinal mucosa is compromised.

Differential diagnosis

1. Salmonellosis. With salmonellosis, the feces have a shade of swamp mud, light or dark greenish in color.
2. Food poisoning. In this condition, there is no severe cramping pain in the iliac peritoneum due to the absence of damage to the large intestine. There is also no urge to defecate.
3. Cholera. The disease is not accompanied by pronounced signs of colitis, it begins with severe diarrhea, vomiting, and the color of the stool resembles rice water. None false urges to bowel movement.
4. Amoebiasis. The disease is not accompanied by an increase in body temperature or febrile syndrome. Feces include blood and mucous components that resemble raspberry-colored jelly. The main pathogen is amoeba.
5. Intestinal colitis. If colitis is of a non-infectious nature, then it often occurs due to toxic damage to the body during uremic syndrome, with pathological development small intestine, cholecystitis, gastritis of various nature. Typically, the disease does not have seasonality and no special antecedent factors against the background general health patient.
6. Typhoid fever. The disease has no signs of specific colitis, but it appears pink rash, severe hyperthermia, the cavity of the large intestine is affected.
7. Oncogenic formations. Colon cancer is accompanied by severe bloody diarrhea. The character of the stool is regular. There are symptoms of general intoxication, but the rapid nature of the disease, as with dysentery, is absent.
8. Haemorrhoids. For inflammation hemorrhoids, and also with advanced hemorrhoids after defecation, the appearance of bloody spots in the stool can be noted. The disease occurs without pronounced inflammatory foci in the rectum.

Timely determination of dysentery and the type of its causative agent makes it possible to draw up necessary plan treatment, speed up the patient’s recovery, and eliminate the risks of complications of the disease.

Complications

Doctors divide the consequences of dysentery into two: large groups. Actually intestinal complications:

• bleeding due to ulceration of the mucous membranes;
• rectal prolapse – especially common in children;
• peritonitis as a result of perforation of the intestinal wall;
• megacolon - distension of the colon;
• intestinal dysfunction, persistent long time after healing.

Extraintestinal complications:

• pneumonia;
• pyelonephritis, severe renal failure;
• polyarthritis;
• myocarditis;
• otitis;
• bacteremia with symptoms of severe intoxication, when dysentery bacilli penetrate all cells through the bloodstream - often such a critical condition ends in death.

Treatment of dysentery

Adult patients can be treated both in a hospital and at home, depending on the severity of the infectious process, the age and condition of the patient, or if it is impossible to treat and care for the patient at home.

The main treatment for dysentery is to prescribe the following drugs:

1. When choosing antimicrobial agents: mild forms are treated with furazolidone, moderate and severe forms are preferable to fluoroquinolones or cephalosporins, aminoglycosides (kanamycin).
2. From the very first days of illness, children should be given glucose and salt supplements. saline solutions– “Glucosolan”, “Oralit”, “Regidron”. One sachet of the drug should be diluted in a liter of water and given to the child every 5 minutes. The daily dose should be 110 ml per 1 kilogram of the child’s weight.
3. Eubiotics - Bifidobacterin, Baktisubtil, Bifiform, Rioflora immuno, Bifikol, Primadofilus, Lactobacterin, Linex, etc. Since antibacterial drugs aggravate the symptoms of intestinal dysbiosis, eubiotics are necessarily indicated, which are prescribed in a course of at least 3-4 weeks (see the entire list of Linex analogues) .
4. According to indications, the doctor may prescribe immunomodulators, vitamins, as well as astringents and antispasmodics.
5. After suffering an acute process, to speed up the recovery of the body, it is recommended to use microenemas with herbal decoctions, rosehip and sea buckthorn oils, infusions of chamomile, eucalyptus, and vinyl.
6. Adsorbents, enterosorbents - Smecta, Polyphepan, Polysorb, Filtrum STI (instructions for use), activated carbon, etc.
7. Enzymatic complex preparations— Festal, Creon, Panzinorm, Mezim.
8. In chronic dysentery, treatment with antibiotics is less effective, so physiotherapeutic treatment, eubiotics, and therapeutic microenemas are prescribed.

A gentle diet is also prescribed - mashed potatoes, rice porridge without salt and rice congee, slimy soup.

Neither an adult nor a child should be force-fed; the main condition is a sufficient amount of liquid. You can drink whey, water, weak, unsweetened tea. Cheeses, sausages, smoked meats, prepared foods, semi-finished products, coffee, sugar, meat, and baked goods should be excluded from the diet. Only on day 5 you can gradually add kefir, omelettes, meatballs, and boiled fish to your diet.

After two weeks you can switch to good nutrition, but it must be dietaryly balanced.

Quarantine

Quarantine for dysentery is declared for 7 days, which corresponds to the incubation period of the disease. The main purpose of quarantine is to limit the contact of a sick person with healthy people. Specific measures when declaring quarantine depend on the type of institution and the epidemiological situation in the country.

The reason for declaring quarantine for dysentery may be:

1. Detection of a repeat case of dysentery in a group within 7 days. In this case preventive actions correspond to those described above.
2. Identifying signs of dysentery in two or more persons in the same locality who do not work/study in the same institution. In this case, there is a high probability that the infection is present in a local pond or in a public canteen. Suspicious institutions and bodies of water are closed, and samples of water and food are sent to the laboratory for detailed examination. All residents of the locality are advised to observe the rules of personal hygiene, and also to consume only well-processed (thermally) food and boiled water.
3. The simultaneous appearance of clinical signs of dysentery in two or more persons in the same group (in kindergarten, in a school class and so on). In this case, a quarantine is declared in the group. Within 7 days, none of the children can be transferred to another group. All those in contact with the patient must undergo a bacteriological examination and begin taking dysentery bacteriophages in prophylactic doses.

Vaccination against dysentery

Immunity (immunity) after suffering from dysentery is developed only to the subspecies of the pathogen that caused the disease in this particular person. Immunity lasts for a maximum of one year. In other words, if a person is infected with one of the varieties of Shigella dysentery, he can easily become infected with other Shigella, and a year later he can become infected again with the same pathogen.

Based on the foregoing, it follows that it is almost impossible to develop an effective vaccine that could protect a person from infection with dysentery for a long time. This is why prevention is key of this disease is allocated to sanitary and hygienic measures aimed at preventing contact of a healthy person with an infectious agent.

However, under certain conditions, people can be vaccinated against certain types of dysentery (in particular, against Shigella Sonne, which are considered the most common).

Vaccination against Shigella Sonne is indicated:

1. Workers of infectious diseases hospitals.
2. Workers of bacteriological laboratories.
3. Persons traveling to epidemiologically dangerous regions (where there is a high incidence of Sonne dysentery).
4. Children attending kindergartens (if the epidemiological situation in the country or region is unfavorable).

After the vaccine is administered, the human body produces specific antibodies that circulate in the blood and prevent infection with Shigella Sonne for 9 to 12 months.

Vaccination is contraindicated for children under three years of age, pregnant women, and people who have had Sonne dysentery within the last year (if the diagnosis was confirmed by laboratory testing).

Prevention of dysentery

To prevent dysentery, a set of measures has been developed and applied, the goals of which are:

1. Sanitary and hygienic education of the population (washing hands, drinking boiled water, washing vegetables and fruits with boiled water before eating will help avoid disease).
2. Improving the sanitary condition of people’s places of residence and improving the material and living conditions of the population.
3. Prevention of food contamination (fly control).
4. Strict adherence to food hygiene rules (compliance with food storage conditions and deadlines for their sale).
5. Treatment of carriers of infection.

After the dysentery pathogen enters the body, the first signs of the disease appear on average after 3 days, in some cases after 7. The first symptoms of the pathology are an increase in central body temperature, usually up to 38 degrees, followed by chills and fever.

In rare cases, the temperature can reach 40 degrees, which completely eliminates home treatment. The febrile state persists for approximately 3-5 days, then the temperature begins to drop. Occasionally, dysentery occurs without fever, but this does not mean that the disease is too mild, since the pathology can cause quite serious consequences.

The disease is characterized by intoxication of the body, so the patient may complain of headache, general weakness, and loss of appetite. These signs are observed quite early and indicate intoxication, which begins to rapidly increase.

The signs described above are symptoms that accompany the development of dysentery and are directly related to the pathological effects of the pathogen's toxin. Signs of a different nature are associated with the effects of Shigella (the causative agent of dysentery) on the gastrointestinal tract.

Against this background, it is customary to distinguish several forms of dysentery:

• colitis;
• gastroenteritis;
• gastroenterocolitic.

Dysentery is bacterial in nature, and therefore most often occurs with damage to the large intestine, due to which colitis and gastroenterocolitic forms are mainly diagnosed.

Dysentery: characteristic symptoms

As a rule, dysentery most often occurs as a type of colitis, so it is advisable to consider its symptoms.

The main signs of this form of dysentery are abdominal pain, localized in the lower part small intestine. The pain is complemented by characteristic intestinal contractions and a false urge to defecate. With dysentery, bowel movements are always scanty, with mild form The stool is liquid and mixed with mucus; in severe cases, the discharge is insignificant and streaked with blood.

In mild cases, bowel movements can occur up to 5-10 times a day, in severe cases - up to 50. Against this background, the patient experiences significant dehydration, requiring rehydration treatment. Also, severe forms of pathology are characterized by the development of intestinal disorders motor activity(peristalsis), due to spasms and bloating, which often occur with dysentery.

In the case of pathology of gastroenterocolitic and gastroenteric forms, to common features dysentery is accompanied by vomiting and diarrhea, already pronounced.

As a result, they develop obvious symptoms dehydration and water-electrolyte imbalance. The insidiousness of dysentery lies in the ability to imitate any other intestinal infection, so passing laboratory tests is an important aspect in making a correct diagnosis.

Chronic dysentery: symptoms of pathology

Incorrect or untimely treatment of dysentery provokes its transition to a chronic form. In this case, recurrent and continuous form diseases.

In clinical practice, a recurrent form is more common, characterized by alternating exacerbation of dysentery and improvement of the patient's condition. Symptoms of chronic dysentery are equivalent to the symptoms of a pathology of moderate severity.

In some cases, dysentery may occur continuously. However, this phenomenon is rare and is diagnosed mainly in elderly patients. Against the backdrop of the continuous course and age of patients standard symptoms pathology is added by progressive dysbacteriosis, disruption of the gastrointestinal tract and general exhaustion of the body.

Dysentery: treatment at home

How and how to treat dysentery at home? It is immediately worth noting that treatment of dysentery at home is permitted in mild forms of the pathology. In case of disease progression and development of more than serious signs(discussed above) you should contact the infectious diseases department of a medical institution.

For simple forms of dysentery in adults, when symptoms are not pronounced, treatment at home is quite possible. If you notice the first symptoms of the disease, increase your fluid intake and also administer the drug Regidron. The product is used to restore acid-base balance in case of diarrhea and vomiting due to acute intestinal infections (acute intestinal infections). Please note that if you have this disease, you should not take antidiarrheal drugs. Further treatment is prescribed only by a doctor; it must be comprehensive and selected individually.

At mild degree For dysentery, the following antibacterial drugs are most often prescribed:

• Furadonin;
• Nitroxoline;
• Macropen.

For moderate illness, stronger drugs are prescribed:

• Ofloxacin;
• Enterofuril.

In case of severe forms of the disease, broad-spectrum antibiotics and antibacterials are prescribed, usually 3-4 generations:

• Ofloxacin;
• Tsiprolet;
• Ceftriaxone.

In case of obvious intoxication, crystalloid solutions in the form of droppers can be added to the main treatment. Also, for any form of dysentery, enterosorbent drugs are prescribed and enzyme agents(Atoxil, Pancreatin). Atoxil eliminates signs of intoxication and removes toxins, Pancreatin- normalizes the functioning of the intestines and pancreas.

For elimination intestinal cramps and pain is prescribed Drotaverine(antispasmodic) and Nalgesin forte (painkiller). It is mandatory to appoint Regidron, to eliminate dehydration.

In addition to standard dysentery, there are other types of disease that require a special approach to therapy. Thus, Sonne and Flexner dysentery is treated with the help of a dysenteric polyvalent bacteriophage. The drug is approved for use by adults and children over 6 months.

The chronic form of the pathology also has its own characteristics. Complex treatment includes not only taking antibacterial agents and rehydrate solutions, but also a course of immunomodulating agents.

Treatment of dysentery is impossible without following a diet. As a rule, foods that provoke fermentation in the intestines are excluded: fruits, bread, some types of vegetables, smoked foods, semi-finished products.

It is mandatory to increase fluid intake (still water, dried fruit compotes) to 2-3 liters per day.

Treatment of dysentery at home: diet

To achieve the highest therapeutic effect, drug therapy must be accompanied by a certain diet, diet. Prescribe gentle products, namely dietary table according to Pevzner (No. 4). IN rehabilitation period It is recommended to follow table No. 2, on average it is about 4 weeks.

All dishes must be boiled or steamed. It is allowed to eat low-fat meat and fish, porridge with water, crackers or yesterday's bread, vegetable/meat broths, jelly, weak tea, compotes. All food should contain a minimum amount of salt and acid; the use of hot seasonings and pepper is excluded.

When treating dysentery at home, as well as during the rehabilitation period, the intake of alcoholic beverages, carbonated waters, canned food, legumes, and fresh baked goods is completely excluded.

Basically, the diet is the basis on the table for patients with exacerbation of ulcer pathology. Therefore, all meals are divided into 5-6 times, the portions are small.

Treatment with folk remedies

It is immediately worth noting that the use of traditional medicine recipes is advisable in combination with drug treatment, when both therapies enhance therapeutic effect each other. Treatment folk remedies as primary therapy - not justified.

The following traditional medicine methods can be used as additional treatment methods:

1. Burdock juice. Take 1 teaspoon 3-4 times a day before meals.
2. Herbal collection. Consists of wild rosemary leaves, marshmallow root, oregano. All components are mixed in equal proportions and brewed. Drink 25 ml every 3 hours.
3. Blueberry. Dry berries are used. For 1 liter of boiling water, 250 grams of berries, brew in a water bath and drink 50 ml 3-4 times a day.
4. Herbal collection No. 2. Take in equal quantities: plantain, peppermint, Ivan tea, marshmallow root. The mixture is infused in a water bath at a ratio of 1 to 2. Take 100 ml 3 times a day before meals.

To reduce the severity of unpleasant symptoms, you can use an alcohol extract of propolis. The product is sold in pharmacy chains, apply at the rate of 1 teaspoon per 450 ml of water. Take 100 ml 3-5 times a day. The therapeutic course is 7-10 days. Please note that this recipe is not suitable for patients with intolerance to bee products.

If the patient does not have allergies, it is recommended to eat a small amount of natural honey during the day. This product promotes faster elimination of Shigella during bowel movements. Due to this, recovery is observed much faster.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is dysentery?

Dysentery- it's spicy infection, characterized by predominant damage to the intestines and pronounced manifestations of general intoxication of the body. The first mention of this disease dates back to the first century BC. Until the 18th century, the cause of this pathology was unknown, and developing epidemics claimed the lives of millions of people ( Most people with dysentery died as a result of developing complications). After the discovery of the causative agent of the disease and the development of effective treatments, the number of deaths decreased significantly, however this pathology still poses a danger, as outbreaks of dysentery can occur due to poor personal hygiene and living in unsanitary conditions.

Incidence of dysentery ( epidemiology)

According to rough estimates by the World Health Organization ( WHO) more than 80 million people fall ill with dysentery every year, of whom about 9% die. It is worth noting that the incidence of dysentery varies depending on many factors.

The incidence of dysentery is due to:

• Sanitary and hygienic conditions. Most often, outbreaks of dysentery occur when sanitary and hygienic standards and rules of personal hygiene are not observed ( during wars, disasters, and also in underdeveloped countries).
• The age of the patients. More than 35% of all cases of dysentery are registered in preschool children ( from 1 to 6 years). This is due to the fact that at this age children begin to actively learn the world, and they “taste” most unfamiliar objects ( that is, they put it in the mouth). And since they do not yet know how to observe the necessary rules of personal hygiene, they are at risk of contracting various infectious diseases ( including dysentery) increases.
• Time of year. Dysentery is characterized by a distinct summer-autumn seasonality. As a result of the research, it was found that from July to September more than half of all cases of dysentery per year are registered. This is most likely due to the fact that at this time many fruits and vegetables are ripening, the consumption of which without appropriate processing can cause infection with dysentery.

The causative agent of dysentery

The causative agents of dysentery are bacteria from the genus Shigella ( Shigella), belonging to the family Enterobacteriaceae ( Enterobacteriaceae). Today, there are several types of Shigella, each of which can cause various shapes dysentery.

Among the causative agents of dysentery are:

• Shigella dysentery ( Shigella dysenteriae). This type includes several subspecies ( bacteria Grigoriev-Shiga, Shtutser-Schmidt and Large-Sachs). The Grigoriev-Shiga bacterium is the most toxic of all known Shigella and was responsible for the majority of fatal cases of dysentery until the early 20th century.
• Shigella Flexnera ( Shigella flexneri). In the middle of the last century, it was the cause of more than 75% of all outbreaks of dysentery.
• Shigella sonne ( Shigella sonnei). From the middle of the last century to the present time, it has been the cause of most outbreaks of dysentery on Earth.
• Shigella Boydy ( Shigella boydii).

All Shigella are immobile and do not form spores ( dispute is special shape existence of bacteria, in which they can survive for a long time in extreme conditions ). The survival of Shigella in the environment depends on temperature, humidity and the amount of pathogen isolated. The optimal environment for the existence of Shigella is food. It is also worth noting that Shigella Sonne can exist and even reproduce in milk and other dairy products.

Shigella die:

• In the water and food products - within a few weeks.
• At a temperature of 60 degrees– within 25 – 30 minutes.
• When exposed to direct sunlight– within 15 – 20 minutes.
• When boiling- instantly.
• In human gastric juice- within a few minutes ( depending on the initial dose of the pathogen, that is, on the amount of Shigella that penetrated the stomach).
• When exposed to chlorine ( and other disinfectants) - within a few minutes.

The toxic effect of Shigella depends on the presence or absence of certain toxins.

Shigella has:

• Endotoxin. This substance is contained in cell wall bacteria and is released into environment upon their destruction. When endotoxin enters the systemic circulation, it is distributed throughout the body, causing the development of symptoms of general intoxication.
• Enterotoxins. Produced by living Shigella. They affect the intestinal mucosa, increasing the release of fluid and salts into the lumen of the affected intestine.
• Cytotoxin. It is secreted by living Shigella and damages the membranes of the cells of the intestinal mucosa.
• Neurotoxin. Capable of hitting the central nervous system person. It is distinguished only by Shigella Grigoriev-Shiga.

Ways of transmission of dysentery

Dysentery is characterized by a fecal-oral transmission mechanism. This means that excreted from the intestines infected person Shigella penetrates the gastrointestinal tract of a healthy person, thereby infecting him.

The source of infection may be:

• A sick man– a patient with a pronounced clinical picture of dysentery or with a chronic form of the disease.
• Convalescent– a recovering patient who has suffered acute form disease, but can still shed Shigella.
• Bacteria carrier– a person in whose gastrointestinal tract Shigella multiplies without causing the development of clinical signs of dysentery.

The causative agent of dysentery can be transmitted:

• By food– with fresh, poorly processed ( thermally or mechanically) food products ( is the main route of spread of Shigella Sonne).
• By water– when drinking untreated water from polluted water bodies ( is the main route of spread of Shigella Flexnera).
• Contact-household way– upon contact with contaminated surfaces or objects ( that is, if a person touches contaminated objects and then takes food with unwashed hands or simply puts his fingers in his mouth, which is typical for children).

Incubation period and pathogenesis ( development mechanism) dysentery

Incubation period (that is, the time from the moment of infection to the development of symptoms of the disease) with dysentery lasts from 1 to 7 days, averaging 2 to 3 days. After penetration into the body, most of the Shigella die in the human stomach as a result of exposure to acidic gastric juice. Some bacteria pass into the intestines, where they are also subjected to the harmful effects of intestinal microflora ( Normally, the intestines constantly contain a certain amount of bacteria that are safe for the person himself, but are capable of fighting foreign infectious agents).

A certain proportion of bacteria overcomes all the described barriers and reaches the intestinal wall, where they invade the cells of its mucous membrane. After this, Shigella begins to actively reproduce, producing exotoxins and cytotoxins. At the same time, the body's immune forces are activated, causing the cells of the immune system ( neutrophils and macrophages) begin to absorb and destroy Shigella. As a result, endotoxin is released into the surrounding tissues, which in total causes the development of the clinical picture of acute dysentery. In parallel with the development of the first symptoms of the disease, some Shigella penetrates the large intestine and affects its mucous membrane, which aggravates the course of dysentery.

Development of infectious inflammatory process in the intestines disrupts all its functions ( including motility, nutrient absorption and so on), causing the development of the corresponding clinical manifestations.

Types and forms of dysentery

IN medical practice There are several forms of dysentery, which is determined by the type of pathogen, the severity of the disease and the characteristics of the clinical picture.

Depending on the clinical manifestations, dysentery can be:

• Spicy. It is characterized by the rapid development of symptoms, pronounced local and general manifestations of the disease, as well as a fairly rapid improvement in the patient’s condition after the start of adequate treatment.

• Chronic. It is characterized by a sluggish, slowly progressive course. It can occur in both continuous and recurrent ( worsening from time to time) form. In the latter case, there is an alternation of exacerbations of the disease with periods of remission, during which there are no symptoms of dysentery.

Bacterial carriage is also classified as a separate form. Clinical signs In this case, there are no diseases, but a certain number of infectious agents constantly remain in the human gastrointestinal tract.

Depending on the affected part of the gastrointestinal tract, there are:

• Colitic variant of acute dysentery. It occurs most often and is characterized by predominant damage to the large intestine, while the stomach and small intestine are practically not involved in pathological process.
• Gastroenteric variant of acute dysentery. It is characterized by signs of damage to the stomach and small intestine, while symptoms of damage to the large intestine are mild or may be completely absent.
• Gastroenterocolitic variant of acute dysentery. A severe form of the disease, in which the mucous membrane of the stomach, as well as the small and large intestines, is simultaneously affected.

Depending on the severity of clinical manifestations, the following are distinguished:

• Mild form of dysentery. It is characterized by mild manifestations of general intoxication, a favorable course and rapid recovery ( which usually occurs within 4 – 6 days).
• Moderate dysentery. It is characterized by severe intoxication of the body and signs of damage to the central nervous system. With timely treatment, recovery occurs within 2 weeks.
• Severe form of dysentery. It is characterized by extremely severe intoxication of the body, which, without timely medical care can lead to human death. The treatment is long-term, and complete recovery occurs no earlier than after 3 to 6 weeks.

Symptoms and signs of dysentery

Clinical manifestations of dysentery are determined by the type of pathogen ( that is, its toxicity), the initial infectious dose, as well as the general condition of the infected person’s body.

Stages of dysentery

In the development of dysentery, several successive stages are distinguished, each of which is characterized by certain symptoms.

In the development of dysentery there are:

• Initial stage. It is characterized by the appearance of the first symptoms of the disease, which progress over time and become more pronounced.
• The stage of the height of the disease. Characterized by the maximum severity of clinical manifestations of dysentery. It is at this stage that there is a high probability of developing various complications ( especially when severe forms diseases).

• Stage of fading of symptoms. At this stage of development, the body's immune system defeats the infectious agent, as a result of which the symptoms of the disease begin to gradually subside. It is worth noting that if treatment is interrupted at this stage, it is possible re-development symptoms of the disease.
• Stage of recovery. There are no clinical manifestations of acute dysentery, but there may be signs of developing complications from other organs and systems. Also at this stage, the disease may become chronic.

Symptoms of dysentery are:

• increased body temperature;
• signs of intoxication of the body;
• bowel dysfunction;
• dehydration of the body.

Temperature with dysentery

An increase in body temperature is one of the first clinical manifestations of the disease. The temperature rises sharply ( during few hours), often accompanied by other signs of intoxication of the body. In mild forms of the disease it can rise to 37 - 38 degrees, while in severe dysentery it can reach 40 degrees. The elevated temperature persists for several hours or even days, after which it also drops sharply ( which indicates the beginning of the recovery period). It is also worth noting that with erased forms of dysentery, body temperature may be normal or slightly elevated ( up to 37 – 37.5 degrees).

An increase in temperature is a natural protective reaction of the human body, which is activated when infected with foreign microorganisms, including Shigella. Development mechanism this symptom associated with the entry into the systemic circulation of special substances called pyrogens. Pyrogens are present in Shigella itself ( the most powerful pyrogen is endotoxin, released during destruction bacterial cell ), as well as in the cells of the body's immune system ( in macrophages).

When an infectious agent penetrates the wall of the gastrointestinal tract, the immune system is activated, as a result of which a large number of leukocytes migrate to the site of bacterial penetration ( immune system cells). Cell data ( predominantly neutrophils and macrophages) destroy and absorb particles of the infectious agent, trying to digest them. Some of the macrophages die, resulting in the release of bacterial endotoxins into the surrounding tissues, as well as pyrogenic substances contained in macrophages ( interleukins, tumor necrosis factor, interferon). All these substances enter the systemic bloodstream and reach the brain, where they affect the thermoregulation center, which leads to an increase in body temperature.

Intoxication due to dysentery

The development of symptoms of general intoxication is associated with the entry of bacterial toxins into the bloodstream ( endotoxin, neurotoxin), as well as with the activation of the immune system in the process of fighting infection. Characteristic of dysentery caused by Grigoriev-Shiga bacteria is the rapid involvement of the nervous system in the pathological process, which is caused by the action of a neurotoxin. In this case, the so-called vegetative ( autonomous) nervous system, responsible for the normal functioning of internal organs ( including the cardiovascular system) and the whole organism as a whole.

Intoxication of the body during dysentery can manifest itself:

• general weakness;
• brokenness;
• increased fatigue;
• depressed mood;
• tachycardia ( an increase in heart rate of more than 90 beats per minute);
• delusional ( in severe forms of the disease).

Most pronounced signs intoxication is determined with a maximum increase in body temperature, after which their gradual regression is noted ( that is, subsidence and disappearance).

Abdominal pain due to dysentery

Abdominal pain appears within the first day after the onset of clinical manifestations of dysentery. Patients complain of cutting, pulling, cramping pain, the localization of which depends on the affected area of ​​the gastrointestinal tract.

Pain in dysentery is localized:

• In colic form– in the lower lateral abdomen ( mostly on the left).
• With gastroenterocolitic form- in all parts of the abdomen.
• With gastroenteric form- only in upper sections abdomen, since the large intestine is not affected.

The mechanism of pain in this case is associated with the development of the inflammatory process in the intestinal mucosa. The biologically active substances released into the surrounding tissues increase the sensitivity of pain receptors. Also, with dysentery, there is a violation of intestinal motility, resulting in spastic ( long lasting and persistent) contraction of its individual sections, which is also accompanied by pain. The cramping nature of the pain is caused by a peristaltic wave, which occurs every few minutes and spreads throughout the intestine ( at this moment the pain intensifies). A few seconds after the peristaltic wave passes, the smooth muscles of the gastrointestinal tract relax, causing the pain to temporarily subside.

Character of stool in dysentery

Stool disturbance is one of the main clinical manifestations of the colitic and gastroenterocolitic forms of the disease, while in the gastroenteric form the stool may be normal. The development of this symptom is due to the effect of cytotoxin and enterotoxins on the cells of the mucous membrane of the gastrointestinal tract, as well as impaired intestinal motility.

At the beginning of the development of dysentery, the stool is usually copious and contains a lot of feces. As the disease progresses, the amount of stool in the intestines decreases, while the amount of fluid increases ( due to the action of enterotoxin).

About a day after the onset of the disease, the patient’s stool consists of thick clear mucus, to which streaks of blood may be attached ( bleeding develops as a result of ulceration of the mucous membrane of the large intestine) or pus. The frequency of stool varies depending on the severity of dysentery.

The frequency of stool in patients with dysentery is:

• For mild forms of the disease– 3 – 10 times a day.
• For moderate dysentery– 10 – 20 times a day.
• In severe forms of the disease– 20 – 50 times a day.

The urge to defecate is usually accompanied by increased pain in the lower abdomen. Tenesmus is also often observed - a false urge to defecate, accompanied by severe nagging pain in the rectal area ( During tenesmus, there is practically no bowel movement).

Vomiting due to dysentery

Vomiting is not a characteristic manifestation of dysentery and is usually observed with severe course diseases, as well as with the development of the gastroenterocolitic form. Vomiting is usually one-time, less often it can be repeated 2-3 times ( no more). Vomit may contain recently eaten food or be bilious in nature. The mechanism of development of vomiting is associated with impaired motility of the gastrointestinal tract ( Gastrointestinal tract), as well as with stagnation of contents in the lumen of the intestines and stomach. As a result of this, so-called antiperistaltic waves are formed, which push the contents of the gastrointestinal tract in the opposite direction ( that is, into the stomach and then into the esophagus).

Dehydration due to dysentery

Dehydration ( loss of body fluids) with dysentery develops due to profuse diarrhea and vomiting. It is also worth noting that as a result of exposure to enterotoxin, not only a large amount of water is released into the intestinal lumen, but also electrolytes, which are also removed from the body along with vomit and feces. That is why, by the end of the first day after the first symptoms of dysentery appear, a person may develop signs of dehydration.

Amoeba can survive:

• In wet feces– up to 1 month.
• In water ( at a temperature of 17 - 20 degrees) – within 3 – 4 weeks.
• In moist soil ( not directly illuminated sun rays ) – up to 8 days.
• In chilled foods- within a few days.
• On furniture surfaces- 12 o'Clock in the noon ( at optimal humidity and air temperature).
• When frozen ( up to minus 20 degrees) - for several months.
• When drying- few seconds.
• When exposed to disinfectants– within 5 minutes – 4 hours ( depending on the substance used).

The source of infection with dysentery amoeba can be a sick or recovering person who excretes amoebas along with feces. Infection of healthy individuals can occur if personal hygiene rules are not observed ( when consuming contaminated food and water, as well as through household items). The spread of infection is facilitated by flies and cockroaches, which can contaminate various objects.

After the amoeba enters the intestines of a healthy person ( their cystic forms) can exist there for a long time without causing the development of disease. When the body's defenses decrease, they can turn into active ones ( tissue and vegetative) forms that penetrate the intestinal mucosa and destroy it, leading to the formation of ulcers. Also, amoebas can penetrate the systemic circulation and be transported through the bloodstream to various organs, lingering in them and leading to the formation of abscesses ( accumulations of pathogens surrounded by a dense capsule) in the liver, lungs, brain and so on.

Clinically, amoebic dysentery is manifested by a moderately severe intoxication syndrome ( body temperature may be normal or slightly elevated). The main symptom of this disease is bowel dysfunction, the frequency of which ranges from 4–6 times a day at the onset of the disease to 10–20 times a day at the height of clinical manifestations. Initially, the stool is copious and contains a large amount of feces with unpleasant smell. After a few days, the amount of discharge decreases significantly, and it becomes mucous in nature. If the intestinal wall is ulcerated, bleeding may develop. The blood mixes with the mucus secreted, causing the stool to take on a “raspberry jelly” appearance. Patients may also complain of acute pain in the lower abdomen, which intensifies during bowel movements.

The diagnosis is considered confirmed when active ( vegetative) forms of amoebas from fresh feces of the patient. Treatment consists of using drugs that have a detrimental effect on various forms of amoebas ( quiniophone, dehydroemetine, metronidazole).

Before use, you should consult a specialist. Dysentery: causes, symptoms and signs, diagnosis and effective methods treatment Dysentery is an acute infectious disease of the intestines, the causative agent of which is bacteria from the genus Shigella. The source of dysentery infection are patients with dysentery. The infection is transmitted mainly through dirty water and food contaminated with microbes. In children's groups, dysentery can occur in the form of outbreaks of infection. The main symptoms of dysentery are fever, abdominal pain, severe diarrhea mixed with blood. If symptoms of dysentery occur, the patient should be taken to the hospital as quickly as possible. Dysentery is treated with antibiotics. What is dysentery? Dysentery (red diarrhea) is an infectious disease that affects the large intestine (usually the final section of the large intestine). The causative agent of dysentery is bacteria of the genus Shigella, which is why dysentery is also called Shigellosis. Dysentery refers to acute intestinal infections. Among all human diseases, intestinal infections are second only in frequency to respiratory diseases(runny nose, bronchitis, pneumonia). Every year, about 120 million people worldwide become ill with dysentery. Most often, dysentery occurs in countries with poor sanitary culture and high population density. You can get dysentery at any time of the year, but most often dysentery occurs in warm time year (summer). The high incidence of dysentery in the warm season is explained by the following factors: What are the sources of dysentery infection? The source of infection is patients with dysentery (they excrete Shigella in their feces), as well as bacteria carriers (patients who have had dysentery and continue to excrete microbes despite apparent recovery). The main causative agents of dysentery include:

Food and water supply workers who suffer from dysentery pose a particular danger to the development of dysentery. From them, microbes can enter food or water and cause widespread outbreaks of disease. The incubation period for dysentery is on average 3-4 days. Dysentery is transmitted primarily through water and food. Household infection with dysentery infection occurs through household items (dishes, switches, door handles). Dirty hands play a huge role in the spread of dysentery infection. Therefore, to prevent dysentery (a disease of dirty hands), it is very important to follow the rules of personal hygiene.

Signs and symptoms of dysentery The main signs and symptoms of dysentery are:

1. Dysentery begins acutely (within a few hours) and is manifested by symptoms of general intoxication. Increased body temperature (38-39 C). The temperature during dysentery stays at 38-39 degrees for about 3-4 days. Simultaneously with the increase in temperature, the patient with dysentery complains of chills and a feeling of heat. Symptoms of gastrointestinal tract damage appear 2-4 days after the onset of the disease.
2. Pain in the lower abdomen (corresponding to the lower part of the large intestine). Initially, with dysentery, dull pain appears, which over time becomes acute.
3. Diarrhea (diarrhea). Patients with dysentery have frequent stools, more than 5 times a day (sometimes up to 20 times). As a rule, with dysentery, the act of defecation coincides with attacks of pain (defecation occurs at the height of a pain attack). Defecation during dysentery is accompanied by painful urges (tenesmus). Initially, with dysentery, patients experience profuse bowel movements. After 3-4 days of dysentery, stool becomes scanty. The stool of a patient with dysentery often contains an admixture of fresh blood.
4. Nausea, vomiting, bloating (if the small intestine is affected).
5. Symptoms of dehydration: dry skin and mucous membranes, feeling of thirst, decreased blood pressure, pointed facial features.

Dysentery in children Dysentery is much more common in children than in adults. The risk of a child contracting dysentery is especially great in large groups of children in preschool institutions. In children's groups, dysentery is easily transmitted from child to child through dirty toys. Symptoms of dysentery in children coincide with those in adults: the child complains of abdominal pain, poor health, and lack of appetite. Parents of a child infected with dysentery may notice a rise in temperature and persistent diarrhea.

In all cases of diarrhea that occurs against the background of a rise in temperature (especially if the diarrhea contains blood and lasts for several days), the child should be taken to the doctor as soon as possible!

Children with dysentery should be isolated from healthy children until full recovery. Children who have been in contact with a child with dysentery are usually kept under observation for 2-3 weeks. Treatment for dysentery in children (see below) should be started as soon as possible. In children, dysentery can lead to severe dehydration, which is very dangerous for the child.