Dysentery is an intestinal disease caused by bacteria of the genus Shigella. Symptoms of dysentery are hyperbole from dysbiosis. This is a disruption of the normal intestinal microflora. A disorder that claims up to 70 thousand lives on the planet every year, not counting cases of amoebiasis. Symptoms in adults are triggered by endotoxin released by bacteria during their life processes. The substance destroys the epithelium and removes moisture from the body. Active rehydration measures are required in the treatment of dysentery.
Shigella is considered to be distant relatives of Escherichia coli and is not normally found among the microflora. Treatment in adults is carried out with antibiotics, aimed at destroying the microbe. Signs of the disease disappear as the concentration of dysentery endotoxin decreases. A person becomes infectious in the first days - the only known source of infection. The latent stage lasts 2-3 days (from hours to a week). In 60% of cases, children of the preparatory group and younger are treated.
General information
Dysentery is a general infectious disease caused by dysentery bacteria. Most often, the development of the disease is provoked by 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. Dysentery is most often diagnosed in children aged two to seven years. But the disease can affect people from any age group. Less often, signs of dysentery are recorded in infants, since in the first months the child has strong immunity inherited from his mother. As a rule, the disease can develop in infants if the water or food contains the causative agent of dysentery.
Symptoms of dysentery mainly appear in the summer.
The infection spreads quickly, and if basic hygiene rules are not followed, the child may need treatment for dysentery. That is why disease prevention consists, first of all, in strict adherence to general hygiene standards. https://youtu.be/https://www.youtube.com/watch?v=Owso4kkyR3Y
Microbes
Shigella under a microscope (sigmoidoscopy) at a magnification of 1000 times looks like motionless rods. The size is units of microns. If a person does not follow the recommendations of doctors, he becomes the cause of trouble. Humans are not the only carriers of the bacterium. No carriers are required - the rods live in the soil for a month.
Rule: hide from the symptoms of the disease - wash your vegetables and fruits. Persistence of infection:
- Shigella lives in water for 10 days.
- Two weeks - in bread.
- 20 days - in milk.
- In fermented milk products – 15 days.
Shigella dies in sunlight after half an hour; the processes of boiling and treatment with disinfectants kill the pathogen. The stick lives longer in the cold (up to a month and a half), or in wet linen (soldiers’ uniforms on a campaign). Shigella excreted in feces is viable for three months.
Shigella bacterium
In dysentery, flies play a role. They carry particles of feces on their paws and intestines. This has been proven in experiments with nutrient media. The fly landed in a Petri dish - after a while, a colony of Shigella grew here. It was clear where each paw touched the surface. Science is actively studying methods of suppressing pathogens. This is how the method of pasteurizing milk appeared - heating for half an hour at a temperature of 63 degrees Celsius.
Stool with dysentery in adults is an infrequent guest. The reason is to develop science-based standards in the food industry. However, a fly appears and lands in the milk - prepare tablets for dysentery. The disease will certainly arise - the wand will begin to multiply. It happens especially quickly at home.
A pattern is noted. If the salad is kept in the refrigerator, the microbe lasts longer without multiplying. Try to remove uneaten food immediately. There was a report in the press about dysentery affecting a Japanese village. The reason: the residents of a house located up the river washed the clothes of the sick in running water. 413 residents needed the medicine.
The disease manifests itself and is dangerous if the body’s resistance is impaired or the strain of Shigella is abundant. Risk factors:
- Stress.
- Fatigue.
- Presence of other infectious diseases.
- Overheat.
Amoebic dysentery
Amoebic dysentery ( amoebiasis ) is caused by gnostolytic amoeba. Infection occurs when mature cysts of the Histolithic amoeba enter the gastrointestinal tract through the mouth. A person can become infected if they drink raw water that has been contaminated, as well as by consuming foods contaminated with the pathogen. Most often this disease is diagnosed in areas where the climate is very hot.
With this form of dysentery, the incubation period can last up to 30 days. There are three forms of the disease: extraintestinal , intestinal , and cutaneous amebiasis . Intestinal amoebiasis is the most common. In turn, this form is divided into amoebic colitis and amoebic dysentery . With amoebic colitis, a person’s appetite decreases, abdominal bloating appears, and constipation and diarrhea . After defecation, the patient constantly experiences the feeling that the intestines have not been completely emptied. The stool has a mushy consistency and contains mucus. Sometimes blood may also be found. The temperature in an acute condition increases slightly and for a short period.
With amoebic dysentery, patients note severe aching or cramping pain, loose stools with blood and mucus, general weakness and malaise. Stool can appear up to 10 times a day. A moderately elevated body temperature persists for 3 to 5 days. There is also bloating and a coating on the tongue. Sometimes doctors also note an enlarged liver.
With both types of amebiasis, a person’s ability to work is reduced, anemia, and poor sleep. During a rectal examination, ulcers in the distal colon and mucosal ulcers are detected.
With extraintestinal amebiasis, the liver is most often affected, and amoebic hepatitis develops. Cutaneous amebiasis develops, as a rule, with the intestinal form.
As complications of amebiasis, pericolitis, intestinal bleeding , intestinal obstruction, lung abscesses, and subdiaphragmatic abscesses can develop.
The diagnosis is made based on epidemiological data. The doctor studies the medical history in detail and examines the patient. Also an informative method of research is sigmoidoscopy and parasntoscopic examination of the patient’s stool.
Treatment of amoebic dysentery involves following a diet and using pathogenetic and symptomatic drugs. Also, if necessary, patients are prescribed antihistamines and vitamins.
Dysentery in children - consequences
With timely and adequate treatment, the pathology considered is completely cured. Negative consequences are accompanied by complicated dysentery - severe symptoms in children occur against the background of a weakened immune system, late detection of the disease, and the presence of chronic disorders of the gastrointestinal tract. Sometimes exacerbation of the disease occurs due to violation of the diet prescribed for a period of 2-3 months.
Dysentery - consequences:
- colon perforation;
- megacolon;
- peritonitis;
- heart, kidney failure;
- hemolytic-uremic syndrome;
- damage to the nervous system;
- collapse;
- appendicitis;
- secondary bacterial infection (otitis media, pneumonia, etc.);
- toxic shock;
- avitaminosis;
- rectal prolapse;
- pliability, gaping of the anus;
- anemia;
- malnutrition.
How is dysentery transmitted?
The causative agents of the disease are in the form of rods. They die instantly at a temperature of 100C; at a temperature of 60C they can survive for about half an hour. The pathogen dies in the stool within a few hours.
The infection spreads from patients with acute and chronic forms of the disease. Infection is also possible from bacteria excretors, which are people with a mild course of the disease. Such patients do not consult a doctor due to the mildness of their symptoms. The infection can be transmitted through food and drink, and it can also be spread by flies. Transmission of the pathogen can also occur through dirty hands.
Treatment
For a mild form, it is enough to replenish the loss of salt and water orally, intravenously. Dysentery goes away within a week. Antibiotics are prescribed in difficult cases, children, the elderly, or when the lives of others are at risk. Medicines include:
- Pivmecillinam.
- Sulfamethoxazole.
- Ciprofloxacin.
- Ampicillin.
Do not fight diarrhea with Loperamide. Treatment is prescribed by a doctor. Doctors have a special view on diet. Against the background of a crushing urge to defecate, patients try not to eat anything. This is wrong - the body plays a key role in fighting infection. The diet should include a sufficient amount of fish, meat, dairy products, and eggs. Fats are given in the form of butter and cream.
For the first two days of an exacerbation, the patient goes to table 1a with the exception: it is allowed to eat meat, mushroom broths, and fruit juices. Additionally, an infusion of rosehip is brewed. A few days later, cutlets, chicken, yogurt, and cottage cheese are introduced into the menu. Excluded:
- Sunflower oil.
- Lard.
- Smoking.
- Black bread.
- Whole (fat) milk.
- Potato.
- Canned food.
- Peas.
- Spicy dishes.
Symptoms of dysentery
There are two forms of dysentery - acute and chronic . In the acute form of the disease, a person can be sick from 3-4 days to three months. If the disease continues longer, then we are talking about a chronic form of dysentery. The duration of the incubation period in both cases can vary from 18 hours to 5 days.
If the patient has a moderate course of the disease, then its symptoms are more acute. Initially, a person feels weak and unwell, and may shiver a little. Later, cramping pain appears in the left side of the lower abdomen. The stool is liquid, with blood and mucus, its frequency sometimes reaches 25 times a day. In the first two days of dysentery development, the frequency of stool increases. In addition, the patient's body temperature rises, which can reach 39 degrees, and he is bothered by a headache. The temperature subsides after 2-5 days.
For most patients, abdominal pain does not subside for a long time. Sometimes the pain does not subside even for a while. As a rule, the stomach hurts in the lower left part, but some patients note that the pain is diffuse. Bloating is also common . In severe forms of acute dysentery, the onset of the disease is always violent. The patient is experiencing very severe pain in the lower abdomen, which is cramping in nature. The stool is loose and very frequent, vomiting, nausea may occur, and the body temperature rapidly rises. In addition to mucus and blood, pus may be found in the stool. The patient's pulse quickens, blood pressure decreases, and shortness of breath . Severe dysentery can last up to 6 weeks. If the disease is not adequately treated, it can become chronic.
A child with dysentery immediately has abundant stool, but then its appearance changes, lumps of gray-green mucus appear in it. At this time, the child’s body becomes very dehydrated. If the baby has dry mucous membranes, then we are talking about a significant loss of fluid. Parents should also be aware of the fact that dehydration is more dangerous the younger the child.
In severe cases of dysentery, the baby may develop cardiovascular failure , seizures , and impaired consciousness . In this case, urgent hospitalization is important.
A sick baby with dysentery has cold limbs and constantly regurgitates. Sleep is very restless and bad.
What is shigellosis
Since the time of the famous Hippocrates, humanity has known what shigellosis is, which in those days was also called “bloody womb” or “publican”. This name hides an infectious disease related to food poisoning. The causative agents of the disease are non-motile dysentery bacteria - Shigella (shih-GEHL-uh) - a microscopic size of only two - three microns, causing an abundance of loose stools, a gag reflex, and severe chills. They affect the mucous membrane of the large intestine and cause intoxication of the body.
Despite their “dimensions,” Shigella is quite viable in the environment. They may well persist for a long time, both in the aquatic environment and in dairy products. The main danger of the disease is that it knows no barriers and every day affects new internal organs with toxins. Shigella are divided into eight main groups, which in turn are divided into serovars. Biologists number up to fifty types of the latter. Each species/subspecies has its own secreted enzymes, toxic effects, and habitat.
Let's look at which groups of people are most sensitive to shigellosis:
- Adults and children with blood group (II) and negative Rh. In this category of people, dysentery symptoms are more pronounced;
- People living in megacities suffer from shigellosis more often than rural residents. The reason is overpopulation of urban housing areas;
- More often, dysentery affects socially disadvantaged people who do not have enough drinking water or funds to buy normal food. They are forced to eat whatever they can;
- The growth of the disease usually progresses in the summer and autumn seasons.
After dysentery bacilli enter the body, they actively multiply.
There are two stages in the development of the disease:
- During the first stage, enterobacteria of the non-motile species Shigella, together with food, enter the laryngeal cavity and then into the human stomach. Later they end up in the large intestine, where they firmly adhere to the walls of the intestine and lead their active life. In this case, toxins are released, which causes side effects such as diarrhea and vomiting;
- With the onset of the second stage, the number of immobile dysentery bacilli increases many times over. Their main localization is the large intestine and its lower section.
The task of Shigella is to destroy the integrity of the cells of the intestinal wall as quickly as possible, then they will become loose like a “sponge” and stop functioning normally. As a result of these disorders, the patient experiences diarrhea, and then ulcerative colitis may develop.
Let's get acquainted with the forms of dysentery
1. Bacterial shigellosis manifests itself in the following types:
- Acute shigellosis. It can torment a person for three months with varying degrees of severity. Usually accompanied by colitis;
- Chronic shigellosis. This type is characterized by alternating improvements in the condition and exacerbation of the disease with varying durations, loose stools, slight body heat, chills;
- Shigellosis of a continuous nature. Characterized by the manifestation of poor health without light intervals, weakness. Most often it goes into a chronic stage;
- carrier status After complete treatment, the patient remains a spreader of the bacilli to other people.
2. Cyclic shigellosis has the following main development points:
- the period when incubation of the dysentery bacillus occurs;
- initial stage;
- the period when Shigella reproduces;
- splitting of cell membranes of harmful bacilli during treatment;
- complete treatment of a person.
Only in rare cases does the infection not respond to treatment, then the disease enters the chronic stage.
Diagnosis of dysentery
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 test material contains a large amount of mucus and at the same time an increased number of leukocytes and red blood cells are present, then the integrity of the intestinal mucosa is most likely compromised.
Types of shigellosis. Light form
Dysentery is a multifaceted and insidious disease. It knocks some people off their feet right away, while others live with it for years, drink “something for diarrhea” and have no idea what danger they pose to others. In order to somehow classify the manifestations and course of the disease and develop the most appropriate treatment methods for each case, doctors conditionally identified what forms dysentery can have. This:
1. Lightweight.
2. Moderate.
3. Sharp, heavy.
A mild form of dysentery is registered in approximately 80% of all cases. It is characterized by the following symptoms:
— temperature up to 37.8-38 degrees Celsius;
- mushy stool;
— mucus and blood are not observed in the stool;
- number of urges per day up to 10;
- pain in the abdomen (moderate).
Hospitalization and bed rest are not required in this case. For treatment the following are used:
- drugs from the nitrofuran series;
— “Regidron” or “Enterodez” for detoxification;
— prebiotics that restore microflora in the intestine;
— dietary food;
- Drink plenty of fluids to avoid dehydration.
Prevention of dysentery
To prevent the disease, it is very important to comply with all sanitary and hygienic standards. In order to prevent mass infection of the population, strict sanitary supervision is carried out over enterprises that produce food products and provide public catering. It is equally important to control the water supply. All these measures are aimed at preventing the massive spread of intestinal infections.
Personal prevention measures include, first of all, regular and thorough hand washing. In addition, it is important to promptly get rid of flies indoors and prevent them from coming into contact with food. Parents should make every effort to protect their child from infection by pathogens. You should not only ensure that the child washes his hands after using the toilet and walking, but also avoid eating unwashed fruits and vegetables.
People don't get dysentery in winter!
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 actually observed in the warm season. Causes:
- swimming in bodies of water where they do anything but analyze bacterial contaminants;
— swarms of flies diving on food after walking in an unknown place;
- temptations to eat a delicious berry or fruit straight from the bush.
In winter and all year round you can become infected with dysentery like this:
— In catering outlets where sanitation is not observed, especially if there are sick employees or self-medicating employees.
- In any public places where you can come into contact 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, which constantly wanders from one owner to another.
— Another way to become infected with dysentery all year round is through the water supply system during accidents at wastewater 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.
Methods of infection
Dysentery often occurs in children's groups, however, adults can also get sick. You can become infected from a sick person and a bacteria carrier. The most dangerous are patients with an acute form, as well as during an exacerbation of chronic dysentery.
The mechanism of occurrence of the disease is fecal-oral. The pathogen enters the body through the oral cavity and is excreted in feces through the intestines.
Ways of contracting dysentery:
- Contact and household . Bacteria can reach humans through contaminated objects and toys. This is especially true among children, since they often do not observe basic rules of personal hygiene (they do not wash their hands after visiting the toilet). Shigella is also transmitted through contaminated dishes and handshakes;
- Water . The infection enters reservoirs and water supply systems. Drinking contaminated water causes illness;
- Food path . Bacteria can be found in prepared foods, confectionery, salads, and so on. They get there if they are prepared by a bacteria carrier or a mildly ill person. Especially if he does not follow the rules of hygiene. The disease occurs when eating unwashed fruits and vegetables contaminated with infected feces.
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:
- Detection of a repeat case of dysentery in a group within 7 days. In this case, preventive measures correspond to those described above.
- 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.
- 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.
Reasons for appearance
The main causes of dysentery include the following factors:
- Bacteria entering the mouth through unwashed hands and contaminated objects. This happens more often with young children who like to try everything by tooth.
- Poorly washed fruits or fresh vegetables before consumption.
- Ingestion of water contaminated with bacteria into the stomach. This happens when swimming in open water or using water from rivers and lakes for drinking.
- Contact with a person with dysentery. You can become infected through close contact or while caring for a patient.
- Unwashed hands after working with soil or going to the toilet.
A large concentration of flies can also provoke the disease. Flies carry infectious agents and can contaminate food left open.
Anti-epidemic measures for dysentery
When the disease spreads, anti-epidemic measures for dysentery involve the following actions:
- Research of water, products, providing the population with safe, high-quality drinking water.
- Hygienic training of the population: how to protect yourself and children from infection.
- Registration of all patients, carriers of infection and those who came into contact with them. Patients are discharged from the hospital only after their clinical recovery and negative examination results.
- Carrying out disinfection at the source of the disease.
What to do if someone is infected near you
A sick person is hospitalized, however, if the disease is mild, he can be left at home.
If an infected person is admitted to a hospital, then SES employees carry out final disinfection at the patient’s home.
Measures to prevent dysentery if the infected person remains at home:
- He is provided with separate dishes , bed linen and hygiene items;
- Contact persons are monitored for 1 week after detection of infection (character of stool, body temperature and general condition);
- An ongoing disinfection is carried out in the outbreak , and after recovery the final one: All feces of the sick person must be treated with bleach, filled with a 10% solution for at least 2 hours;
- Processing dishes by boiling;
- Daily change of linen followed by disinfection (Lysol solution) or boiling;
- Hands should be washed and treated with Chloramine 0.5% solution;
Current prevalence of the disease
Modern medicine knows everything about dysentery. Experts have found drugs that kill pathogens. However, the prevalence of the disease is still high. Even deaths continue to be recorded. Official statistics indicate that approximately 200 million people experience dysentery every year. About 1.1 million people die from this disease.
Dysentery is encountered in all modern countries. However, the disease is most common in developing countries, where the population lives in unsatisfactory sanitary and hygienic conditions:
- with low quality drinking water;
- unsanitary living conditions;
- the presence of strange customs and prejudices, etc.
Shigellosis is recorded throughout the year. However, the largest number of patients begin to seek treatment for dysentery in the summer-autumn period. This seasonality is explained by several factors - the ripening and consumption of vegetables, fruits, berries during this period, and swimming in reservoirs that are contaminated with sewage.
Dysentery, as can be seen from statistics, is not an absolutely fatal disease. Fatalities are mainly recorded in developing countries. In developed countries, death from this disease is a relatively rare occurrence, because measures have been developed to prevent and treat dysentery. It is worth noting that the likelihood of death increases in people with poor nutrition. Also at high risk include:
- children and adults over 50 years of age;
- babies who are bottle-fed;
- patients with immunodeficiencies;
- persons who develop dehydration experience loss of consciousness.
Illness in the past
Humanity has known about dysentery since ancient times. This term appeared back in the 5th century. BC e. thanks to Hippocrates. However, for many centuries, dysentery was not understood as a specific disease. The term was used to refer to a whole group of ailments that were characterized by diarrhea.
Dysentery was a terrible disease in the past. There was no cure for it. Epidemics broke out all over the world. From surviving historical sources it is known that a major outbreak of the disease occurred at the very beginning of the 15th century. in France. In the city of Bordeaux, the most people died - about 14 thousand people. Subsequently, epidemics were registered in Germany, Holland, and other countries. Most often, outbreaks were provoked by natural disasters and wars.
The first statement about the existence of the causative agent of dysentery dates back to 1891. It was made by Alexey Vasilyevich Grigoriev, a Russian microbiologist and pathologist. He wrote a work “On microorganisms in dysentery”, expressed an opinion about the development of the disease due to the entry into the human body of special immobile coliform bacteria.
A few years later, the pathogen was isolated in pure culture. This discovery was made by the Japanese doctor and microbiologist Kiyoshi Shiga (in some sources his last name is written a little differently - Shiga). Later, experts became interested in dysentery, symptoms, treatment and prevention of this disease. The studies carried out allowed us to identify other pathogens. They were named after their discoverers (Flexner, Sonne, Stutzer-Schmitz, etc.)
