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Transcript
Bacillary Dysentery (shigellosis) Dept. Of Infectious Disease Huang Fen Definition Acute infectious disease of intestine caused by dysentery bacilli(genus shigella) Place of lesion: sigmoid & rectum Pathological feature: diffuse fibrious exudative inflammation Definition Clinical manifestation: fever, abdominal pain, diarrhea, tenesmus , stool mixed with mucus blood, & pus. even companied with shock, toxic-encepholopthy. Etiology Causative organism: dysentery bacilli, genus shigella, gram-stained negative, non-motile short rod, Groups: 4 serogroups &47 serotypes Etiology S. dysenteriae: the most severe S. flexneri: the epidemic group and easily turn to chronic S. boydii: tropical and subon S. sonnei: the most mild Etiology Pathogenicity: - virulence endotoxin - exotoxin - invasiveness (attach-penetrate-multiply) Resistance: Strong, 1-2week in fruits,vegetable and dirty soil, heat for 60℃ 30 min Epidemiology Source of infection: patients and carriers Route of transmission: fecal-oral route Suceptibility of population: immunity after infection is short and unsteady, no cross-immune Epidemiology Epidemic features: season: summer & fall Flexneri, Soneii, dysentery age: younger children Pathogenesis number of bacteria toxicity invasiveness attachment penetration multiplication immunity common Bacteria intestine penetrate mucus multiply in epithelia cell & proper lamina inflammation vessel contraction normal intestinal flora sIg A prevent attaching endotoxin endogenous pyrogen superficial mucosal necrosis and ulcer diarrhea mixed with blood & pus, abdominal pain fever Pathogenesis-toxic strong - allergy to endotoxin demethyl-adrenaline micro-circulatory failure shock, cerebral edema cerebral hernia DIC Pathology site of lesion: entire large bowelsigmoid colon & rectum feature: acute: diffuse fibrinous exudative inflammation, Pathology hyperemia, edema, leukocyte infiltration, superficial necrosis, ulcer. chronic: edema, polypoid hyperplasia, toxic: colon: hyperemia, edema, micro- capillary was invaded Clinical manifestation Incubation period: 1-2 day, (hours to 7 days) Acute dysentery common type mild type toxic type Clinical manifestation common type: (typical type) acute onset , shiver, high fever abdominal pain(tenderness) diarrhea: stool mixed with mucus, blood & pus tenesmus, 1 week Clinical manifestation mild type: ( atypical type) caused by S. sonnei low fever or no fever abdominal pain is mild stool mixed with mucus, without blood & pus diagnosis by isolation of bacteria 3~7d Clinical manifestation toxic type: age: 2 to 7 yrs. abrupt onset, high fever, T 40oC dysphoria, lethargy, convulsion repeatedly,coma. circulatory & respiratory collapse diarrhea mild or absent at beginning Clinical manifestation shock form: septic shock brain form: dysphoria,lethargy,convulsion repeatedly,coma, brain hernia. respiratory failure mixed form Clinical manifestation chronic dysentery: > 2 months chronic delayed type:chronic obscure type acute attack type Clinical manifestation chronic delayed type: long-time and repeated abdominal pain, diarrhea, stool mixed with mucus, blood & pus. with fatigue, anemia, malnutrition. Clinical manifestation chronic obscure type: acute history in 1 year, no symptoms, stool culture positive or sigmoidscopy acute attack type: same as common acute dysentery Laboratory Findings Blood picture: WBC count increase, (10~20×109/L) neutrophils increase Stool examination: gross examination: stool mixed with mucus, blood & pus. Laboratory Findings direct microscopic examination: WBC, RBC, pus cells bacteria culture: PCR:DNA Sigmoidoscopy: chronic patients shallow ulcer scar polyp Differential diagnosis acute dysentery amebic dysentery Entamoeba histolytica stool: reddish brown, like jam flask-shaped ulcer, amebic trophozoite Differential diagnosis enteritis caused by E. Coli, salmonella, virus. intussusception: jam-like stools, abdominal mass absence of fever Differential diagnosis chronic dysentery rectal & colonic carcinoma: no cure for long-term, drop of weight of body non-specific ulcer colitis: no cure for long-term, culture of stool is negative, Differential diagnosis sigmoidoscopy: hemorrhage, ulcer, lead pipe. chronic schistosomiasis Japonica contact with the contaminated water hepatomegaly and splenomegaly founding the ovum of schistosomiasis Japonica Differential diagnosis toxic dysentery encephalitis B: highfever,convulsion,coma. • <24h • circulatory failure • stool examination • CSF • meningeal irritation • Specific IgM Treatment Common dysentery Toxic dysentery general treatment pathogenic treatment : ofloxine Ampicillin given by IV Treatment symptomatic treatment: • control of high fever,convulsion: subhibernation • treatment of shock: same as ECM • treatment of cerebral edema: 20% mannitol Treatment chronic dysentery general therapy: live diet, nurishing avoid overwork exercise. Treatment etiologic therapy: sensitive antibiotics used in turn or combined use according to results of culture enema expectant treatment. Prevention Control the source of infection: until culture negative Interrupting the route of transmission: Protecting the susceptible population: F2a-secretary IgA protect 80%-6-12mon