* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Bacillary Dysentery (shigellosis)
Survey
Document related concepts
Plasmodium falciparum wikipedia , lookup
Trichinosis wikipedia , lookup
Sarcocystis wikipedia , lookup
Chagas disease wikipedia , lookup
Typhoid fever wikipedia , lookup
Clostridium difficile infection wikipedia , lookup
Hepatitis B wikipedia , lookup
Hepatitis C wikipedia , lookup
Leptospirosis wikipedia , lookup
Rocky Mountain spotted fever wikipedia , lookup
Yellow fever in Buenos Aires wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Oesophagostomum wikipedia , lookup
Gastroenteritis wikipedia , lookup
Transcript
Bacillary Dysentery (shigellosis) Dept. Of Infectious Disease Huang Fen Definition Acute infectious disease of intestine caused by dysentery bacilli 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 and toxic encepholopthy. Etiology Causative organism: dysentery bacilli, genus shigellae, gram-stain negative, short rod, non-motile Groups: 4 serogroups 47 serotypes S. Dysenteriae the most severe Etiology S. Flexneri the epidemic group and easily turn to chronic S. Boydii tropical areas S. sonnei the most mild Etiology Pathogenicity: - virulence endotoxin - interotoxin (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, age: younger children Pathogenesis number of bacteria pathogenicity 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 fever diarrhea mixed with blood & pus, abdominal pain interotoxin Pathogenesis-toxic strong - allergy to endotoxin demethyl-adrenaline micro-circulatory failure shock, DIC, cerebral edema cerebral hernia Pathology site of lesion: entire colon -sigmoid & rectum feature: acute: diffuse fibrinous exudative inflammation, hyperemia, edema, leukocyte infiltration, necrosis, superficial ulceration. Pathology chronic: edema, ulceration, polypoid hyperplasia, toxic: hyperemia, edema, Clinical manifestation Incubation period: 1-2 day, (hours to 7 days) Acute dysentery common type mild type toxic type Clinical manifestation common type: acute onset , shiver, high fever abdominal pain diarrhea: stool mixed with mucus, blood & pus tenesmus, Clinical manifestation mild type: caused by S. sonnei low fever or no fever abdominal pain is mild stool mixed with mucus, without blood & pus diagnosis by isolation bacteria Clinical manifestation toxic type: age: 2 to 7 yrs. abrupt onset, high fever, T> 40oC convulsion repeatedly, altered consciousness circulatory & /or respiratory collapse diarrhea mild or absent at beginning Clinical manifestation shock form: septic shock brain form: listlessness,lethargy,convulsion, coma. 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 diarrhea and repeated 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, neutrophils increase Stool examination: direct microscopic examination: WBC, RBC, pus cells Laboratory Findings bacteria culture: PCR :DNA Serologic examination: Sigmoidoscopy: chronic patients shallow ulcer scar polyp Diagnosis Epidemiologic data: contact history Clinical manifestation: Laboratory findings: 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, X-ray : lead pipe. chronic schistosomiasis Japonica contact with the contaminated water hepatomegaly and splenomegaly founding the ovum of schistosomiasis Differential diagnosis toxic dysentery encephalitis B: high fever,convulsion,coma. • <24h • circulatory failure • stool examination • CSF • meningeal irritation • specific IgM Treatment Common dysentery general treatment: isolation diet fluid and electrolyte pathogenic treatment: norfloxacin 0.2~0.4 q6h po 5~7d Ampicillin given by po or iv Getamycin Treatment symptomatic treatment: Toxic dysentery general treatment pathogenic treatment: L-ofloxacin: 0.2 bid ivdrop cefotaxime: Ampicillin : Treatment symptomatic treatment: • control of high fever,convulsion: subhibernation • treatment of shock: 654-2: 1- 2mg/kg • treatment of cerebral edema: 20% mannitol respiratory failure Treatment chronic dysentery general therapy: live, avoid overwork exercise diet Treatment etiologic therapy: sensitive antibiotics, according to results of culture used in turn or combined use enema. Prevention Control the source of infection: until culture negative Interrupting the route of transmission: Protecting the susceptible population: F2a: secretary IgA protect rate: 80% 6-12mon