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Dysentery

Dysentery is an acute infectious disease that occurs with a primary lesion of the large intestine and, in some cases, symptoms of general intoxication .

Etiology . Causative agents of dysentery - sticks with rounded ends, immobile, gram-negative. (Amoebic dysentery - see Amebiasis.) The main types of dysentery bacteria (Grigoriev-Shigi, Shtuzer-Schmitz, Lardz-Sachs, Flexner, Sonne) differ from each other in biochemical and antigenic properties. At present, the bacteria Zonné and Flexner are predominant in our country. Dysentery pathogens are sensitive to sunlight, high temperature and disinfectants ( bleach , carbolic acid, etc.).

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Epidemiology . The source of infection is a patient with dysentery and a bacteria excreta. Patients with acute dysentery are particularly infectious in the early days of the disease. Patients with chronic dysentery support the incidence of dysentery during the off-season (winter) period. In the external environment, the pathogen is excreted in the feces. Ways of transmission of infection - contact, food and water. Contact by transmission occurs through unwashed hands, food and water - as a result of the use of infected food (eg milk) and water. Mechanical vectors of infection can be flies. The incidence of dysentery is higher in hot and warm climates. Rises are observed in summer and autumn, especially in cities with a high population density and poor sanitary conditions. The susceptibility of the population to dysentery is high, especially in children. Those who have been ill form a short- lasting immunity to a specific type of pathogen.

Pathogenesis . More often, weakened people suffering from various diseases of the gastrointestinal tract ( chronic gastritis , cholecystitis , etc.), and helminthiasis, get sick. Dysentery bacteria that are not destroyed in the stomach and have passed through the small intestine, are introduced into the lymphatic colon formations, multiply, produce toxins , causing inflammation of the mucous membrane of the colon and general intoxication. The severity of the local process decreases in an ascending order — the rectum and sigmoid colon , then the descending, transverse colon, ascending, blind, and in severe cases sometimes the small intestine are most affected. At the same time, catarrhal-diphtheritic inflammation, ulceration and their regeneration are observed; development of intestinal dysbacteriosis (change - intestinal microflora). In dysbacteriosis, the number of Escherichia coli decreases, the number of conditionally pathogenic bacteria increases (Proteus, Staphylococcus , Fungi, Enterococci , etc.). The development of dysbiosis complicates and delays the course of the disease. In dysentery, the enzymatic and motor activity of the gastrointestinal tract is inhibited, the absorption and synthesis of vitamins are reduced. There may be violations of protein, water-salt and carbohydrate metabolism .

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The clinical picture (symptoms and signs). Acute dysentery . The incubation period is 2-5 days, sometimes 12-24 hours.

In typical cases, dysentery begins acutely. The temperature rises to 38-39 °, the patient complains of pain in muscles and joints, chilling, headache. Already in the 1-3rd day of the disease there are pains in the abdomen of a cramping character, usually localized in the left half of the abdomen, and stools become more frequent. Cal - liquid, soon becomes scanty, mucus and blood appear in it in the form of streaks, in severe cases - pus and fibrin film. The urge to defecate painful ( tenesmus ), characterized by false urges. The number of bowel movements - 10-20 times a day or more. Some patients (often with dysentery caused by Zonne's wand) may first have vomiting , abundant liquid stool, right-sided localization of abdominal pain, and dehydration - seizures . The tongue is overlaid. Stomach is sunken, painful with palpation along the colon, most of all in the left iliac region, where the sigmoid colon is palpable. Fever lasts 2-5 days, rarely more. With severe intoxication marked tachycardia , lower blood pressure, deafness of heart sounds. Leukocytosis, neutrophilic shift of the white blood formula to rod-nuclear forms, moderate acceleration of ESR is possible in the blood. The full development of the clinical picture is observed by the 2nd to 4th day of the disease, after which, especially during treatment, the patient's condition improves, abdominal pain and tenesmus decrease, the chair becomes less frequent, the mucus and blood in the stool disappears. Clinical recovery occurs by the 8th-15th day, when most patients usually stop bacterial division. Full recovery with the restoration of all functions - in 1-2 months, sometimes later. In case of incomplete recovery, relapses , protracted course, transition to the chronic form are possible. Along with the typical cases of dysentery, it is possible that the erased, slightly expressed, mild course, as well as bacteriological secretion without clinical manifestations. The severity of dysentery has decreased in the last 10-15 years. The percentage of severe toxic forms is small. On the contrary, the number of forms of dysentery has increased, in which only a mixture of mucus appears in the feces.