Characteristic clinical symptoms of dysentery. Dysentery (shigellosis): symptoms and treatment

Content

It is not without reason that this infectious disease is called the “disease of dirty hands.” The main causative agents of Shigella dysentery easily pass from the skin to food, water, drinks, affecting intestinal tract and poisoning the entire body. The disease is dangerous with severe complications, so it is important to recognize it in time.

Symptoms of dysentery in adults

The infection very rarely manifests itself without causing fever and fever. This is more common among older people. Much more often, the course of dysentery (in common parlance - red diarrhea) is sudden and acute. The main causative agents of the disease are the following types of Shigella:

• Sonne;
• Flexner;
• Grigorieva-Shiga.

There are four stages in the development of the disease. This:

• initial;
• acute;
• the climax and decline of the disease;
• final recovery.

The very first signs of dysentery in adults:

• slight chills;
• stomach ache;
• diarrhea;
• rise in temperature.

At the same time, signs of damage to nerve cells appear:

• headache;
• pressure surges;
• arrhythmia;
• loss of strength, feeling of weakness;
• depressed mood.

Classic signs of dysentery infection are high fever and diarrhea. I am tormented by frequent urge to stool, sometimes up to 20-30 times a day. In this case, the patient is exhausted by cutting pain in the abdomen, which has the nature of contractions. Very little feces are excreted. The stool is liquid, with mucus, and some time later tests show the presence of blood and pus. The temperature during diarrhea in an adult can rise to 30-40 degrees. The acute period of dysentery development can last from 2-3 to 10 days.

Afterwards, the symptoms of the disease subside. The temperature with diarrhea in adults quickly becomes normal, but final recovery may require another 2, and sometimes 3 weeks. Often people mistake diarrhea for food poisoning and practice self-medication. In such cases, due to inadequate treatment, the disease becomes chronic and can last for more than one month. Recently, dysentery often occurs in mild form. Shigella Grigoriev-Shiga is becoming less common, and Sonne and Flexner bacilli are less aggressive.

Sonne dysentery

The disease begins acutely, with severe spasms of the large intestine. Signs of dysentery in adults include fever and vomiting. The insidiousness of this type of disease is that it can easily be mistaken for food poisoning or an attack of appendicitis. Stool with Sonne dysentery is also frequent and liquid. All these signs and features should be taken into account in order to prevent a medical error when determining the diagnosis.

Flexner's dysentery

Grigoriev-Shiga dysentery

Bacteria of this type are distinguished by the fact that they produce toxins, especially poisonous to human body. In addition, they are resistant to many drugs. Such pathogens are rare. Besides this pathogenic flora does not tolerate heat and cold, and quickly dies from disinfection solutions containing chlorine. However, at a comfortable room temperature, Grigoriev-Shiga bacteria actively multiply while in the feces, on the skin, and underwear of the patient.

How does dysentery manifest in adults?

This disease in two patients of the same age, health status, and gender can proceed completely differently. Sometimes the differences in the signs of the disease are simply striking. Much depends on the form of the pathology. Acute dysentery can occur in the following ways:

• colitic, when the large intestine is affected;
• gastroenteritis, if the stomach is also affected;
• gastroenterocolitic, in which the entire gastrointestinal tract suffers.

Among typical signs dysentery in adults, acutely ill patients:

• frequent urge to stool and profuse diarrhea with fever;
• cutting cramps in the abdomen, rectal pain;
• feverish condition;
• nausea turning into vomiting.

Signs of dysentery in adults, patients chronic form infections:

• diarrhea also occurs, but not as frequent and debilitating;
• in the analysis of stool there is little mucus and no traces of blood at all;
• the temperature does not rise above 38 degrees;
• no vomiting;
• general health is much better.

What is the danger of acute and chronic dysentery?

Many people who have had this disease, then again for a long time experience signs of exhaustion, anemia, loss of strength, and lack of appetite. Often the reason for this lies in dysbiosis due to antibiotics. However, anemia is the most surmountable consequence of the disease. Beneficial microflora intestines is not so difficult to restore with the help of pro- and prebiotics. The threat of dehydration is also easy to avoid thanks to drinking plenty of fluids and taking Regidron. What is much more dangerous is that this pathology can be complicated by severe damage to many organs.

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 that persists for a long time after treatment.

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 this critical condition ends in death.

Video: diarrhea and fever in an adult - what to do

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

Found an error in the text? Select it, press Ctrl + Enter and we will fix everything!

Contents of the article: classList.toggle()">toggle

Dysentery (shigellosis) is a common infectious disease caused by bacteria from the genus Syigella, which damage the mucous membrane of the large intestine.

Causes

The main source of the disease is a sick person or an asymptomatic carrier. Of particular danger from an epidemiological point of view are patients with a mild form of dysentery, the symptoms of which are mild, so the patient leads a normal life.

Dysentery is transmitted in two ways:

• Contact and household - through handshakes or household items;
• Fecal-oral – the causative agent of the disease, together with feces, enters the soil, water or onto the patient’s hands, and then onto food. Together with food or water, bacteria enter the large intestine, penetrating into its epithelium, causing an inflammatory process and disrupting the intestinal microflora.

Symptoms of the disease

The latent period of the disease can last up to 7 days. Ulcers, erosions and hemorrhages appear on the intestinal mucosa. In most cases, the disease begins with acute symptoms, which appear on days 2–3:

• The patient's body temperature rises;
• Abdominal pain appears, initially dull and diffuse, and then sharp and cramping. They appear in the lower abdomen, mainly on the left;
• The patient begins to have a headache and loses his appetite;
• Frequent stools, up to 10 times a day;
• During the act of defecation, a nagging pain appears in the rectum, which radiates to the sacrum;
• Appear false urges to defecation, after which there is a feeling of unfinished bowel movement;
• The stool is normal at first, then mucus and blood appear in it;
• In severe cases, the patient defecates bloody mucus;
• Also when severe forms dysentery, there may be a decrease in body temperature or blood pressure, lips and skin become bluish, the pulse quickens;
• When the stomach and intestines are damaged, and occurs.

In the acute form of dysentery, there are several variants of its course:

• Gastroenteric form, in which the stomach and small intestine are affected;
• Gastroenterocolitic form - the entire digestive system is affected;
• Colitic form - the large intestine is affected.

In chronic dysentery, the symptoms of the disease may differ from the acute form, they are not so pronounced:

• The illness can last more than 3 months;
• Periods of remission alternate with periods of exacerbation of dysentery, but the course of the disease can be continuous;
• The patient's body temperature rises to 37–38˚С;
• Frequent bowel movements appear, which may be accompanied by mild abdominal pain;
• There is a small amount of mucus in the stool, but there may be no blood.

With asymptomatic dysentery, the causative agent of the disease is isolated from a sick person within 10 days after he was infected. Then comes the period of recovery.

Treatment of dysentery

Patients with dysentery in most cases are hospitalized in the infectious diseases department. With a mild form of the disease, the body can cope with it on its own. In severe cases, the patient must remain in bed and take medications:

Consequences

The danger of dysentery is that if treated incorrectly or untimely, it can cause complications in the form of damage to the intestines or other organs. Due to the painful urge to defecate, rectal prolapse may occur. Dehydration is common, especially in children or older adults.

The most serious complications of dysentery include:

• Ulceration of the intestinal mucosa with bleeding from the affected areas;
• Formation of toxic megacolon (the large intestine dilates pathologically, leading to death);
• The appearance of hemolytic-uremic syndrome;
• Sepsis when the pathogen enters the blood;

After suffering from dysentery, the patient has no appetite for a long time, exhaustion and weakness appear. The microflora in the intestines is disrupted, and dysbiosis occurs.

With chronic dysentery, organic changes in the epithelium of the intestinal wall almost always occur and the digestive process is seriously disrupted.

Diet

For dysentery, you must follow a special diet. On the first day of illness, the patient is given only water or weak tea with crackers. In the following, table No. 4 according to Pevzner is shown. The food should have reduced quantity carbohydrates and fats at the same time normal level squirrel.

Foods that irritate the digestive tract and provoke the formation of gases in the intestines are excluded from the diet. The food is crushed and given in semi-liquid form, in small portions.

Foods that should not be consumed

Foods you can eat

Bakery products, muffins, fresh pastries; Strong meat and fish broths; Vegetable soups cooked in meat broth; Smoked meats and pickles; Canned food; Vegetables: legumes, cabbage; Pasta; Porridge: pearl barley, wheat; Fried and hard-boiled eggs; Whole milk; Fatty fermented milk products; Raw vegetables and fruits; Sausages; Sweets: candies, chocolate, honey, jam; Carbonated drinks, coffee, cocoa, alcohol; Fatty meat and fish.

Vegetable and slimy soups; Cream soups; White bread crackers; Boiled vegetables; Baked fruits; Porridge: buckwheat, rice; Lean meat, steamed or boiled; Steamed cutlets or quenelles; Fresh cottage cheese made from skim milk; Steamed or soft-boiled eggs, no more than 2 per day; Ripe, non-acidic fruits and berries, pureed; Pastila or marshmallows.

In children

Dysentery is especially dangerous in childhood because it quickly causes dehydration. More often, this disease affects preschoolers, since children do not observe personal hygiene rules and put their fingers and toys in their mouths.

You can read more about dysentery in children.

In pregnant women

Dysentery during pregnancy is often complicated by miscarriage. In 40% of cases it ends in premature birth. This happens because the disease has a stimulating effect on the uterus, increasing its contractile activity. This contributes to spontaneous miscarriage or shortening of labor.

Women with dysentery experience bleeding in their veins much more often than usual. postpartum period. Dysentery also increases the risk of death during childbirth or stillbirth.

During labor, the baby can become infected with the disease from the mother., this is confirmed by medical descriptions of dysentery in newborns.

Prevention

In order to prevent illness, it is necessary:

• Observe the rules of personal hygiene, wash your hands before eating and after visiting public places;
• It is necessary to carefully monitor the expiration date and proper storage of food products;
• If a family member is sick with dysentery, it is necessary to disinfect the entire house, Special attention paying attention to toilet and cutlery;
• When swimming in open reservoirs, you should not swallow water, and after swimming you must take a shower;
• You cannot drink raw water from wells or springs;
• When caring for a patient with dysentery, it is necessary to strictly observe the rules of personal hygiene, boil linen and dishes.

At the first signs of the disease, you should immediately consult a general practitioner or infectious disease specialist.

An infectious disease with a fecal-oral transmission mechanism, caused by bacteria of the genus Shigella and occurring with primary damage to the mucous membrane of the large intestine.

Dysentery is manifested by such symptoms as general malaise, cramping abdominal pain, frequent liquid diarrhea, which in typical cases contains an admixture of mucus and blood and is accompanied by false urges.

The clinical concept of "dysentery" has existed since ancient times. This term meant any disease accompanied by “bloody or straining diarrhea.” Only much later did this term begin to be used to refer to infectious intestinal diseases.

Pathogens of dysentery

The causative agents of dysentery belong to the genus Shigella. Their length is 2-3 microns. width 0.5-0.7 microns. They do not form capsules or spores, are nonmotile, gram-negative. Shigella contains a heat-stable O-antigen. When destroyed, they release endotoxin and are also capable of producing exotoxin. Shigella Grigoriev-Shiga produces a neurotoxin.

According to the international classification, Shigella is divided into 4 subgroups: A (Grigoriev-Shiga, Stutzer-Schmitz, Large-Sachs), B (Flexner, Newcastle), C (Boydy), D (Sonne). At a temperature of 100°C they die instantly, at 60°C and from direct sunlight after 30 minutes. Viable in the shade - 79 days, in milk - 2-17 days, butter - 8-62 days, in sour cream from 10 hours to 4 days, in cottage cheese - 6-15 days, in bread crumb - 7-12 days, in they can multiply in minced meat, in sewage for 25-30 days and in soil for up to several months.

How does dysentery become infected?

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.

Symptoms of dysentery

Based on the nature of the symptoms, dysentery is usually divided into acute and chronic. Acute dysentery lasts from several days to three months; a disease with a longer course is considered chronic. Most often, the disease occurs in an acute form and is currently characterized by a relatively mild course and very low mortality. Light form acute dysentery is characterized by a typical, although pronounced, clinical picture.

The incubation (latent) period, as with other forms of dysentery, traditionally lasts 2-5 days, but can be shortened to 18-24 hours. The disease most often begins suddenly. Patients experience moderate pain in the lower abdomen, mainly on the left; there may be nagging pain in the rectal area. Stools are frequent, from 3-5 to 10 times a day, mixed with mucus and sometimes blood. Body temperature is normal or slightly high.

The symptoms of dysentery are more clearly expressed in cases of moderate severity of the disease. Typically, acutely or after a short period of malaise, weakness, chills, and an unpleasant feeling in the abdomen, characteristic signs of the disease are detected. In the majority of cases, cramping pain appears first in the lower abdomen, mainly on the left. The frequency of stools (painful, liquid, mixed with mucus and blood) ranges from 10-15 to 25 times a day and can increase during the first 2 days.

At the same time, a headache appears and the temperature rises, which lasts for 2-5 days, reaching 38-39C. The duration of the increase in body temperature is no more than 2-3 days. In approximately 80% of patients, cramping abdominal pain lasts a long time. In some patients they may be permanent. Usually the pain is in the lower half of the abdomen, sometimes mainly on the left. In 30% of patients, the pain is diffuse, in 5-7% - in the epigastric region or within the umbilical region. Sometimes there is bloating with gases.

The severe form of acute dysentery is characterized by the presence of an acute clinical picture. The disease begins rapidly, patients mainly complain of severe cramping pain in the abdomen, frequent loose stool, weakness, high body temperature, not often nausea and vomiting. Stools are very frequent, mixed with mucus, blood, and sometimes pus. The pulse increases sharply, shortness of breath is observed, and blood pressure is reduced. The disease can last up to 6 weeks and, if the course is unfavorable, becomes chronic.

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, bad feeling, lack of appetite. Parents of a child infected with dysentery may notice an increase in temperature and the appearance of persistent diarrhea. In all cases of diarrhea that occurs against the background of an increase 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 complete recovery. Children who have been in contact with a child with dysentery are usually kept under observation for 2-3 weeks. Treatment of dysentery in children should begin as soon as possible. In children, dysentery can lead to severe dehydration, which is very dangerous for the child. If your child has diarrhea and fever: before calling a doctor, give your child as much fluid as possible!

Complications of dysentery

Possible complications of dysentery: infectious-toxic shock, infectious-toxic encephalopathy, intestinal perforation with the development of peritonitis, pneumonia, etc. Depending on the severity, changes in the mucous membrane of the colon are detected in varying degrees of severity (catarrhal, catarrhal jugemorrhagic, erosive, ulcerative, fibrinous). The most typical complications of dysentery are hemorrhagic and erosive changes against the background of inflammation of the mucous membrane.

Diagnosis of dysentery

Evidence of the dysenteric nature of the disease is the isolation of Shigella from feces, but this is only possible in 50% of patients (more often during outbreaks). To confirm the diagnosis, immunological methods are also used to detect antigens of pathogens and their toxins in saliva, urine, coprofiltrates, blood and antibodies to Shigella. For the diagnosis of chronic dysentery, it is important to indicate acute dysentery during the last 3 months. Dysentery must be differentiated from acute colitis of another etiology (Salmonella, etc.), as well as amoebiasis, balantidiasis, nonspecific ulcerative colitis, colon cancer.

Treatment of dysentery

Treatment of patients with dysentery can be carried out both in an infectious diseases hospital and at home. Hospitalize patients with moderate and severe forms, children under 3 years of age, weakened patients, and also if it is impossible to organize treatment at home; According to epidemiological indications, children attending preschool institutions, food workers, and people living in dormitories are hospitalized.

In the treatment of dysentery, nitrofurans (furazalidone, furadonin 0.1 g 4 times a day, ersefuril 0.2 g 4 times a day), hydroxyquinolines (nitroxoline 0.1 g 4 times a day, 1-2 tablets 3 times a day), cotrimaxazole (Biseptol 2 tablets 2 times a day), fluoroquinolones (ofloxacin 0.2-0.4 g 2 times a day, ciprofloxacin 0.25-0.5 g 2 once a day), aminoglycosides, cephalosporins. For mild dysentery, nitrofurans, cotrimaxazole, hydroxyquinolines are used for treatment; for moderate dysentery, fluoroquinolones are used; for severe dysentery, fluoroquinolones are used (if necessary, in combination with aminoglycosides), cephalosporins in combination with aminoglycosides.

For Flexner and Sonne dysentery, a polyvalent dysentery bacteriophage is used. In case of dehydration, dehydration is carried out, in case of severe intoxication - detoxification therapy. With pronounced pain syndrome To relieve spasms of the colon, antispasmodics (noshpa, papaverine) are used; astringents are indicated (vikalin, vikair, tannacomp). A complex of vitamins is prescribed, including ascorbic acid(500-600 mg per day), nicotinic acid(60 mg per day), thiamine and riboflavin (9 mg per day). To correct the intestinal biocenosis, bacterial preparations are used (for severe colitic syndrome - biosporin, bactisubtil, flonivinBS, for severe enteric syndrome - enterol; on the 6th day of bacteriotherapy, Linex, bifidumbacterin, Vitaflor, etc. are prescribed).

In case of a prolonged course of the disease, stimulating therapy is carried out - for 5-7 days, pentoxyl 0.25 g 3 times a day, or yetiluracil 0.5 g 3 times a day, or sodium nucleinate 0.1 g 3 times a day is prescribed, or dibazol 0.02 g 3 times a day. Careful identification and treatment is necessary to prevent recurrence of dysentery concomitant diseases. The prognosis is favorable. The transition to chronic forms is observed relatively rarely with perfect therapy (12%).

Diet for dysentery

During treatment for dysentery, the patient must adhere to a diet. In case of severe disease, you need to fast during the first day, you can only drink water-salt solutions. Then they switch to diet No. 4. Required condition dietary nutrition for dysentery - exclusion of whole milk from the diet. A diet for dysentery must be followed for at least 3 weeks.

Prevention of dysentery is primarily associated with sanitary and hygienic measures. Sanitary supervision of food industrial enterprises, dairy farms, catering establishments. Control of sanitary improvement of children's preschool institutions, public and residential institutions. Sanitary supervision of drinking water supply and nutrition of the population. The purpose of all these measures is to prevent the transmission of all intestinal infections. In this regard, great importance is attached to sanitary educational work. Personal prevention of dysentery comes down to careful adherence to the rules of personal hygiene. In a word, dysentery is a disease of dirty hands! Wash your hands often with soap and kill flies!

Questions and answers on the topic "Dysentery"

Question: hello, my son is 4 years old, he was diagnosed with amoebic dysentery, the infectious disease specialist prescribed medications, alas, it’s been a week since the panos with mucus does not end, tell me, the recovery process is still long and does it have any side effects?(((

Answer: Recovery of children occurs in the absence of complications (usually three or four weeks from the onset of the disease). But full recovery mucous membrane lasts up to 3 months or longer. Violation of the diet threatens exacerbation.

Question:My son is 6 months old. The feces were always mushy, sometimes yellow, sometimes green. Diarrhea started two days ago. Water and mucus come out. He hasn’t pooped normally for a day now, and streaks of blood sometimes appear in his diarrhea (or rather, more and more often). I went to the clinic, but then there was no blood yet, they said dysbiosis. He screams a lot when he swears and his butt is all red from irritation, he won’t even let you touch it. I don't know what to do. I'm afraid it might be dysentery.

Answer: It is very unlikely that the child has dysentery. You need to take him to the doctor as soon as possible for an examination and a stool test.

Question:I am 21 years old. I came back from vacation 6 days ago. On the 2nd day after arrival, severe diarrhea began, in the first two days I took loperamide only a couple of times a day. It didn’t help and on the 3rd day the condition worsened, the diarrhea became very thin and frequent, the temperature was 38 degrees, I started drinking bactisubtil, an infusion of cinquefoil, chamomile and rehydron for dehydration. The next day and until now the temperature is 37 degrees, diarrhea a couple of times a day and bloating. I only eat rice, toast, chicken broth. Tell me what is the treatment and what could it be? In 5 days I was already exhausted.

Answer: See your doctor as soon as possible! You may have dysentery, which requires special treatment with antibiotics. Do not take Loperamide again under any circumstances; it is strictly contraindicated if you suspect an intestinal infection.

Question:For the 5th day now, my son has had loose stools up to 10 times a day, its consistency changes from green with mucus to normal, slightly runny. The process of emptying is painful, the doctor came, prescribed smecta, we have already drank it, we are taking a course of enterofuril, the temperature today rose to 39. They previously diagnosed salmonella. Question - according to the complaints, what does this look like?

Answer: The symptoms you describe are indeed characteristic of intestinal infection(salmonellosis or dysentery). The child should be hospitalized as soon as possible and treated in a hospital setting.

Question:I've had it almost every hour for three days now severe pain in the stomach and diarrhea. I woke up at night from them. This morning I had a slight headache in the temple area, I found the temperature was 37.8, but by 14:00 it had dropped to 36.9. How long will the pain last? Is this serious? How to treat? Should I see a doctor?

Answer: Your condition is indeed very serious. Judging by the description of your symptoms, you may have an intestinal infection (possibly dysentery), which requires immediate treatment. You should call ambulance or consult a doctor as soon as possible. Your headache is most likely caused by severe dehydration. During the entire period of treatment for diarrhea, try to drink as much as possible (at least 2-3 liters mineral water per day).

Question:3 days ago I had diarrhea at night. By the evening of the next day the temperature rose to 37.5. So now the diarrhea, fever, and weakness continue. Sometimes pain in the lower abdomen, rumbling in the intestines. There was no vomiting or nausea. I took charcoal, I think that’s why the stool is dark, green-black. I didn't notice any blood in the stool. Yesterday and today I drank 1 glass of potassium permanganate solution. Help!

Answer: You should consult a doctor as soon as possible, because if you have dysentery (judging by the symptoms, this may indeed be the case), then the situation can be very serious and you need the help of specialists. Before seeing a doctor, try to drink more and continue taking activated charcoal.

Question:Hello. I have a question. My mother got sick at 6 o’clock in the morning, the temperature was 37 and she went to the toilet once an hour with diarrhea, the next day my father got sick, he also had a temperature of 38 and diarrhea, on the 3rd day my sister also got sick - a temperature of 37 and diarrhea, the first day they had weakness. After which I fell ill, early in the morning my temperature was 39.8, I was terrible, and for the second day now I was going to the toilet every half hour. Mucus comes out and it looks like offal, all slightly red in color. My parents and sister began to feel better on the 2nd day, but I’m worried about what’s wrong with me. I called the doctor and told me and my parents to take Furazolidone 4 tablets a day. I ate a lot of different intestinal flora strengthening tablets - no results. How to strengthen my condition, I went 100 times in two days. and gases and mucus, I don’t know what to do. Tell me what can be done, thanks in advance. I am 20 years old.

Answer: The symptoms you describe are characteristic of an intestinal infection (possibly dysentery). You should continue the treatment prescribed by your doctor, and if the diarrhea does not go away within the next 2 days, call your doctor again. The most important point Treatment for you now is to drink frequently and heavily (a cup of water after each urge to go to the toilet), take enterosorbents (for example, Smecta) and an antibiotic. There is no point in taking drugs that restore microflora now. All beneficial bacteria and substances that are in these medications are excreted with diarrhea. It is better to start a course of treatment with these drugs only after the diarrhea ends.

Question:Hello, my wife is 39 weeks old, 4 weeks ago she was in the infectious diseases clinic with vomiting and fever, she was discharged from there 3 days after she got sick, and two days later the tests were ready. Dysentery was diagnosed. The infectious disease doctor at the clinic does not prescribe treatment for her, citing the fact that he does not want to feed her antibiotics and that they will have a harmful effect on the child, but only tests for dysentery every week, and each time it is confirmed. We have an agreement with a doctor in a regular maternity hospital, with whom we would like to give birth, but she is not ready to accept her with dysentery, only if there is written confirmation from an infectious disease specialist that she can give birth in a regular maternity hospital. The doctor in consultation wants to admit her to the infectious diseases clinic. But we don’t want to go there because we don’t know the doctors there or how everything will be. 1) Is there any possibility of giving birth in a regular maternity hospital with the doctor we want? After all, the incubation period of dysentery is 7 days. 2) Is it possible, if an infectious disease specialist prescribes treatment, to recover from dysentery in the time before childbirth. 3) What is the risk of giving birth to a child if the dysentery does not end? 4) Take tests tomorrow, but they will be ready in only 5 days, by that time labor may have already begun, what can you advise? Best regards, Rushan.

Answer: Hello! According to the law, in normal maternity hospital with dysentery they do not have the right to be hospitalized, since there are healthy women there. Dysentery cannot be cured before childbirth, especially since labor can begin at any time, even tomorrow. You have no options; you will have to give birth in an infectious diseases maternity hospital.

Question:My wife was diagnosed with dysentery at 4 weeks of pregnancy! What to do? How to treat?

Answer: Be sure to treat according to the recommendations of an infectious disease specialist and with the choice of the drugs that are safest for the fetus.

Question:three weeks ago I fell ill with SARS. The temperature was under 40. Runny nose and cough. A week later, diarrhea with mucus and blood, that is, no. We spent three days in the infectious disease ward. Now they seem to say that it’s dysentery, but it’s still in question! And in the evening the nurses (having called for an infection) said that there was nothing. And we have diarrhea without blood and the temperature has risen to 38.8. There are a lot of teeth at the top that are ready to come out. Drooling sea (OCEAN). what can you recommend?

Answer: Most likely a real increase in temperature and profuse salivation associated with teething - within 2-3 days the teeth should erupt and the temperature should normalize. If bloody diarrhea occurs again, be sure to tell your doctor.

Thank you

The site provides background 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 is an acute infectious disease 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, but this pathology still poses a danger, as outbreaks of dysentery can occur when personal hygiene is not observed and when 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 ( A spore is a special form of 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. Optimal environment for the existence of Shigella are food products. 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 others 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 the cell wall of 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 affecting the human central nervous system. 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 Shigella released from the intestines of an infected person penetrates the gastrointestinal tract 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 had an acute form of the disease, but can still excrete 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 entering 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 of the disease in in this case are absent, however, 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. Characterized by mild manifestations of general intoxication, favorable course and quick recovery ( which usually occurs within 4 – 6 days).
• Moderate dysentery. 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 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 in severe forms of the disease).

• 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, symptoms of the disease may re-develop.
• 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. Fever persists for several hours or even days, after which it also decreases 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 when a bacterial cell is destroyed), 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 internal organs (including of cardio-vascular 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).

The most pronounced signs of intoxication are 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 parts of the abdomen ( mostly on the left).
• With gastroenterocolitic form- in all parts of the abdomen.
• With gastroenteric form- only in the upper 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 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 transparent mucus, which may be accompanied by streaks of blood ( 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 pronounced 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 in severe cases of the disease, as well as in 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 involves the use of drugs that have a detrimental effect on various forms of amoebas ( quiniophone, dehydroemetine, metronidazole).

Before use, you should consult a specialist.