Treatment regimen for dysentery. Dysentery - diagnosis, treatment, prevention and complications

Dysentery develops as a result of infection of the body by pathogenic bacteria belonging to the genus Shigella. Once inside, the infection affects parts of the lower intestine. Most often the colon is affected.

Pathogens enter the body orally and through contact, through the consumption of contaminated water, dirty vegetables, or through contact with a sick person. People infected with the bacteria are contagious to others from the onset of the disease until two weeks after recovery.

The infection penetrates through the stomach into the small intestine, and toxic substances begin to be released. As a result, the intestinal mucosa becomes inflamed, toxins enter the bloodstream and cause intoxication of the body. Later, bacteria move into the colon, toxin production increases, and symptoms of poisoning increase.

The main causes of dysentery include the following factors:

1. Bacteria entering the mouth through unwashed hands and contaminated objects. This happens more often with young children who like to try everything by tooth.
2. Poorly washed fruits or fresh vegetables before consumption.
3. 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.
4. Contact with a person with dysentery. You can become infected through close contact or while caring for a patient.
5. 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.

Signs of the disease usually begin to appear a couple of days after infection, but symptoms may appear within a period of several hours to 5-6 days.

The following complaints are noted with dysentery:

• temperature increase up to 40 degrees;
• pressure drop;
• attacks of nausea, vomiting, headache;
• feeling of weakness and general malaise;
• expressed painful sensations in the abdomen of an aching or paroxysmal nature;
• frequent bowel movements with liquid stool containing mucus and blood;
• decreased urine output due to dehydration.

Acts of defecation can occur more than 10 times a day, which causes irritation of the anus. In addition, when you urge, the pain becomes more intense.

Forms of development

Dysentery can develop in three forms of disease severity: mild, moderate and severe.

IN early easy stage of the disease, the following signs are noticeable:

1. The temperature rises to 38 degrees and is accompanied by migraines, cold sweat, and general weakness. Symptoms of fever usually subside within 24 hours.
2. The urge to defecate becomes more frequent. Feces change consistency and become semi-liquid.
3. Aching pain occurs in the abdominal area, intensifying before defecation.

Usually such phenomena disappear after two or three days and after three weeks the patient recovers.

Moderate infection is more pronounced. The disease develops rapidly. Within a few hours, with this form, the following complaints are noted:

• The temperature stays at 39 degrees for more than 3 days.
• headaches appear white coating on the tongue.
• the skin turns pale.
• dizziness, a feeling of weakness, and chills are observed.
• the pain becomes paroxysmal.
• the urge to go to the toilet becomes more frequent, but is often ineffective.
• the feces contain mucous impurities with blood streaks.

Unpleasant manifestations persist for about 5 days, and the condition completely normalizes after 5-6 weeks.

The course of severe dysentery is characterized by a febrile state with a temperature of about 40 degrees, the appearance of intense pain in the abdominal area, and migraine. There are attacks of vomiting and a feeling of coldness in the extremities.

The severe form is cured within more than two months, and acute period lasts from 7 to 10 days. A disease lasting more than 3 months is diagnosed as a chronic form of dysentery.

Diagnosis of the disease

When the first symptoms appear, you should immediately contact an infectious disease specialist. After assessing the patient’s complaints and condition, tests are prescribed to detect the infectious agent.

The examination package may include:

• stool coprogram and bacterial examination;
• enzyme immunoassay that determines pathogen antigens;
• clinical blood test;
• examination of the intestine using an endoscope - sigmoidoscopy.

Based on the test results, dysentery is diagnosed and treatment is prescribed. The disease can cause serious consequences, so the disease must be stopped with early stages, preventing the development of a chronic form.

Possible complications

Dysentery is dangerous due to its ability to provoke the development severe complications. This advanced disease can cause the following consequences:

1. The intestinal microflora is disrupted.
2. The appearance of hemorrhoids and cracks in anus. During bowel movements, part of the rectum may even fall out.
3. Under the influence of bacteria, the intestinal walls may be damaged, which leads to bleeding.
4. As a result of intestinal perforation, intestinal contents enter the abdominal cavity and peritonitis develops.
5. Through the thinning wall of the intestine, toxins enter the blood, and severe intoxication of the body occurs, which poses a threat to the patient’s life.
6. The nervous system suffers from poisoning by bacterial toxins. Possible development of heart and kidney failure.
7. Due to prolonged diarrhea, the body becomes dehydrated.

Such consequences are especially dangerous for children. In combination with a weakened body, this can lead to death.

Treatment in hospital

Patients with severe symptoms, severe and moderate forms of the disease are hospitalized in a hospital. In a hospital setting, they are provided with strict bed rest (for patients with severe forms) and dietary nutrition. Patients with moderate illness can walk to the toilet. With a mild form, children and patients with pathologies of the cardiovascular system are admitted to the hospital.

basis drug therapy is the application antibacterial drugs. Treatment of patients with moderate forms of dysentery with antibiotics does not exceed 4 days. For patients with severe forms, the course is extended to 5 days.

At the same time, the water balance in the body is replenished. Patients with mild to moderate dysentery are prescribed plenty of fluids. It could be tea saline solutions or glucose solutions. For severe patients intravenous infusion solutions of hemodez, glucose, albumin.

Therapy also includes:

• preparations containing enzymes, bifidobacteria and lactobacilli;
• antispasmodics for relief pain syndrome;
• vitamin complexes and immunomodulators;
• enterosorbents

A mandatory part of treatment is strict adherence to the diet. Meat, fatty and spicy foods, and dishes made from fresh fruits and vegetables are excluded. Sweet foods, baked goods, carbonated drinks and drinks containing alcohol are also prohibited.

Discharge from the hospital is carried out after 3 days after normalization of symptoms and the absence of infectious agents in the tests.

You can also learn about the symptoms and causes of dysentery from the following video:

Treatment for adults and children at home

If the patient's symptoms and condition do not require hospitalization, then light form Dysentery can be treated at home. Dysentery is an infectious disease, so the use of home remedies should complement those prescribed by a doctor drug treatment rather than replacing it.

You can get rid of diarrhea using a saturated salt solution. Pour salt into a glass of water until it stops dissolving. In the morning before meals, drink 1 tbsp. l. Such over-salted liquid. Do not eat anything all day, but you can drink after two hours. Diarrhea will stop after the first use.

For the same purposes, it will be useful to take half a glass of water with starch mixed in it (1 tsp).

In children, bird cherry fruits will help stop diarrhea. 1 tbsp. l. Infuse dry and fresh berries for half an hour in a glass of boiling water. Give 1 tbsp before meals 5 times a day. l.

Boil about 10 alder cones for half an hour in 200 ml of water. Give the child 1 tbsp of water for 14 days. l. three times a day before meals.

A good remedy for adults would be strong green tea with a large spoonful of honey added to it. You need to drink a glass three times a day for a week.

You can simply chew 0.5 tsp. dry tea, no matter black or green, and wash it down with water. Do this several times a day.

A well-known remedy for diarrhea is congee or boiled rice. It envelops the walls of the stomach and intestines, reduces irritation and has a strengthening effect. The decoction can be drunk half a glass several times a day. Rice is also divided into portions and eaten throughout the day. Do not add salt or oil.

Remove the film from the washed chicken stomach and dry until brittle. Grind the films into powder and take a quarter teaspoon three times a day. You can drink it with water.

Add a spoonful of dry plantain to half a liter of boiling water and leave for two hours. Drink the entire infusion during the day. Repeat treatment for two weeks. This remedy can be used by both adults and children.

Prognosis and prevention

Timely consultation with a doctor and complex therapy provides complete cure dysentery and reduces the likelihood of the disease progressing to chronic stage. Treatment carried out at an early stage of infection protects against complications.

You can prevent infection from entering the body if you adhere to certain preventive measures:

1. Monitor the purity of the water consumed. Do not use water from open reservoirs for these purposes and do not swim in polluted lakes.
2. Tap water and homemade milk must be boiled.
3. Consume only washed fruits, herbs, and vegetables and do not leave ready-made dishes in the open.
4. Eliminate clusters of flies indoors
5. Wash your hands often, especially after using the toilet or working with soil.
6. Avoid contact with infected people.

After completing the course of treatment, you should not forget that the likelihood of infecting others will continue for about two weeks after recovery.

Conclusion

Dysentery is an unpleasant and dangerous disease, and often people expose themselves to the risk of infection by ignoring well-known methods of protecting themselves from infection. Having discovered the first symptoms of the disease, they self-medicate, causing complications, chronic infection and infecting others.

Meanwhile, modern medicine allows us to minimize the occurrence of dangerous consequences and cure the disease in a short time. Even a mild course of the disease should occur with strict adherence to medical recommendations. Any treatment at home must be previously agreed with the doctor.

We bring to your attention a video describing folk remedies for treating dysentery at home:

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Treatment of dysentery. Dysentery is an infectious disease that leads to fever, stool upset, abdominal discomfort, dizziness, and general malaise. The causative agent of dysentery is Shigella, a dysentery bacillus. It can enter the human body through unwashed hands, contaminated food or water. Diagnosis of dysentery is based on examination of the patient and laboratory tests.

Nature, development and spread of dysentery

The causative agent of dysentery is the dysentery bacillus - Shigella, named after the researcher who isolated it in pure culture. There are several variants of Shigella, but in the European territory of our country two species predominate - Flexner and Sonne, and in the southern regions - only Flexner.

Shigella is characterized by pronounced variability, resulting in variants that are resistant to antibiotics. Shigella enters the child's body through the mouth through infected water, food or dirty hands, passes through the entire gastrointestinal tract and is fixed on the mucous membrane of its distal sections (usually in the sigmoid colon).

There Shigella multiply and secrete a toxin that affects all tissues, but primarily nerve cells and fibers. All subsequent disorders in the body are associated with the action of the toxin. In the final section of the large intestine, inflammation first occurs, then ulcers form, then the stage of their healing and removal of Shigella from the body begins.

The source of infection is a patient with acute or chronic dysentery and a bacteria carrier. As with all intestinal infections, the transmission mechanism is fecal-oral. Shigella can be spread by contaminated water, contaminated food, great importance have flies that are capable of carrying a large number of microorganisms on their legs.

Old doctors called dysentery “the disease of dirty hands,” which is absolutely true. Moreover, this route of transmission is typical for children younger age, and in older children the food route of infection is more common (in Lately There are often cases of infection when eating sour cream).

There was a significant increase in the incidence of dysentery in July - October, with the maximum incidence occurring in July - August. In infants, the peak is shifted by about a month, and the maximum cases of dysentery among them occur in September. Isolated cases can be observed year-round.

Causes of dysentery

Dysentery is transmitted only from humans through food, water contaminated with feces, and also by contact.

Treatment of dysentery. The source of the causative agent of infection in dysentery is patients, as well as bacteria carriers who release Shigella into the external environment with feces. Patients with dysentery are contagious from the onset of the disease. The duration of isolation of the pathogen by patients, as a rule, does not exceed a week, but can last up to 2-3 weeks. The greatest sensitivity to infection is in people with blood group A (II).

The leading factor in the development of the disease is the entry of bacterial poisons into the blood. The nervous system, as well as the cardiovascular system, adrenal glands and digestive organs are primarily affected.

Shigella can remain in the stomach from several hours to several days (in rare cases). Having overcome the acid barrier of the stomach, Shigella enters the intestines. In the small intestine, they attach to intestinal cells and release a toxin that causes increased secretion of fluid and salts into the intestinal lumen.

Shigella actively moves, causing an inflammatory process in the small intestine, which is maintained and aggravated by the action of the toxin produced by Shigella. Shigella toxin enters the bloodstream and causes the development of intoxication.

Shigella enters the large intestine somewhat later, but in large numbers. This leads to greater exposure to toxins.

Treatment of dysentery. Recovery from dysentery is usually accompanied by the body being freed from the pathogen. However, if there is insufficiency immune system cleansing the body of the pathogen takes up to 1 month or more. A carrier state is formed, and in some of those who have recovered, the disease becomes chronic.

After an illness, short-term immunity is formed.

The incubation period is 1-7 (on average 2-3) days, but can be reduced to 2-12 hours.

The form, variant and severity of dysentery depend on the routes and methods of infection, the number of microbes that have entered the body, and the level of the body's immunity.

Manifestations of dysentery

The disease begins quickly. At the beginning, a syndrome of general intoxication develops, characterized by an increase in body temperature, chills, a feeling of heat, weakness, loss of appetite, headache, and a decrease in blood pressure.

Damage to the gastrointestinal tract is manifested by abdominal pain, initially dull, spread throughout the abdomen, and of a constant nature. Then they become more acute, cramping, and are localized in the lower abdomen, often on the left. The pain usually intensifies before bowel movement.

Mild form of dysentery

Treatment of dysentery. In mild cases of the disease, the fever is short-lived, from several hours to 1-2 days; body temperature, as a rule, rises to 38°C.

Patients are bothered by moderate abdominal pain, mainly before bowel movement.

The stool has a pasty or semi-liquid consistency, the frequency of bowel movements is up to 10 times a day, the admixture of mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs in 2-3 weeks.

Moderate form

The onset of this form of dysentery is rapid. Body temperature with chills rises to 38~39°C and remains at this level from several hours to 2-4 days.

Patients are concerned about general weakness, headache, dizziness, and lack of appetite. Intestinal disorders, as a rule, join in the next 2-3 hours from the onset of the disease.

Patients experience periodic cramping pain in the lower abdomen, frequent false urge to defecate, and a feeling of incomplete defecation. The frequency of stool reaches 10-20 times a day. The stool is scanty and often consists of mucus streaked with blood.

Present increased irritability, pale skin. The tongue is covered with a thick white coating and is dry. Intoxication and diarrhea last from 2 to 4-5 days. Complete healing of the intestinal mucosa and normalization of all body functions occurs no earlier than 1-1.5 months.

Severe form

Treatment of dysentery. Severe dysentery is characterized by a very rapid development of the disease, pronounced intoxication, and profound impairment of the cardiovascular system.

The disease begins extremely quickly. Body temperature with chills quickly rises to 40°C and above, patients complain of severe headache, severe general weakness, increased chilliness, especially in the extremities, dizziness when getting out of bed, complete absence appetite.

Nausea, vomiting, and hiccups often occur. Patients are bothered by abdominal pain accompanied by frequent urges for defecation and urination. Stool more than 20 times a day, often the number of bowel movements is difficult to count (“stool without counting”). The peak period of the disease lasts 5-10 days. Recovery occurs slowly, up to 3-4 weeks; complete normalization of the intestinal mucosa occurs after 2 months or more.

Dysentery stool

Treatment of dysentery. Characteristic feature dysentery is stool with a bloody and mucous component. The vital activity of shiggel bacteria entering the gastrointestinal tract is accompanied by disruptions and anatomical lesions of the intestines, leading to the appearance of bloody impurities in the patient’s stool. The bacteria then decompose, releasing toxic substances.

Different strains of shiggel have different degrees of toxin production. At the same time, the goblet cells of the intestinal mucosa begin to intensively secrete mucus in order to thus protect it from irritating factors. This process is regulated by the nervous system, therefore, the stronger the intoxication, the more pathological mucous impurities in the stool of the infected person.

The amount of blood in the patient’s stool varies and depends on the general condition of the infected person, the form, severity and stage of dysentery. Depending on the above factors, the stool may have a liquid (acute form) or semi-liquid consistency with blood streaks. It may have the character of rectal spitting and resemble a smear of purulent, thick, cloudy mucus.

In severe cases of the disease (continuous form of dysentery), mucous exudate with copious amounts of blood is released, so stool without feces resembles a bloody mess.

The patient's stool contains millions of bacteria, so the infected person is a “reservoir of Shigella” and a potential spreader of the bacilli. It does not matter in what form and severity the disease occurs.

Chronic dysentery in this sense poses a great danger because it is long-lasting. In addition, during asymptomatic periods, the patient continues to visit public places and, perhaps without knowing it, spreads the infection.

It should be understood that even such seemingly harmless intestinal dysfunction as diarrhea can pose a serious threat to health and cause serious consequences.

Diagnosis of dysentery

The diagnosis is based on the results of examination of the patient. Examination of stool is of great diagnostic importance, during which an admixture of mucus streaked with blood can be detected.

Treatment of dysentery. Laboratory confirmation of dysentery is carried out by bacteriological and serological methods. The bacteriological method (seeding Shigella from feces) with a 3-fold study provides confirmation of the diagnosis in 40-60% of patients.

Accelerated diagnosis of acute intestinal diarrheal infections can be carried out by detecting pathogen antigens and their toxins in biosubstrates - saliva, urine, feces, blood.

For this purpose, immunological methods are used that have high sensitivity and specificity: enzyme-linked immunosorbent assay (ELISA), latex agglutination reaction (RAL), coagglutination reaction (PCA), immunofluorescence (RIF), polymerase chain reaction (PCR).

Medicines

Antibacterial drugs are mainly used to treat dysentery, since the disease is caused by bacteriological infection. Medicines include:

• chloramphenicol;
• nitrofuran derivatives; sulfonamides;
• fluoroquinolones;
• aminoglycosides.

If the patient is severely dehydrated, he is prescribed drips with saline and colloid solutions.
Treatment of dysentery. After the source of the disease is eliminated, the patient can take drugs to restore intestinal microflora, vitamins, immunomodulators and others. And to quickly restore the damaged intestinal mucosa, you can use:

• sea ​​buckthorn oil;
• microenemas with fish oil;
• suppositories with methyluracil.

Folk remedies

Folk remedies are not often used to treat dysentery, since treatment in a hospital is much more reliable. However, when treating a mild form of infection, it is fashionable to use the following techniques.

Black bread with vodka, toasted until charcoal, is mixed with vodka or dry red wine. The resulting drink is drunk immediately after preparation.

If the body is dehydrated, you can use a saline solution for oral use. For a liter of boiled water you will need two tablespoons of sugar and a tablespoon of salt. All components are mixed and drunk by a person throughout the day.

You can take a teaspoon of burdock juice three times a day. This remedy helps treat dysentery.

Blackberry decoction also helps against illness. The berries are boiled, and the resulting liquid is decanted and drunk as tea throughout the day.

Some people use potato starch to combat illness. 50 g of starch are diluted in half a liter of cool water. The liquid is drunk completely at one time.

Medicinal herbs

You can use medicinal herbs to treat dysentery only after consulting a doctor.
Horse sorrel is often used to treat intestines. The dry plant is poured with boiling water and this drink is used as tea. It helps relieve intestinal inflammation.
A mixture of:

• oak bark;
• St. John's wort;
• chamomile;
• knotweed.

All herbs should be taken in the same volume. A spoonful of the mixture must be filled with a liter of boiling water. The infusion is cooled and taken throughout the day.

A collection of wild rosemary and marshmallow is also used. 10 g of wild rosemary flowers are mixed with 25 g of marshmallow roots. The mixture is poured with a liter of boiling water and left for an hour. The resulting drink is taken one spoonful every two hours.

How to distinguish the symptoms of dysentery from other stomach disorders

Treatment of dysentery. Dysentery must be distinguished from other intestinal infections or non-infectious intestinal diseases, such as:

Amoebiasis

The symptoms of amebiasis differ from infectious dysentery by a characteristic chronic process without a noticeable change in temperature. Defecation retains the appearance of feces, but blood and mucus are evenly mixed, in which amoebas, the causative agents of the disease, are found.

Toxic infections in products, salmonellosis

These diseases begin with frequent vomiting, chills, pain in the pit of the stomach. Food poisoning does not affect the colon, and therefore there is no spastic pain in the left iliac region, and there is no false urge to have a bowel movement.

With salmonellosis, feces have a greenish tint or, as they say, look like swamp mud.

Typhoid fever

The course of the disease is characterized by spastic colitis, sometimes the colon may be affected, an increase in temperature for a long period of time and a roseola rash.

Cholera

The disease occurs in the absence of symptoms of spastic colitis. Cholera manifests itself at the initial stage with severe vomiting, diarrhea, feces look like rice water, and is also absent heat body, false urge to defecate and pain in the abdomen.

However, cholera is characterized by a rapid increase in symptoms of dehydration, which can subsequently lead to a serious condition in the patient's body.

Colitis

This is a disease of non-infectious origin.

Colitis occurs due to chemical intoxication, and this poisoning also accompanies diseases such as cholecystitis, hypoacid gastritis, pathology of the small intestine, and uremia.

This colitis does not depend on the season, is associated with dysfunction of the gastrointestinal tract and is not a contagious disease.

Colon cancer

Rectal cancer is characterized by symptoms of poisoning at the stage of tumor disintegration and excretion of feces with blood. Does not manifest itself in oncological diseases sharp character course, but there are metastases in individual organs or lymph nodes.

Haemorrhoids

The disease is especially noticeable due to bloody feces, without inflammation in the colon. With hemorrhoids, at the end of the bowel movement, blood is mixed into the stool.

Treatment of dysentery

Treatment of patients with dysentery should be comprehensive and strictly individualized. Bed rest is usually necessary only for patients with severe forms of the disease. Patients with moderate forms are allowed to go to the toilet. Lung patients Forms prescribe ward regime and physical therapy.

One of the most important components in the complex therapy of intestinal patients is therapeutic nutrition. In the acute period, with significant intestinal disorders, table No. 4 is prescribed; with improvement of condition, decrease in intestinal dysfunction and appearance of appetite, patients are transferred to table No. 2, and 2-3 days before discharge from the hospital - to the general table.

It is necessary to prescribe an antibacterial drug to a patient taking into account information about the “territorial landscape of drug resistance”, i.e. sensitivity to it of Shigella isolated from patients in the area recently. Combinations of two or more antibiotics (chemo drugs) are prescribed only in severe cases.

Treatment of dysentery. The duration of the course of treatment for dysentery is determined by the improvement of the patient's condition, normalization of body temperature, and reduction of intestinal disorders.

For moderate forms of dysentery, the course of therapy can be limited to 3-4 days, for severe ones - 4-5 days. Persisting during the early period recovery easy intestinal dysfunction (mushy stool up to 2-3 times a day, moderate flatulence) should not be a reason to continue antibacterial treatment.

Patients with mild dysentery at the height of the disease, which occurs with an admixture of mucus and blood in the stool, are prescribed one of the following drugs:

• nitrofurans (furazolidone, furadonin 0.1 g 4 times a day,
• ersefuril (nifuroxazide) 0.2 g 4 times a day),
• cotrimoxazole 2 tablets 2 times a day,
• hydroxyquinolines (nitroxoline 0.1 g 4 times a day, intetrix 1-2 tablets 3 times a day).

For moderate dysentery, drugs from the fluoroquinolone group are prescribed:

• ofloxacin 0.2 g 2 times a day or ciprofloxacin 0.25 g 2 times a day;
• cotrimoxazole 2 tablets 2 times a day;
• intetrix 2 tablets 3 times a day.

For severe dysentery, it is prescribed

• ofloxacin 0.4 g 2 times a day or ciprofloxacin 0.5 g 2 times a day;
• fluoroquinolones in combination with aminoglycosides;
• aminoglycosides in combination with cephalosporins.

For Flexner and Sonne dysentery, a polyvalent dysentery bacteriophage is prescribed. The drug is available in liquid form and in acid-resistant tablets. Take 30-40 ml orally 3 times a day 1 hour before meals or 2-3 tablets 3 times a day.

In case of mild dysentery, compensation for fluid losses is carried out using one of the ready-made formulations (citroglucosalan, rehydron, gastrolit, etc.). These solutions are given to drink in small portions. The amount of liquid drunk should be 1.5 times greater than lost through feces and urine.

Treatment of dysentery. In case of severe intoxication, intravenous drip infusion of 10% albumin solution, hemodez and other crystalloid solutions (Trisol, Laktasol, Acesol, Chlosol), 5-10% glucose solution with insulin is indicated. In most cases, it is enough to administer 1000-1500 ml of one or two of these solutions to achieve a significant improvement in the patient's condition.

To bind and remove toxin from the intestines, one of the enterosorbents is prescribed - Polyphepan 1 tablespoon 3 times a day, activated carbon 15-20 g 3 times a day, enterodesis 5 g 3 times a day, Polysorb MP 3 g 3 times per day, smecta 1 sachet 3 times a day or others.

To bind and remove toxin from the intestines, one of the enterosorbents is prescribed - Polyphepan, 1 tablespoon 3 times a day

To neutralize toxins, enzyme preparations are used: pancreatin, panzinorm in combination with calcium preparations.

In the acute period of diarrhea, to eliminate spasm of the colon, the use of:

• drotaverine hydrochloride (no-spa) 0.04 g 3 times a day,
• papaverine hydrochloride 0.02 g 3 times a day.

In case of significant pain syndrome, no-shpa is prescribed 2 ml of a 2% solution intramuscularly or 1-2 ml of a 0.2% solution of platyphylline hydrotartrate subcutaneously.

During the entire period of treatment, patients are prescribed a complex of vitamins.

In order to correct the intestinal biocenosis, biosporin, bactisporin, bactisubtil, flonivin-BS are prescribed, 2 doses 2 times a day for 5-7 days. When choosing a drug, preference should be given to modern complex drugs - Linex, Bifidumbacterin-Forte, Vitaflor, etc. The drugs are prescribed in a standard dosage.

Treatment of dysentery. If tolerated well, during the recovery period fermented milk therapeutic and dietary bifido- and lactose-containing products are indicated, which have high therapeutic effectiveness.

Treatment of patients with chronic dysentery (recurrent and continuous) is carried out in an infectious diseases hospital. Treatment includes:

• fluoroquinolones ciprofloxacin 0.5 g 2 times a day or ofloxacin 0.2 g 2 times a day for 7 days;
• immunotherapy depending on the state of immunity - thymalin, thymogen, levamisole, dibazole, etc.;
• panzinorm, festal, pancreatin, pepsin, etc.;
• increased daily doses of vitamins;
• treatment of concomitant diseases, helminthic and protozoal intestinal invasions;
• to restore the intestinal biocenosis, biosporin, bactisporin, linex, bifidumbacterin-forte, vitaflor, lactobacterin are prescribed; These drugs are prescribed in a standard dosage for 2 weeks after etiotropic therapy simultaneously with pathogenetic agents.

The prognosis for the treatment of patients with dysentery is usually favorable.

Prevention of dysentery in adults

Treatment of dysentery. Those who have recovered from acute dysentery are discharged from the hospital no earlier than 3 days after clinical recovery (normalization of body temperature, stool, disappearance of signs of intoxication, abdominal pain, spasms and soreness of the intestines), in the absence of pathological changes in laboratory tests. Chemoprophylaxis is not carried out for persons in contact with the patient.

Dysentery (shigellosis) is an infectious disease, the development of which affects the gastrointestinal tract, namely the colon. The reason for this is the effect on the body of bacteria of the genus Shigella, which, under favorable conditions, actively multiply in food products (this can be vinaigrette, salads, boiled meat, minced meat, fish, dairy products, compote, jelly, etc.). How to treat dysentery is determined depending on the severity of the pathology. The therapy is based on a special diet.

Features of treatment

Sometimes it happens that a person is misdiagnosed and a disease such as amoebiasis is confused with ordinary dysentery. It is immediately worth noting that this is completely various pathologies: the first occurs with damage to the proximal parts of the intestine, and the second - with damage to the distal parts of the colon. Another difference is the localization of pain: with dysentery it is left side abdomen, and with amoebiasis - right part. In addition, amoebic dysentery and ordinary dysentery are caused by different pathogens.

Treatment of shigellosis is determined strictly on an individual basis. If the disease is severe, the patient will need to adhere to bed rest, and if it is mild, then physical therapy and ward rest will be required.

The nutrition of a patient with dysentery plays an important role in the treatment of the disease. In case of acute pathology and significant suppression of intestinal activity, a person is prescribed table No. 4. If the general condition improves and stabilizes (the appearance of a healthy appetite, a decrease in gastrointestinal dysfunction), the patient is transferred to table No. 2.

In combination with the diet, you will need to take medications. First of all, these are antibiotics, which are selected strictly on an individual basis, taking into account the sensitivity of bacteria to the product. Combination therapy Antibacterial drugs are prescribed extremely rarely and only in severe cases.

Diet

By adhering to proper nutrition, you can speed up the elimination of toxic substances from the body, improve the condition of the immune system, and restore water-salt balance. If you choose the right diet, you can short time overcome bacterial infection, reduce intoxication syndrome, prevent chronic inflammatory process.

Nutritional treatment must be complete.

During the development of dysentery, the body must receive a sufficient amount nutrients, vitamins and microelements. You cannot withstand a long fasting pause and a long strict diet.

For adults

If the pathology is severe and vomiting is present, on the first day only slightly sweetened strong tea, still mineral water, and rice water are allowed. If there is no vomiting, fasting is not necessary. On the second day, mucous soups in weak broth are included in the diet, adding semolina or rolled oats, rice. You can already eat grated raw or baked apples and rosehip decoction.

An excellent fixing agent is rice water.

As soon as the symptoms of general intoxication began to decline in intensity and the general condition improved, the person was transferred to table No. 4. The total daily calories should be 2100 kcal. It is also important to regulate your water diet: the amount of liquid you drink per day should not be less than 1 liter, but not more than 2 liters. Meals should be fractional: better in small portions, but often.

Allowed to use following products:

• meat and fish broth (low-fat), with the addition of meatballs or grated meat/fish;
• cereals boiled in water (rice, buckwheat, oatmeal, semolina) or steamed;
• meat cutlets prepared from rabbit, beef, chicken, turkey or fish (cod, pike, pike perch, carp are allowed);
• steamed omelette or soft-boiled eggs;
• wheat crackers;
• butter;
• jelly and jelly;
• sugar (no more than 40 g per day);
• fresh cottage cheese and stale kefir.

It is gradually necessary to increase the calorie content of food, but still exclude the use of spicy, smoked, fried, preserved and seasonings.

For children

The diet for dysentery in a child is practically no different from that prescribed for adult patients. You should not force your child to eat. When the body is ready to digest food, it will ask for food. Even with a noticeable improvement in the general condition, you should not immediately transfer the child to a common table. For the period prescribed by the doctor, he will need to adhere to a gentle diet with the exception of milk, legumes, beets, cucumbers, cabbage, and black bread.

IN mandatory It is necessary to stop eating fatty, fried and sweet foods. This also includes fast food. Drinking should be plentiful, but not including sparkling water and drinks, natural juices. The use of compotes, fruit drinks, mineral water.

Medications

The only and most effective treatment for shigellosis is based on taking antibacterial drugs. Unfortunately, these are not always useful. In some cases, they can worsen a person’s general condition, causing dysbacteriosis. It is for this reason that only a specialist should select antibiotics, taking into account the characteristics of the development of the disease and the level of sensitivity of bacteria to to a certain means.

Doxycycline is considered one of the most effective drugs for dysentery.

In addition to antibiotic therapy, other medications may be prescribed to help restore microflora in the intestinal environment, as well as those that alleviate the unpleasant symptoms of the disease.

Antibiotics

These will help in a short time to eliminate the source of the disease, that is, dysentery bacteria (Shigella). This could be a product such as Furazolidone, released in tablet form. In a small dosage, the medicine will have a bacteriostatic effect, that is, inhibit the proliferation of bacteria, and in an increased dosage, it will cause the death of pathogenic microorganisms.

Another antibiotic used in the treatment of dysentery is Nalidixic acid, which is a synthetic drug. It is highly effective against gram-negative bacteria and dysentery bacteria. Just like Furazolidone, the acid has different actions, taking into account the dosage of the drug. The antibiotic is well absorbed from the gastrointestinal tract and is excreted from the body in the urine.

Antibiotics belonging to the tetracycline group are often prescribed, which are effective against both gram-negative and gram-positive bacteria. Such agents have a detrimental effect on bacteria that have high sensitivity to penicillin and erythromycin. In the treatment of shigellosis, the drug Doxycycline is usually used.

Additional funds

If shigellosis develops in an acute form, antibiotics alone will not help cure the disease. An addition to the main course will be the prescription of drugs that help remove toxic substances from the bloodstream and intestines. It can be:

• enterosorbents that quickly remove waste products of pathogenic microorganisms (for example, Atoxil or Enterosgel);
• saline solutions and agents with glucose that enhance renal filtration, normalize the intravascular system, and help eliminate signs of dehydration (for example, Regidron);
• colloidal solutions, which are intended for intravenous injection and help speed up the detoxification process (do not use for symptoms of dehydration).

The medicine Atoxil will help remove toxic substances from the body.

To increase functional abilities immune system, especially if dysentery is prolonged and acute course, requires taking appropriate medications. First of all, these are immunomodulatory drugs, with the help of which you can increase the body’s protective function and thereby speed up recovery. To restore the intestinal microflora after long-term use of antibiotics, the doctor prescribes probiotic substances, and to normalize digestive system and improve the absorption of probiotics by the gastrointestinal tract, enzyme preparations.

Folk remedies

You can prepare infusions from the following components:

• wild rosemary, marshmallow roots, oregano (the herbs are mixed in equal volume, take 20 g of raw materials, pour 250 ml hot water and leave to infuse for an hour; take the finished product orally, 25 ml with each meal);
• blueberries (dried berries in a volume of 250 g are poured with a liter of boiling water and left to infuse for 2 hours; the finished product should be consumed orally, 50 g three times a day);
• plantain, knotweed, marshmallow root (the ingredients are mixed in equal volumes and poured with boiling water at a ratio of 1:2; after infusing for an hour, the product is consumed orally, half a glass three times a day before meals).

Burdock juice, taken orally 1 tsp, is effective in the treatment of dysentery. three or four times a day before meals. To reduce the severity unpleasant symptoms, use propolis, or rather, its alcohol extract. The product can be purchased at a pharmacy. Prepare and use it like this: 1 tsp. diluted in 450 ml of water and taken orally half a glass at a time three times a day.

If the patient is not allergic to bee products, you can eat small amounts of natural honey throughout the day. This remedy helps speed up the removal of pathogenic bacteria from the body along with feces.

Of course, you can use it at home folk remedies, but only in combination with the main treatment prescribed by a specialist. Only in this case ethnoscience will be effective and will help achieve a speedy recovery.

Dysentery: symptoms in adults, treatment and prevention

Dysentery is an acute bacterial intestinal infection characterized by primary damage to the mucous membrane of the large intestine.

The causative agents of the disease are bacteria of the genus Shigella, immobile gram-negative rods that do not form spores, reproduce well in nutrient media, but are extremely resistant to external factors. In particular, Shigella die instantly when boiled, and within 10 minutes at temperatures exceeding 60 degrees.

The main source of the disease is an asymptomatic carrier or a sick person. A particular epidemiological danger is posed by patients with erased or mild forms of dysentery, as well as people employed in public catering establishments and food industry enterprises.

What it is?

Dysentery is infectious disease general, which is caused by dysentery bacteria.

The most common cause of the disease is 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.

How the disease develops

With dysentery, the lower part of the large intestine is damaged - the sigmoid and rectum and its sphincter.

1. With food, water or through household items, Shigella first enters the stomach, where it remains for several hours (rarely days). Some of them die. This releases endotoxins.
2. Next, the pathogens enter small intestine, where they adhere to enterocytes and release an enterotoxic exotoxin, under the influence of which fluid and electrolytes are intensively secreted into the intestinal lumen.
3. Shigella hemolysin, found in their outer membrane, promotes the penetration of pathogens into epithelial cells (mainly the ileum), where they begin to multiply intensively. Enterocytes are damaged. Inflammation of the intestinal wall develops. Immune complexes, which include endotoxin, increase damage to the intestinal wall. They become fixed in the capillaries of the colon mucosa and disrupt microcirculation.
4. Sensitized eosinophils and mast cells begin to secrete toxic substances. The cytotoxic effect of leukocytes is enhanced. All this contributes to the development of DIC syndrome from the 2nd week from the onset of the disease. Thrombosis of mesenteric vessels develops, including those of the lungs and brain.
5. Intoxication of the body is caused by the entry of endotoxin from dead Shigella into the patient’s blood. When bacteria enter the blood, bacteremia develops.

Shigella toxins affect the central and vegetative nervous system, cardiovascular and digestive systems, adrenal glands. In the chronic course of dysentery, it is not intoxication that comes to the fore, but disruption of the gastrointestinal tract.

When cured, the body is completely freed from infection. If the immune system is not functioning properly, recovery may take up to one month or more. Some patients become carriers of the infection. In some patients the disease becomes chronic.

The causative agent of dysentery

The causative agent of shigellosis is a bacterium - a non-motile bacillus of the genus Shigella. There are 4 types of this bacterium, each of which is capable of causing dysentery in humans: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

A special feature of Shigella is its ability to quickly acquire resistance to antibacterial drugs. Bacteria resistant to traditional treatment are becoming increasingly common. In addition, the bacteria are extremely resistant to external environment– under favorable conditions, they can retain their pathogenic properties for up to several months, including in food products.

Shigella have a number of properties that make them pathogenic for humans, i.e. ability to cause disease.

The mechanism of infection for dysentery is fecal-oral, i.e. bacteria from the intestines of a sick person enters the gastrointestinal tract healthy person.

There are several routes of transmission of the pathogen. This is a contact and household route - through unwashed hands and failure to comply with personal hygiene rules; food – when bacteria get into food; and also water - when drinking infected water. In addition, infection is possible by swimming in polluted waters.

Symptoms of dysentery

The first symptoms of dysentery begin to appear 2-3 days after infection; with the food route, this time can be reduced to hours; with contact and household routes, it can extend up to 7 days. In most cases, the disease begins acutely; sometimes there may be a prodrome in the form of malaise, chills or headache. Based on the degree of severity, there are mild, moderate, severe and very severe forms.

The most characteristic signs of the disease in the variant of dysentery affecting the large intestine.

The disease, as a rule, begins with the appearance of abdominal pain, followed by stool disorder. Dysentery can begin with general manifestations - weakness, lethargy, fever, headache, etc. The manifestations of the disease reach their greatest severity on the 2-3rd day of the disease. This form of dysentery is characterized by a predominance of local phenomena.

The most complete signs of dysentery are presented in the moderate form of the disease. Characterized by an acute onset, increased temperature with chills (up to 38-39 ° C), which lasts 2-3 days. Worried about weakness, headache, loss of appetite. Intestinal disorders occur in the first 2-3 hours from the onset of the disease and are manifested by discomfort in the lower abdomen, rumbling, periodic, cramping pain in the lower abdomen, the frequency of stool varies from 10 to 20 times a day. The stool initially has a fecal character, then an admixture of mucus, blood and pus appears, the volume of feces decreases, they can take on the appearance of spit - mucus and blood.

There is an acute urge to defecate. The skin becomes pale, the tongue becomes covered with a thick brown coating. From the cardiovascular system, rapid heartbeat and decreased blood pressure are noted. The most characteristic features are spasm and pain when palpating the left iliac region.

The duration of intoxication for moderate forms of dysentery is 4-5 days. The stool returns to normal by the 8-10th day of illness, but the disease can drag on for up to 3-4 weeks.

Severe form

Severe dysentery is characterized by a very rapid development of the disease, pronounced intoxication, and profound impairment of the cardiovascular system.

The disease begins extremely quickly. Body temperature with chills quickly rises to 40°C and above, patients complain of severe headache, severe general weakness, increased chilliness, especially in the extremities, dizziness when getting out of bed, and a complete lack of appetite.

Nausea, vomiting, and hiccups often occur. Patients are bothered by abdominal pain, accompanied by a frequent urge to defecate and urinate. Stool more than 20 times a day, often the number of bowel movements is difficult to count (“stool without counting”). The peak period of the disease lasts 5-10 days. Recovery occurs slowly, up to 3-4 weeks; complete normalization of the intestinal mucosa occurs after 2 months or more.

The diagnosis of chronic dysentery is established if the disease lasts more than 3 months.

Moderate form

Elevated body temperature (up to 39 ° C) is accompanied by chills and can last from several hours to 4 days. Symptoms of intoxication are pronounced. The frequency of stools reaches 20 times a day. The stool is streaked with blood and mucus. The pain in the lower abdomen is cramping.

Symptoms of damage to the cardiovascular system are recorded: small pulse, tachycardia, systolic pressure drops to 100 mm. rt. Art., heart sounds are muffled. The tongue is dry, thickly coated with white coating. During sigmoidoscopy, catarrhal-erosive changes are recorded. Multiple hemorrhages and often ulcerative defects are visible. The level of neutrophil leukocytes in the blood increases to 109/l. The symptoms of intoxication and diarrhea last 2 - 5 days. Restoration of the mucous membrane and normalization of the body's functioning occurs after 1 - 1.5 months.

Mild form of dysentery

In mild cases of the disease, the fever is short-lived, from several hours to 1-2 days; body temperature, as a rule, rises to 38°C. Patients are bothered by moderate abdominal pain, mainly before bowel movement.

The stool has a pasty or semi-liquid consistency, the frequency of bowel movements is up to 10 times a day, the admixture of mucus and blood is not visible. Intoxication and diarrhea persist for 1-3 days. Full recovery occurs in 2-3 weeks.

Shigella bacteria carriage

If a patient in the recovery stage produces Shigella for 3 months, then they speak of convalescent carriage of the bacteria. If a practically healthy person who has never had dysentery and has not had intestinal dysfunction over the past three months has had a single release of Shigella bacteria, then they speak of transient bacterial carriage.

Diagnostics

To diagnose dysentery in a patient, the laboratory performs bacteriological culture feces 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 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.

Differential diagnosis

1. Salmonellosis. With salmonellosis, the feces have a shade of swamp mud, light or dark greenish in color.
2. Food poisoning. In this condition, there is no severe cramping pain in the iliac peritoneum due to the absence of damage to the large intestine. There is also no urge to defecate.
3. Cholera. The disease is not accompanied by pronounced signs of colitis and begins with severe diarrhea, vomiting, and the color of the stool resembles rice water. There are no false urges to defecate.
4. Amoebiasis. The disease is not accompanied by an increase in body temperature or febrile syndrome. Feces include blood and mucous components that resemble raspberry-colored jelly. The main pathogen is amoeba.
5. Intestinal colitis. If colitis is of a non-infectious nature, then it often occurs due to toxic lesions of the body in uremic syndrome, with pathological development small intestine, cholecystitis, gastritis of various nature. Typically, the disease does not have seasonality or special antecedent factors against the background of the patient’s general health.
6. Typhoid fever. The disease has no signs of specific colitis, but a pink rash appears, severe hyperthermia, and the cavity of the large intestine is affected.
7. Oncogenic formations. Colon cancer is accompanied by severe bloody diarrhea. The character of the stool is regular. There are symptoms of general intoxication, but the rapid nature of the disease, as with dysentery, is absent.
8. Haemorrhoids. With inflammation of the hemorrhoids, as well as with advanced hemorrhoids after defecation, the appearance of bloody spots in the stool can be noted. The disease occurs without pronounced inflammatory foci in the rectum.

Timely identification of dysentery and the type of its causative agent allows you to draw up the necessary treatment plan, speed up the patient’s recovery, and eliminate the risks of complications of the disease.

Complications

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, persistent long time after healing.

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 such a critical condition ends in death.

Treatment of dysentery

Adult patients can be treated both in a hospital and at home, depending on the severity infectious process, age and condition of the patient, or if it is impossible to treat and care for the patient at home.

The main treatment for dysentery is to prescribe the following drugs:

1. When choosing antimicrobial agents: mild forms are treated with furazolidone, moderate and severe forms are preferable to fluoroquinolones or cephalosporins, aminoglycosides (kanamycin).
2. From the very first days of illness, children should be given glucose-salt and saline solutions - Glucosolan, Oralit, Regidron. One sachet medicinal product should be diluted in a liter of water and given to the child every 5 minutes. The daily dose should be 110 ml per 1 kilogram of the child’s weight.
3. Eubiotics - Bifidobacterin, Baktisubtil, Bifiform, Rioflora immuno, Bifikol, Primadofilus, Lactobacterin, Linex, etc. Since antibacterial drugs aggravate the symptoms of intestinal dysbiosis, eubiotics are necessarily indicated, which are prescribed in a course of at least 3-4 weeks (see the entire list of Linex analogues) .
4. According to indications, the doctor may prescribe immunomodulators, vitamins, as well as astringents and antispasmodics.
5. After suffering an acute process, to speed up the recovery of the body, it is recommended to use microenemas with herbal decoctions, rosehip and sea buckthorn oils, infusions of chamomile, eucalyptus, and vinyl.
6. Adsorbents, enterosorbents - Smecta, Polyphepan, Polysorb, Filtrum STI (instructions for use), activated carbon, etc.
7. Enzyme complex preparations - Festal, Creon, Panzinorm, Mezim.
8. In chronic dysentery, treatment with antibiotics is less effective, so physiotherapeutic treatment, eubiotics, and therapeutic microenemas are prescribed.

A gentle diet is also prescribed - mashed potatoes, rice porridge without salt and rice water, slimy soup.

Neither an adult nor a child should be force-fed; the main condition is a sufficient amount of liquid. You can drink whey, water, weak, unsweetened tea. Cheeses, sausages, smoked meats, prepared foods, semi-finished products, coffee, sugar, meat, and baked goods should be excluded from the diet. Only on day 5 you can gradually add kefir, omelettes, meatballs, and boiled fish to your diet.

After two weeks you can switch to good nutrition, but it must be dietaryly balanced.

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:

1. Detection of a repeat case of dysentery in a group within 7 days. In this case, preventive measures correspond to those described above.
2. 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.
3. Simultaneous appearance clinical signs 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.

Vaccination against dysentery

Immunity (immunity) after suffering from dysentery is developed only to the subspecies of the pathogen that caused the disease in this particular person. Immunity lasts for a maximum of one year. In other words, if a person is infected with one of the varieties of Shigella dysentery, he can easily become infected with other Shigella, and a year later he can become infected again with the same pathogen.

Based on the above, it follows that to develop effective vaccine, which could protect a person from contracting dysentery for a long time is almost impossible. This is why prevention is key of this disease is allocated to sanitary and hygienic measures aimed at preventing contact of a healthy person with an infectious agent.

However, under certain conditions, people can be vaccinated against certain types of dysentery (in particular, against Shigella Sonne, which are considered the most common).

Vaccination against Shigella Sonne is indicated:

1. Workers of infectious diseases hospitals.
2. Workers of bacteriological laboratories.
3. Persons traveling to epidemiologically dangerous regions (where there is a high incidence of Sonne dysentery).
4. Children attending kindergartens (if the epidemiological situation in the country or region is unfavorable).

After the vaccine is administered, the human body produces specific antibodies that circulate in the blood and prevent infection with Shigella Sonne for 9 to 12 months.

Vaccination is contraindicated for children under three years of age, pregnant women, as well as people who have had Sonne dysentery within last year(if the diagnosis was confirmed by laboratory tests).

Prevention of dysentery

To prevent dysentery, a set of measures has been developed and applied, the goals of which are:

1. Sanitary and hygienic education of the population (washing hands, drinking boiled water, washing before eating vegetables and fruits boiled water will help prevent illness).
2. Improving the sanitary condition of people’s places of residence and improving the material and living conditions of the population.
3. Prevention of food contamination (fly control).
4. Strict adherence to food hygiene rules (compliance with food storage conditions and deadlines for their sale).
5. Treatment of carriers of infection.

is an acute intestinal infection, caused by bacteria of the genus Shigella, characterized by predominant localization pathological process in the mucous membrane of the large intestine. Dysentery is transmitted by the fecal-oral route (food or water). Clinically, a patient with dysentery experiences diarrhea, abdominal pain, tenesmus, and intoxication syndrome (weakness, weakness, nausea). The diagnosis of dysentery is established by isolating the pathogen from the patient’s feces; for Grigoriev-Shiga dysentery, from the blood. Treatment is carried out mainly on an outpatient basis and consists of rehydration, antibacterial and detoxification therapy.

General information

is an acute intestinal infection caused by bacteria of the genus Shigella, characterized by the predominant localization of the pathological process in the mucous membrane of the large intestine.

Characteristics of the pathogen

The causative agents of dysentery - Shigella, are currently represented by four species (S. dysenteriae, S.flexneri, S. boydii, S. Sonnei), each of which (with the exception of Shigella Sonne) in turn is divided into serovars, of which there are currently more than fifty. The population of S. sonnei is homogeneous in antigenic composition, but differs in its ability to produce various enzymes. Shigella is a nonmotile gram-negative rod, does not form spores, reproduces well on nutrient media, and is usually not very stable in the external environment.

The optimal temperature environment for Shigella is 37 ° C, Sonne bacilli are capable of reproduction at a temperature of 10-15 ° C, can form colonies in milk and dairy products, can remain viable for a long time in water (like Shigella Flexner), and are resistant to antibacterial agents. . Shigella quickly die when heated: instantly - when boiling, after 10 minutes - at a temperature of more than 60 degrees.

The reservoir and source of dysentery is a person - a sick or asymptomatic carrier. Patients with mild or erased forms of dysentery, especially those related to the food industry and public catering establishments, are of greatest epidemiological importance. Shigella is released from the body of an infected person, starting from the first days of clinical symptoms, infectivity persists for 7-10 days, followed by a period of convalescence, during which, however, the release of bacteria is also possible (sometimes it can last several weeks and months).

Flexner's dysentery is most prone to becoming chronic; the least tendency to chronicity is observed with infection caused by Sonne bacteria. Dysentery is transmitted via the fecal-oral mechanism mainly by food (Sonne's dysentery) or water (Flexner's dysentery) route. When transmitting Grigoriev-Shiga dysentery, the transmission route is predominantly through contact and household transmission.

People have a high natural susceptibility to infection; after suffering from dysentery, unstable type-specific immunity is formed. Those who have recovered from Flexner's dysentery can retain post-infectious immunity, which protects against recurrent disease for several years.

Pathogenesis of dysentery

Shigella enters the digestive system with food or water (partially dying under the influence of the acidic contents of the stomach and normal intestinal biocenosis) and reaches the colon, partially penetrating into its mucous membrane and causing inflammatory reaction. The mucous membrane affected by Shigella is prone to the formation of areas of erosion, ulcers, and hemorrhages. The toxins released by bacteria disrupt digestion, and the presence of Shigella destroys the natural biobalance of the intestinal flora.

Classification

Currently, the clinical classification of dysentery is used. There are its acute form (differing in the predominant symptoms into typical colitic and atypical gastroenteric), chronic dysentery (recurrent and continuous) and bacterial excretion (convalescent or subclinical).

Symptoms of dysentery

The incubation period of acute dysentery can last from one day to a week, most often it is 2-3 days. The colitic variant of dysentery usually begins acutely, the body temperature rises to febrile levels, and symptoms of intoxication appear. Appetite is noticeably reduced and may be completely absent. Sometimes nausea and vomiting are noted. Patients complain of intense cutting pain in the abdomen, initially diffuse, later concentrating in the right iliac region and lower abdomen. The pain is accompanied by frequent (up to 10 times a day) diarrhea, stool quickly loses its fecal consistency, becomes scanty, and contains pathological impurities - blood, mucus, and sometimes pus (“rectal spit”). The urge to defecate is excruciatingly painful (tenesmus), sometimes false. Total daily bowel movements, as a rule, are not large.

On examination, the tongue is dry, coated, tachycardia, and sometimes arterial hypotension. Acute clinical symptoms usually begin to subside and finally fade away by the end of the first week, the beginning of the second, but ulcerative defects of the mucous membrane usually heal completely within a month. The severity of the colitis variant is determined by the intensity of intoxication and pain syndrome and the duration of the acute period. In severe cases, disorders of consciousness caused by severe intoxication are noted, the frequency of stools (like “rectal spitting” or “meat slop”) reaches dozens of times a day, painful abdominal pain, and significant hemodynamic disturbances are noted.

Acute dysentery in the gastroenteric variant is characterized by a short incubation period (6-8 hours) and predominantly enteral symptoms against the background of a general intoxication syndrome: nausea, repeated vomiting. The course resembles that of salmonellosis or toxic infection. The pain in this form of dysentery is localized in the epigastric region and around the navel, has a cramping nature, the stool is loose and profuse, there are no pathological impurities; with intense loss of fluid, dehydration syndrome may occur. The symptoms of the gastroenteric form are violent, but short-lived.

Initially, gastroenterocolitic dysentery also resembles in its course a foodborne toxic infection; subsequently, colitic symptoms begin to appear: mucus and bloody streaks in the stool. The severity of the gastroenterocolitic form is determined by the severity of dehydration.

Dysentery of the erased course today occurs quite often. There is discomfort, moderate pain in the abdomen, mushy stool 1-2 times a day, mostly without impurities, hyperthermia and intoxication are absent (or extremely insignificant). Dysentery lasting more than three months is considered chronic. Currently, cases of chronic dysentery in developed countries are rare. The recurrent variant consists of periodic episodes clinical picture acute dysentery, interspersed with periods of remission, when patients feel relatively well.

Continuous chronic dysentery leads to the development severe violations digestion, organic changes in the mucous membrane of the intestinal wall. Intoxication symptoms in continuous chronic dysentery are usually absent, there is constant daily diarrhea, stools are mushy and may have a greenish tint. Chronic malabsorption leads to weight loss, hypovitaminosis, and the development of malabsorption syndrome. Convalescent bacterial excretion is usually observed after acute infection, subclinical - happens when suffering from dysentery in an erased form.

Complications

Complications with the current level of medical care are extremely rare, mainly in the case of severe Grigoriev-Shiga dysentery. This form of infection can be complicated by infectious-toxic shock, intestinal perforation, peritonitis. In addition, the development of intestinal paresis is likely.

Dysentery with intense long-term diarrhea may be complicated by hemorrhoids, anal fissure, rectal prolapse. In many cases, dysentery contributes to the development of dysbiosis.

Diagnostics

Bacteriological diagnostics is extremely specific. The pathogen is usually isolated from feces, and in the case of Grigoriev-Shiga dysentery, from the blood. Since the increase in titer of specific antibodies occurs rather slowly, methods serological diagnostics(RNGA) have retrospective significance. Increasingly, laboratory practice for diagnosing dysentery includes the identification of Shigella antigens in feces (usually done using RCA, RLA, ELISA and RNGA with an antibody diagnosticum), the complement binding reaction and hemagglutination aggregate.

As general diagnostic measures, various laboratory techniques are used to determine the severity and extent of the process and identify metabolic disorders. A stool test is performed for dysbacteriosis and coprogram. Endoscopic examination (sigmoidoscopy) can often provide the necessary information for differential diagnosis in doubtful cases. For the same purpose, patients with dysentery, depending on its clinical form, may need to consult a gastroenterologist or proctologist.

Treatment of dysentery

Mild forms of dysentery are treated on an outpatient basis, inpatient treatment is indicated for persons with severe infection and complicated forms. Patients are also hospitalized for epidemiological reasons, in old age, having accompanying chronic diseases, and children of the first year of life. Patients are prescribed bed rest for fever and intoxication, dietary nutrition (in the acute period - diet No. 4, when diarrhea subsides - table No. 13).

Etiotropic therapy for acute dysentery consists of prescribing a 5-7-day course of antibacterial agents (fluoroquinolone, tetracycline antibiotics, ampicillin, cotrimoxazole, cephalosporins). Antibiotics are prescribed for severe and moderate forms. Taking into account the ability of antibacterial drugs to aggravate dysbiosis, eubiotics are used in combination for a course of 3-4 weeks.

If necessary, detoxification therapy is performed (depending on the severity of detoxification, drugs are prescribed orally or parenterally). Absorption disorders are corrected using enzyme preparations (pancreatin, lipase, amylase, protease). According to indications, immunomodulators, antispasmodics, astringents, and enterosorbents are prescribed.

To accelerate regenerative processes and improve the condition of the mucous membrane during the period of convalescence, microenemas with infusion of eucalyptus and chamomile, rosehip and sea buckthorn oil, and vinylin are recommended. Chronic form dysentery is treated in the same way as acute dysentery, but antibiotic therapy is usually less effective. It is recommended to prescribe therapeutic enemas, physiotherapeutic treatment, and bacterial agents for recovery normal microflora intestines.

Prognosis and prevention

The prognosis is mostly favorable, with timely complex treatment In acute forms of dysentery, chronicity of the process is extremely rare. In some cases, after an infection, residual functional disorders work of the large intestine (post-dysenteric colitis).

General measures to prevent dysentery include compliance with sanitary and hygienic standards in everyday life, in food production and catering establishments, monitoring the condition of water sources, and cleaning sewage waste (especially disinfection of wastewater from medical institutions).

Patients with dysentery are discharged from the hospital no earlier than three days after clinical recovery with a negative single bacteriological test (collection of material for bacteriological research performed no earlier than 2 days after the end of treatment). Food industry workers and other persons equivalent to them are subject to discharge after a double negative result of a bacteriological analysis.