Dysentery (shigellosis) is one of the common acute intestinal infections. In the past, it claimed a huge number of lives. Now this disease continues to pose a danger to humanity, despite the fact that the social conditions of life have changed dramatically, there are tools that allow effective treatment of dysentery.
Past illness
Mankind has known about dysentery since ancient times. This term appeared in the 5th century. BC e. thanks to Hippocrates. However, for many centuries, dysentery was not understood as a specific disease. The term was used to refer to a whole group of ailments that were characterized by diarrhea.
Dysentery in the past was a terrible disease. There was no cure for her. Epidemics broke out all over the world. It is known from surviving historical sources that a major outbreak of the disease occurred at the very beginning of the 15th century. in France. In the city of Bordeaux, the most people died - about 14 thousand people. Later epidemics were recordedand in Germany, and in Holland, and in other countries. Most often, outbreaks provoked natural disasters, wars.
The first statement about the existence of the causative agent of dysentery dates back to 1891. It was made by Alexei Vasilyevich Grigoriev, a Russian microbiologist and pathologist. He wrote the work "On microorganisms in dysentery", expressed an opinion on the development of the disease due to the ingestion of special non-motile intestinal rod-shaped bacteria into the human body.
A few years later, the pathogen was isolated in pure culture. This discovery was made by the Japanese doctor and microbiologist Kiyoshi Shiga (in some sources his surname is spelled a little differently - Shiga). Later, specialists became interested in dysentery, symptoms, treatment and prevention of this disease. The conducted research allowed to identify other pathogens. They were named after their discoverers (Flexner, Sonne, Stutzer-Schmitz, etc.)
Current prevalence of disease
Modern medicine knows everything about dysentery. Experts have found drugs that kill pathogens. However, the prevalence of the disease is still high. Even deaths continue to be recorded. Official statistics indicate that approximately 200 million people are affected by dysentery every year. About 1.1 million people die from this disease.
Dysentery is encountered in all modern countries. However, the disease is most common in developing countries, where the population lives inunsatisfactory sanitary and hygienic conditions:
- with poor drinking water quality;
- unsanitary living conditions;
- presence of strange customs and prejudices, etc.
Shigellosis is recorded throughout the year. However, the largest number of patients for the treatment of dysentery begins to apply in the summer-autumn period. This seasonality is explained by several factors - the ripening and consumption of vegetables, fruits, berries during this period, swimming in reservoirs that are polluted with sewage.
Dysentery, as can be seen from the statistics, is not an absolutely fatal disease. Deaths are mostly recorded in developing countries. In developed countries, death from this disease is relatively rare, because measures have been developed to prevent and treat dysentery. It should be noted that the likelihood of death increases in people with malnutrition. Also at high risk include:
- children and adults over 50;
- babies who are bottle-fed;
- immunocompromised patients;
- persons who develop dehydration, loss of consciousness.
Dysentery pathogen
Shigellosis can cause a whole group of related microorganisms. The causative agents belong to the Enterobacteriaceae family and the Shigella genus. They are Gram-negative non-motile rods. Experts distinguish 4 types of these microorganisms:
- Shigella dysenteriae, serogroupA, serotypes 1–15.
- Shigella flexneri, serogroup B, serotypes 1–6 (with 15 subtypes).
- Shigella boydii, serogroup C, serotypes 1–18.
- Shigella sonnei, serogroup D, serotype 1.
Pathogens of dysentery are characterized by resistance in the external environment. As a rule, sticks remain viable from 3 days to 2 months. Experts know that pathogens can be active in the soil for up to several months, in sewage water - from 25 to 30 days. Microorganisms, when they get into food and under favorable conditions, actively multiply, remain on household items (door handles, toys, dishes). Instant death of sticks occurs at a temperature of 100 degrees. At a temperature of 60 degrees, pathogens die within 30 minutes. Microorganisms are negatively affected by direct sunlight, 1% phenol solution.
Source of infection, mechanism of transmission and causes of infection
The source of pathogens is a sick person who has an acute or chronic form of this disease or who is a carrier. It is important to note that an important role in the spread of infection is played by insects (cockroaches, flies), which carry sticks on their paws from the soil, feces.
The transmission mechanism of Shigella is fecal-oral. It is implemented in several ways:
- food;
- water;
- contact household.
The cause of foodborne infection is the use of products that are not exposed toheat treatment. Pathogens can be present in milk, dairy and meat products, vegetables, berries and fruits. In the waterway, the disease begins to develop due to the use of unboiled infected water. The contact-household route of infection is most often associated with young children, who often shove infected toys or dirty pens into their mouths.
The literature also describes the sexual transmission of Shigella. It was first mentioned in 2000. Previously, experts have not encountered this route of transmission. In 2000, there was an outbreak in New South Wales - in one of the clubs in this city. It affected gay men (homosexuals).
Classification of the disease and signs of classic dysentery
During the years, experts have studied dysentery, symptoms in adults, and treatment at home and in the hospital. Past work has led to several classifications of shigellosis. Depending on the severity of the course of the disease, they are distinguished:
- light form;
- moderate form;
- heavy shape.
According to the duration of the course of dysentery, acute, protracted and chronic forms are distinguished. With the first of them, the symptoms can torment for a whole month. For a protracted course, the presence of signs of the disease within 3 months is characteristic. If symptoms are observed after 3 months, then chronic dysentery is diagnosed.
The acute form of shigellosis, in turn, is divided into several clinical variants - colitis, gastroenterocolitic, gastroenteric. colitisvariant is considered the classic (most common) manifestation of dysentery. It is caused by pathogens such as Shigella dysenteriae and Shigella flexneri. It is characterized by a specific clinical picture:
- The incubation period lasts from 1 to 7 days. At this time, symptoms do not yet appear.
- After the incubation period, a prodromal period sometimes begins with a slight chill, headache, discomfort in the abdomen.
- Most often, after the completion of the incubation period, the peak of the disease begins. There are symptoms such as an increase in body temperature from 37 to 38 degrees (and in some cases up to 40), cramping pains in the lower abdomen or on the left side in the iliac region (sometimes they are characterized by a diffuse character), urge to defecate.
- With proper treatment of dysentery at home or in a hospital, a period of convalescence begins, when the body is released from the pathogen, all previously impaired functions are restored.
Features of the gastrointestinal tract in classic dysentery
The disease causes dysfunction of all parts of the gastrointestinal tract. The work of the salivary glands is inhibited, dryness in the mouth begins to be felt. The stomach also suffers from the disease. First, the secretion of gastric juice changes. Many people diagnosed with dysentery have low acidity. Some patients have achlorhydria, a condition in which there is no hydrochloric acid in the gastric juice. In-secondly, the motility of the stomach is perverted.
Stool with dysentery becomes more frequent up to 3-5 times a day. In severe cases, bowel movements can occur 20-30 times a day. In the first hours, the stool is fecal, copious, liquid or semi-liquid. Further, he loses his fecal character. The stools become slimy. Later, blood and pus appear in them.
Gastroenterocolitic and gastroenteric variants of dysentery
Gastroenterocolitic variant of dysentery is usually caused by Shigella sonnei. In the initial period, the disease resembles food poisoning. At the same time, syndromes of general intoxication and gastroenteritis develop. Later, enterocolitis syndrome comes to the fore. This variant of dysentery has a short incubation period of only 6-8 hours, and in some cases even shorter.
After the incubation period, the body temperature rises, pain appears in the epigastric region. Patients who turn to specialists for the treatment of dysentery at home or in a hospital complain of nausea and vomiting. A rumbling is heard in the stomach. Later, pains begin to be felt in the entire abdomen. There are frequent urges to the toilet. Fecal masses are characterized by a light yellow or greenish color. They may contain pieces of undigested food, mucus. On the 2-3rd day, colitis syndrome joins the disease (it indicates the spread of the pathological process to the mucous membrane of the large intestine). Patients begin to complain of false urges. Some people have blood in their stools. Vomitstops. On examination, spasm and moderate tenderness of the sigmoid colon are revealed.
In the gastroenteritis variant, the causative agent is most often Shigella sonnei, less often Shigella flexneri. The initial period of the disease is similar to the gastroenterocolitis variant. Differences appear later. In the later stages, the dominance of enterocolitis is not observed. During the entire illness, the leading signs are gastroenteritis and dehydration. These features bring together the gastroenteric variant of dysentery with food poisoning.
Chronic dysentery
About 4% of cases, acute dysentery becomes chronic. This happens in the presence of special factors - due to some features of the pathogen, diseases of the digestive system, improper diet. It is also possible that the acute form of dysentery may become chronic if treated incorrectly or out of time.
Chronic dysentery is divided into 2 forms - recurrent and continuous. The first of them is characterized by the alternation of periods of exacerbation and periods of complete well-being. With relapses, well-being is disturbed insignificantly. Usually body temperature is normal. The frequency of bowel movements is 3 to 5 times a day. The stool is usually mushy with mucus. Some patients notice blood in it. Sometimes they worry about pain in the abdomen, false urges.
There are no periods of remission for continuous dysentery. The pathological process progresses. human condition,suffering from continuous dysentery worsens. The patient develops deep and trophic changes in the large intestine during the disease. All digestive organs are involved in the pathological process. Intestinal dysbacteriosis begins. With this form, immediate treatment of dysentery with drugs is required. The further the disease progresses, the worse the prognosis becomes.
Differences between bacterial and amoebic dysentery
In medicine, the term "dysentery" is understood as a bacterial disease that is caused by the above Shigella. There is also such a thing as amoebic dysentery. This disease has a second name - amoebiasis. This disease is also characterized by a fecal-oral transmission mechanism. The disease can also cause death.
However, there are differences between bacterial and amoebic dysentery. The latter has a completely different pathogen - Entamoeba histolytica. This is an amoeba, which belongs to the simplest. The causative agent is completely different, therefore, the treatment of dysentery requires a different one. If there are signs of a bacterial form, a differential diagnosis is carried out to exclude infection with amoebas and other diseases.
Amoebiasis is characterized by certain distinguishing features, features. Here is their list:
- gradual onset of disease;
- manifestation of a tendency to a protracted, chronic and undulating course;
- pain in the abdomen (most often they torment on the right side);
- thickening of the caecum and liver enlargement;
- the presence of blood and mucus in the feces (one characteristic is suitable for such a chair - “raspberry jelly”);
- weight loss;
- anemia;
- stay at the time of infection in the Central Asian region, tropics, subtropics.
The diagnosis of "amebiasis" is made only after the discovery in the feces of the tissue form of the amoeba. All patients must be hospitalized. In the treatment of amoebic dysentery, drugs such as Tinidazole, Metronidazole are mainly used. These are antiprotozoal drugs.
Treatment of disease
Dysentery is being treated at home or in a hospital. The location of the patient is determined by the doctor. The specialist takes into account the form of the disease, the presence of concomitant ailments. Treatment is based on two principles - individuality and complexity. Preparations are selected for each patient, taking into account contraindications, tolerability of the components. The principle of complexity includes:
- bed rest in severe forms of the disease during the peak period, prolonged physiological sleep, therapeutic exercises, elimination of the effects of all negative stimuli on the body;
- diet;
- etiotropic, pathogenetic and symptomatic treatment of dysentery.
Regarding nutrition, it is worth noting that in case of serious intestinal disorders, table number 4 is assigned, and shortly before recovery - table number 2. After the body is restored, they switch to a common table. During treatment, as well as within a month after recovery, do not include in your dietfatty and fried foods, spicy spices, smoked meats, alcoholic beverages.
Etiotropic treatment refers to the appointment of antibacterial drugs. A specific remedy is prescribed by a doctor, taking into account the sensitivity of the pathogen. For example, for the treatment of dysentery, Ofloxacin, Ciprofloxacin are used. Pathogenetic treatment includes the appointment of heavy drinking, oral rehydration solutions, infusion-detoxification therapy. Symptomatic therapy is prescribed to eliminate the tormenting signs of the disease. For example, antispasmodics are used to relieve colon spasm.
Preventive measures
If you always follow the preventive measures of dysentery, you will not have to deal with treatment. General preventive measures include compliance with the norms of sanitary and hygienic rules in everyday life. First, before preparing and eating food, after using the toilet, you should always wash your hands with soap and water. Secondly, vegetables, fruits and berries should always be washed with running water before use. It is recommended to pour boiling water over the fruits, because pathogens die from high temperatures. Thirdly, all perishable foods should be stored in the refrigerator. Fourth, all raw foods must undergo heat treatment (for example, meat must be boiled or fried, but in no case should it be eaten raw).
At the first symptoms of the disease, you should consult a doctor about the treatment of dysentery in adults at home or in a hospital. Self-medication is unacceptable, because withoutdiagnostics and without medical knowledge, it will not be possible to choose an effective drug. The wrong remedy will cause harm.
