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Bacillary Dysentery (shigellosis)

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Bacillary Dysentery (shigellosis) Dept. Of Infectious Disease Wang Jingyan Definition Acute infectious disease of intestine caused by dysentery bacilli Place of ... – PowerPoint PPT presentation

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Title: Bacillary Dysentery (shigellosis)


1
Bacillary Dysentery (shigellosis)
  • Dept. Of Infectious Disease
  • Wang Jingyan

2
Definition
  • Acute infectious disease of intestine caused by
    dysentery bacilli
  • Place of lesion sigmoid rectum
  • Pathological feature diffuse fibrious exudative
    inflammation
  • Clinical manifestation fever, abdominal pain,
    diarrhea, tenesmus , stool mixed with blood,
    mucus pus. Even companied with marked toxicity
    and shock,toxic-encepholopthy.

3
Etiology
  • Causative organism dysentery bacilli, genus
    shigella, gram-stain negative, short
    rod,non-motile
  • Groups 4 groups 50 serotypes
  • - S. Dysenteriae-the most sever
  • - S. Flexnerii-the epidemic group
    and easily turn to chronic
  • - S. Boydii-tropical and subon
  • - S. sonnei-the most mild

4
Etiology
  • Pathogenicity
  • - virulence
  • (endotoxin) - interotoxin (exotoxin)
  • - invasiveness
  • (attach-penetrate-multiply)
  • Resistance Strong.1-2week in fruits,vegetable
    and dirty soil. heat for 60? 30 min

5
Epidemiology
  • Source of infection
  • - patients
  • - carriers
  • Route of transmission fecal-oral route
  • Suceptibility of populationimmunity after
    infection is short and unstead,no cross-immune
  • Epidemic features
  • - season summer fall
  • - Flexneri, Soneii, dysentery
  • - age younger children

6
Pathogenesis
  • Number of bacteria
  • toxicity
  • immunity
  • invasiveness
  • - attachment
  • - penetration
  • - multiplication

7
Pathogenesis-common
Bacteria
intestine
Penetrate mucus
Normal bacteria flora sIg A
Multiply in epithelia cell proper lamina
Prevent attaching
endotoxin
Inflammation vessel contraction
Endogenous pyrogen
fever
Superficial mucosal in,nec and ulcer
Diarrhea mixed with blood pus, abdominalache
8
Pathogenesis-toxic
Strong - allergy to endotoxin
Demethyl-adrenaline
Micro-circulatory failure
Shock, DIC, cerebral edema
cerebral hernia
9
Pathology
  • Site of lesion entire large bowel-colone,
    sigmoid rectum
  • Feature
  • acute diffuse fibrinous exudative inflammation,
    hyperemia, edema, leukocyte infiltration,
    superficial necrosis
  • chronic edema, polypoid hyperplasis
  • toxic endothelial cell of micro-capillary
    necrosis

10
Clinical manifestation
  • Incubation period 1-2 day, (Hrs. To 7 days)
  • Acute dysentery
  • common type
  • onset in sudden, shiver, high fever
  • abdominal pain
  • diarrheastool mixed with blood, mucus pus
  • tenesmus, continence

11
Clinical manifestation
  • Acute dysentery
  • mild type
  • caused by S. sonnei
  • low fever or no fever
  • Abdominal pain is mild
  • stool mixed with mucus, without blood pus
  • diagnosis by isolation bacteria

12
Clinical manifestation
  • Acute dysentery
  • Toxic type
  • Age 2 to 7 yrs.
  • Abrupt onset, high fever, Trise to 40oC
  • Listlessness,lethargy,convulsion,coma.
  • circulatory respiratory collapse
  • diarrhea mild or absent at beginning
  • shock form septic shock
  • brain form respiratory failure
  • mixed form

13
Clinical manifestation
  • Chronic dysentery gt 2 months
  • Chronic delayed typediahhrea long-time and
    repeated
  • Chronic obscure type acute history in 1 year, no
    symptoms, stool culture Pos. or sigmoidscopy
  • Acute attack type same as common acute dysentery

14
Laboratory Findings
  • Blood picture total WBC count increase,
  • neutrophils
    increase
  • Stool examination
  • direct microscopic exam. WBC, RBC, pus cells
  • bacteria culture
  • Sigmoidoscope shallow ulcer,scar, polyps

15
Differential diagnosis
  • Acute dysentery
  • Amebic dysentery
  • Entameba histolytica
  • stool reddish brow, like jam
  • flask-shaped ulcer,Amebic trophozoite
  • Enteritis caused by E. Coli, salmonella,viral
    diarrhea
  • Intussusception jelly-like stools, abdominal
    mass and absence of fever

16
Differential diagnosis
  • Chronic dysentery
  • Rectal colonic carcinoma no cure for
    long-term,drop of weiht of body
  • non-specific ulcer colitis no cure for
    long-term,culture of stool is negetive,
    sigmoidoscopehemorrhage, ulcer,lead pipe.
  • Chronic schistosomiasis Japonica
  • a. co ntact with the disease-water
  • b. hepatomegaly and splenomegaly
  • c .founding the ova of schistosomiasis
    Japonica

17
  • Toxic dysentery
  • Encephalitis B
  • brain formJapaness B encephalitis
  • a.stool
  • b.CFS-IgM
  • c.slowly
  • d.shock rarely

18
Treatment
  • Common dysentery
  • Toxic dysentery
  • general treatment
  • Pathogenic treatment ofloxine or Amp. Given by
    IV
  • Synptomatic treatmentControl high fever,
    convulsion sub-winter sleep
  • Treatment of shocksame as ECM
  • Treatment of cerebral edema same as EBC

19
Treatment
  • Chronic dysentery
  • General therapylive,nurishing,diet,avoid
    overwork,excise.
  • Etiologic therapy sensitive antibiotics used in
    turn or combined useaccording to results of
    cultureenemaexpectant treatment.

20
Prevention
  • Control the source of infection until culture
    negative
  • Interruptted the route of transmission method of
    mainly
  • Protct the susceptabilityF2a-secratory IgA
    protect 80-6-12mon
  • return
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