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BACILLARY DYSENTRY SHIGELLA SPECIES

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Title: BACILLARY DYSENTRY SHIGELLA SPECIES


1
BACILLARY DYSENTRYSHIGELLA SPECIES
  • Dr.Indumathi

2
KLEBSIELLA
  • GRAM NEGATIVE
  • NON MOTILE
  • CAPSULATED
  • LACTOSE FERMENTING(MUCOID)
  • IMViC --
  • FORMS GUT AND RESPIRATORY FLORA IN 5 NORMAL
    INDIVIDUALS

3
CLASSIFICATION
  • 3 SPECIES
  • K.pneumonia K.rhinoscleromatis and K.ozanae
  • PATHOGENIC LESIONS
  • HAEMORRHAGIC NECROTIZING CONSOLIDATION OF LUNG
    (1)
  • UTI
  • BACTEREMIA OTHER FOCAL INFECTION
  • NOSOCOMIAL INFECTION

4
PNEUMONIA
  • FRIEDLANDERS PNEUMONIA CAP
  • MIDDLE AGED AND OLD ALCOHOLICS
  • SEVERE RAPID ONSET
  • OFTEN FATAL
  • HIGH FEVER, CHILLS, CURRENT JELLY SPUTUM
  • ABSCESS, CAVITATION, EMPYEMA
  • LOBAR PNEUMONIA WITH DESTRUCTIVE CHANGES
    USUALLY UPPER LOBE

5
KLEBSIELLA PNEUMONIA
6
RHINOSCLEROMA
  • K.RHINOSCLEROMATIS
  • AFRICA, ASIA, LATIN AMERICA
  • DESTRUCTIVE GRANULOMA OF NOSE AND PHARYNX
  • PURULENT NASAL DISCHARGE
  • CRUSTING LESIONS WITH NODULE
  • RESPIRATORY OBSTRUCTION
  • DIAGNOSIS BY HPE AND POSITIVE BLOOD CULTURE

7
RHINOSCLEROMA
8
OZENA
  • K.OZAENAE
  • FETID PROGRESSIVE ATROPHY OF NASAL MUCOSA
  • NASAL CONGESTION
  • PRIMARY ATROPHIC RHINITIS IN ELDERLY
  • NASAL BAD SMELL
  • HEADACHE

9
HISTORICAL REVIEW
  • TERM DYSENTRY BY HIPPOCRATES
  • FREQUENT PASSAGE OF STOOL WITH BLOOD AND MUCOUS
  • STRAINING AND PAINFUL DEFECATION
  • 19TH CENTRURY 2 FORMS OF DYSENTRY ACCURATELY
    SEPARATED
  • EPIDEMICS DYSENTRY IN MILITARY CAMPS, ASYLUMS,
    JAILS BY SHIGELLA
  • SPORADIC CASES OF DYSENTRY BY AMEOBA

10
SHIGELLA
  • GRAM NEGATIVE SHORT RODS
  • NON MOTILE
  • ANAEROGENIC
  • NON CAPSULATED
  • GIT PATHOGEN
  • NON LACTOSE FERMENTER
  • COMPLEX ANTIGENIC STRUCTURE
  • NAMED AFTER SHIGA 1896

11
CLASSIFICATION
  • 4 SPECIES/SUBGROUPS BASED ON BIOCHEMICAL AND
    SEROLOGICAL CHARACTERS
  • SHIGELLA DYSENTERIAE 12 Serotypes
  • SHIGELLA FLEXNERI 6 serotypes
  • SHIGELLA BOYDII 18
  • SHIGELLA SONNEI 17 Colicine types

12
EPIDEMIOLOGY BACILLARY DYSENTRY
  • PREVALENT IN TROPICS/WORLD WIDE
  • SUMMER MONTHS
  • POOR SANITATION
  • OVERCROWDING /POVERTY
  • EPIDEMICS
  • MAN IS THE ONLY HOST CASE/CARRIER RESERVOIR
  • SHORT INCUBATION (48 HRS)

13
EPIDEMIOLOGY
  • CYCLIC PATTERN OF DISEASE
  • EPIDEMICS DUE TO ONE SPECIES LASTING FOR
    20-30YRS.
  • E.G. 20TH CENTURY S.DYSENTERIAE
  • IN EUROPE
  • 1926-38 S.FLEXNERI
  • CURRENTLY S.SONNEI IN INDUSTRIALISED COUNTRIES

14
EPIDEMIOLOGYINDIA
  • ENDEMIC /HIGHLY COMMUNICABLE
  • FOUND IN ALL AGE GROUPS
  • ALL SPECIES S.FLEXNERI PREDOMINANT(50-85)
  • S.DYSENTERIAE(8-25)
  • S.SONNEI (2-24)
  • S.BOYDII(0-8)
  • EPIDEMICS AND SERVERAL OUTBREAKS FROM 1974
    KERALA AND WEST BENGAL
  • MULTIPLE DRUG RESISTANT STRAINS CAUSING
    EPIDEMICS

15
PATHOGENESIS
  • SOURCE MAN CASE OR CARRIER
  • MODE OF SPREAD CONTAMINATED FINGERS, FOOD,
    FLIES, FOMITES
  • PERSON TO PERSON TRANSMISSION
  • INFECTIVE DOSE 10-100 VIABLE BACILLI
  • HIGHEST CONCENTRATION IN STOOL DURING EARLY/ACUTE
    INFECTION 103 TO 109 VIABLE BACILLI PER GRAM OF
    STOOL
  • POST CONVALESCENT SHEDDING LOW COUNTS 102 TO 103

16
PATHOGENESIS
  • VIRULENCE FACTORS
  • 1.INVASIVENESS ASSOCIATED WITH BACTERIAL
    PROTEIN CODED IN PLASMIDS OR CHROMOSOME.
  • 2. TOXIN PRODUCTION EXOTOXIN THAT IS
    ENTERO,NEURO AND CYTOTOXIC SHIGA TOXIN

17
PATHOGENESIS

  • INGESTED BACILLI
  • ?
  • TRANSIENTLY MULTIPLY IN SMALL INTESTINE
    CONCENTRATION OF 107 TO109 PER ML
  • ?
  • ENTER THE DISTAL COLON (MULTIPLY) INVADE THE
    MUCOSAL CELLS,
  • ?
  • MULTIPLY AND SPREAD TO ADJECENT
    CELLS(INTRACELLULAR SPREAD)
  • ?
  • ACUTE INFLAMMATION AND MICROABSCESS/CAP
    THROMOBOSIS
  • SUPERFICIAL ULCERATION (SERPIGINOUS)
  • ?
  • ENDOTOXIN PRODUCTION TO PRODUCE BOWEL IRRITATION
    AND DIARRHOEA WITH BLOOD/MUCUS AND TOXEMIA

18
(No Transcript)
19
PATHOGENESIS
  • NO BLOOD STREAM INVASION
  • BACTERIA RAPIDLY PHAGOCYTOSED BY MACROPHAGES
  • ENTEROTOXIN LOCAL MUCOSAL DESTRUCTION
  • CLINICALLY DYSENTRY LASTS FOR 1 TO 7 DAYS SELF
    LIMITING
  • HIGH MORTALITY IN MALNOURISHED
  • COMPLICATIONS HEMOLYTIC UREMIC SYNDROME SHIGA
    TOXIN RENAL FAILURE, TOXIC NEURITIS, ARTHRITIS
  • RARELY IKARI SYNDROME MASSIVE INFECTION AND
    EARLY DEATH IN CHILDREN

20
CLINICAL FEATURES
  • FEVER HIGH GRADE
  • TOXEMIA
  • ABDOMINAL CRAMPS
  • VOLUMINOUS WATERY DIARRHOEA
  • FOLLOWED BY SMALL VOLUME FREQUENT PASSAGE OF
    BLOODY STOOLS.
  • (OVER 10/DAY)
  • ABDOMINAL TENDERNESS
  • COMPLICATIONS FEBRILE SEIZURES, SEPSIS, PNEUMONIA

21
LAB DIAGNOSIS
  • SPECIMEN COLLECTION
  • STOOL CONTAINING MUCOUS/BLOOD
  • RECTAL SWAB
  • RECTAL CATHETERIZATION
  • RECOVERY IS BEST IN THE ACUTE STAGE WHERE BACILLI
    ARE SHED IN LARGE NUMBERS

22
LAB DIAGNOSIS
  • TRANSPORT MEDIUM
  • BGS/CARY BLAIR
  • ENRICHMENT SELENITE F
  • METHODS OF DIAGNOSIS
  • DIRECT MICROSCOPY
  • CULTURE
  • SLIDE AGGLUTINATION TEST

23
LAB DIAGNOSIS
  • MACROSCOPY
  • BRIGHT RED STOOL
  • ADHERENT TO CONTAINER
  • ALKALINE
  • ODOURLESS
  • NO FAECAL MATTER
  • SMALL QUANTITY

24
LAB DIAGNOSIS
  • MICROSCOPY
  • NUMEROUS PUS CELLS STAINED FEACAL SMEARS WITH
    METHYLENE BLUE (SINGLE MOST IMPORTANT LAB TEST
    OTHER THAN STOOL CULTURE)
  • NUMEROUS DISCRETE/ROULEUX RBCS
  • NO BACTERIA SEEN
  • PLENTY OF MACROPHAGES
  • GHOST CELLS CELLS WITH NO NUCLEUS AND ONLY
    CYTOPLASMIC OUTLINE PRESENT

25
LAB DIAGNOSIS
  • CULTURE MEDIA USED
  • FLUID SELENITE F ENRICHMENT
  • SOLID MAC CONKEYS
  • DCA
  • SSA
  • STEPS DIRECT PLATING ENRICHMENT CULTURE
  • GROWTH FROM FLUID MEDIUM SUBCULTURED ONTO MA

26
LAB DIAGNOSIS
  • COLONIES ON MA/DCA NLF PALE AND TRANSLUCENT
  • COLONIES PICKED UP FOR THE FOLLOWING TESTS
  • HANGING DROP NON MOTILE
  • GRAMS GNB
  • BIOCHEMICAL TESTS IMVIC -- ANEROGENIC
    FERMENTERS
  • SLIDE AGGLUTINATION WITH SPECIFIC HTS

27
BIOCHEMICAL TESTS
SPECIES GLUCOSE LACTOSE MANNITOL INDOLE
S.DYS ACID - - V
S.FLEX ACID - V
S.BOYDI ACID - V
S.SONEI ACID - -
28
TREATMENT AND PREVENTION
  • ANTIBIOTICS TO BE GIVEN BECAUSE
  • 1. PERSON TO PERSON TRANSMISSION INFECTED
    PERSON IS THE RESERVOIR IN ORDER TO PREVENT THE
    CHAIN OF TRANSMISSION
  • GOOD SANITATION/SAFE DISPOSAL OF SEWAGE
  • SAFE WATER SUPPLY
  • SHIGELLA VACCINE (ORAL STREP DEP MUTANTLIVE
    ATTEN)4 DOSES PROTECTION 6 MONTHS. EXP IN
    HYPERENDEMIC AREAS.

29
SALMONELLA GASTROENTERITIS
  • FOOD POISONING
  • ZOONOTIC INFECTION
  • ANIMAL OR ANIMALPRODUCTS MEAT PRODUCTS, EGGS,
    CREAM, MILK (FOOD CONTAMINATION WITH RAT OR
    LIZARD DROPPINGS)
  • S.TYPHIMURIUM/S.ENTERITIDIS, S.NEWPORT
  • IP 24 HOURS DIARRHOEA, VOMITTING, PAIN ABDOMEN,
    FEVER
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