痢疾Bacillary Dysentery

BacillaryDysentery(shigellosis)Dept.OfInfectiousDiseaseHuangFenDefinitionAcuteinfectiousdiseaseofintestinecausedbydysenterybacilliPlaceoflesion:sigmoid&rectumPathologicalfeature:diffusefibriousexudativeinflammationDefinitionClinicalmanifestation:fever,abdominalpain,diarrhea,tenesmus,stoolmixedwithmucusblood,&pus.evencompaniedwithshockandtoxicencepholopthy.EtiologyCausativeorganism:dysenterybacilli,genusshigellae,gram-stainnegative,shortrod,non-motileGroups:4serogroups47serotypesS.DysenteriaethemostsevereEtiologyS.FlexneritheepidemicgroupandeasilyturntochronicS.BoydiitropicalareasS.sonneithemostmildEtiologyPathogenicity:-virulenceendotoxin-interotoxin(exotoxin)-invasiveness(attach-penetrate-multiply)Resistance:Strong,1-2weekinfruits,vegetableanddirtysoil,heatfor60℃30minEpidemiologySourceofinfection:patientsandcarriersRouteoftransmission:fecal-oralrouteSuceptibilityofpopulation:immunityafterinfectionisshortandunsteady,nocross-immuneEpidemiologyEpidemicfeatures:season:summer&fallFlexneri,Soneii,age:youngerchildrenPathogenesisnumberofbacteriapathogenicitytoxicityinvasivenessattachmentpenetrationmultiplicationimmunitycommonBacteriaintestinenormalintestinalflorasIgApreventattachingpenetratemucusmultiplyinepitheliacell&properlaminaendotoxininterotoxinendogenouspyrogenfeverinflammationvesselcontractionsuperficialmucosalnecrosisandulcerdiarrheamixedwithblood&pus,abdominalpainPathogenesis-toxicstrong-allergytoendotoxindemethyl-adrenalinemicro-circulatoryfailureshock,DIC,cerebraledemacerebralherniaPathologysiteoflesion:entirecolon-sigmoid&rectumfeature:acute:diffusefibrinousexudativeinflammation,hyperemia,edema,leukocyteinfiltration,necrosis,superficialulceration.Pathologychronic:edema,ulceration,polypoidhyperplasia,toxic:hyperemia,edema,ClinicalmanifestationIncubationperiod:1-2day,(hoursto7days)AcutedysenterycommontypemildtypetoxictypeClinicalmanifestationcommontype:acuteonset,shiver,highfeverabdominalpaindiarrhea:stoolmixedwithmucus,blood&pustenesmus,Clinicalmanifestationmildtype:causedbyS.sonneilowfeverornofeverabdominalpainismildstoolmixedwithmucus,withoutblood&pusdiagnosisbyisolationbacteriaClinicalmanifestationtoxictype:age:2to7yrs.abruptonset,highfever,T40oCconvulsionrepeatedly,alteredconsciousnesscirculatory&/orrespiratorycollapsediarrheamildorabsentatbeginningClinicalmanifestationshockform:septicshockbrainform:listlessness,lethargy,convulsion,coma.respiratoryfailuremixedformClinicalmanifestationchronicdysentery:2monthschronicdelayedtypechronicobscuretypeacuteattacktypeClinicalmanifestationchronicdelayedtype:long-timediarrheaandrepeatedchronicobscuretype:acutehistoryin1year,nosymptoms,stoolculturepositiveorsigmoidscopyacuteattacktype:sameascommonacutedysenteryLaboratoryFindingsBloodpicture:WBCcountincrease,neutrophilsincreaseStoolexamination:directmicroscopicexamination:WBC,RBC,puscellsLaboratoryFindingsbacteriaculture:PCR:DNASerologicexamination:Sigmoidoscopy:chronicpatientsshallowulcerscarpolypDiagnosisEpidemiologicdata:contacthistoryClinicalmanifestation:Laboratoryfindings:DifferentialdiagnosisacutedysenteryamebicdysenteryEntamoebahistolyticastool:reddishbrown,likejamflask-shapedulcer,amebictrophozoiteDifferentialdiagnosisenteritiscausedbyE.Coli,salmonella,virus.intussusception:jam-likestools,abdominalmassabsenceoffeverDifferentialdiagnosischronicdysenteryrectal&coloniccarcinoma:nocureforlong-term,dropofweightofbodynon-specificulcercolitis:nocureforlong-term,cultureofstoolisnegative,Differentialdiagnosissigmoidoscopy:hemorrhage,ulcer,X-ray:leadpipe.chronicschistosomiasisJaponicacontactwiththecontaminatedwaterhepatomegalyandsplenomegalyfoundingtheovumofschistosomiasisDifferentialdiagnosistoxicdysenteryencephalitisB:highfever,convulsion,coma.•24h•circulatoryfailure•stoolexamination•CSF•meningealirritation•specificIgMTreatmentCommondysenterygeneraltreatment:isolationdietfluidandelectrolytepathogenictreatment:norfloxacin0.2~0.4q6hpo5~7dAmpicillingivenbypoorivGetamycinTreatmentsymptomatictreatment:Toxicdysenterygeneraltreatmentpathogenictreatment:L-ofloxacin:0.2bidivdropcefotaxime:Ampicillin:Treatmentsymptomatictreatment:•controlofhighfever,convulsion:subhibernation•treatmentofshock:654-2:1-2mg/kg•treatmentofcerebraledema:20%mannitolrespiratoryfailureTreatmentchronicdysenterygeneraltherapy:live,avoidoverworkexercisedietetiologictherapy:sensitiveantibiotics,accordingtoresultsofcultureusedinturnorcombineduseenema.TreatmentPreventionControlthesourceofinfection:untilculturenegativeInterruptingtherouteoftransmission:Protectingthesusceptiblepopulation:F2a:secretaryIgAprotectrate:80%6-12mon