痢疾dysentery

BacillaryDysentery(shigellosis)Dept.OfInfectiousDiseaseWangJingyanDefinitionAcuteinfectiousdiseaseofintestinecausedbydysenterybacilliPlaceoflesion:sigmoid&rectumPathologicalfeature:diffusefibriousexudativeinflammationClinicalmanifestation:fever,abdominalpain,diarrhea,tenesmus,stoolmixedwithblood,mucus&pus.Evencompaniedwithmarkedtoxicityandshock,toxic-encepholopthy.EtiologyCausativeorganism:dysenterybacilli,genusshigella,gram-stainnegative,shortrod,non-motileGroups:4groups&50serotypes-S.Dysenteriae-themostsever-S.Flexnerii-theepidemicgroupandeasilyturntochronic-S.Boydii-tropicalandsubon-S.sonnei-themostmildEtiologyPathogenicity:-virulence(endotoxin)-interotoxin(exotoxin)-invasiveness(attach-penetrate-multiply)Resistance:Strong.1-2weekinfruits,vegetableanddirtysoil.heatfor60℃30minEpidemiologySourceofinfection:-patients-carriersRouteoftransmission:fecal-oralrouteSuceptibilityofpopulation:immunityafterinfectionisshortandunstead,nocross-immuneEpidemicfeatures:-season:summer&fall-Flexneri,Soneii,dysentery-age:youngerchildrenPathogenesisNumberofbacteriatoxicityimmunityinvasiveness-attachment-penetration-multiplicationPathogenesis-commonBacteriaintestineNormalbacteriaflorasIgAPreventattachingPenetratemucusMultiplyinepitheliacell&properlaminaendotoxinEndogenouspyrogenfeverInflammationvesselcontractionSuperficialmucosalin,necandulcerDiarrheamixedwithblood&pus,abdominalachePathogenesis-toxicStrong-allergytoendotoxinDemethyl-adrenalineMicro-circulatoryfailureShock,DIC,cerebraledemacerebralherniaPathologySiteoflesion:entirelargebowel-colone,sigmoid&rectumFeature:acute:diffusefibrinousexudativeinflammation,hyperemia,edema,leukocyteinfiltration,superficialnecrosischronic:edema,polypoidhyperplasistoxic:endothelialcellofmicro-capillarynecrosisClinicalmanifestationIncubationperiod:1-2day,(Hrs.To7days)Acutedysenterycommontype:onsetinsudden,shiver,highfeverabdominalpaindiarrhea:stoolmixedwithblood,mucus&pustenesmus,continenceClinicalmanifestationAcutedysenterymildtype:causedbyS.sonneilowfeverornofeverAbdominalpainismildstoolmixedwithmucus,withoutblood&pusdiagnosisbyisolationbacteriaClinicalmanifestationAcutedysentery:Toxictype:Age:2to7yrs.Abruptonset,highfever,Triseto40oCListlessness,lethargy,convulsion,coma.circulatory&respiratorycollapsediarrheamildorabsentatbeginningshockform:septicshockbrainform:respiratoryfailuremixedformClinicalmanifestationChronicdysentery:2monthsChronicdelayedtype:diahhrealong-timeandrepeatedChronicobscuretype:acutehistoryin1year,nosymptoms,stoolculturePos.orsigmoidscopyAcuteattacktype:sameascommonacutedysenteryLaboratoryFindingsBloodpicture:totalWBCcountincrease,neutrophilsincreaseStoolexamination:directmicroscopicexam.:WBC,RBC,puscellsbacteriaculture:Sigmoidoscope:shallowulcer,scar,polypsDifferentialdiagnosisAcutedysenteryAmebicdysenteryEntamebahistolyticastool:reddishbrow,likejamflask-shapedulcer,AmebictrophozoiteEnteritiscausedbyE.Coli,salmonella,viraldiarrheaIntussusception:jelly-likestools,abdominalmassandabsenceoffeverDifferentialdiagnosisChronicdysenteryRectal&coloniccarcinoma:nocureforlong-term,dropofweihtofbodynon-specificulcercolitis:nocureforlong-term,cultureofstoolisnegetive,sigmoidoscope:hemorrhage,ulcer,leadpipe.ChronicschistosomiasisJaponicaa.contactwiththedisease-waterb.hepatomegalyandsplenomegalyc.foundingtheovaofschistosomiasisJaponicaToxicdysenteryEncephalitisBbrainform:JapanessBencephalitisa.stoolb.CFS-IgMc.slowlyd.shockrarelyTreatmentCommondysenteryToxicdysenterygeneraltreatmentPathogenictreatment:ofloxineorAmp.GivenbyIVSynptomatictreatment:Controlhighfever,convulsion:sub-wintersleepTreatmentofshock:sameasECMTreatmentofcerebraledema:sameasEBCTreatmentChronicdysenteryGeneraltherapy:live,nurishing,diet,avoidoverwork,excise.Etiologictherapy:sensitiveantibioticsusedinturnorcombineduse;accordingtoresultsofculture;enema;expectanttreatment.Prevention•Controlthesourceofinfection:untilculturenegative•Interrupttedtherouteoftransmission:methodofmainly•Protctthesusceptability:F2a-secratoryIgAprotect80%-6-12mon•return