Dysentery (shigellosis) is among 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, funds have appeared that allow the effective treatment of dysentery.
Disease in the past
Humanity has known about dysentery since ancient times. This term appeared back 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 for which diarrhea was characteristic.
Dysentery in the past was a terrible disease. There was no cure for her. Epidemics flared up around the world. From preserved historical sources it is known that a major outbreak of the disease occurred at the very beginning of the XV century. in France. In the city of Bordeaux, the most people died - about 14 thousand people. Subsequently, epidemics were recorded in Germany, and the Netherlands, and in other countries. Most often, outbreaks provoked natural disasters, wars.
The first statement on the existence of the causative agent of dysentery dates back to 1891. It was made by Alexei Vasilievich Grigoriev, a Russian microbiologist and pathologist. He wrote the work "On microorganisms in dysentery," expressed his opinion on the development of the disease due to the ingestion of special immobile intestinal rod-shaped bacteria into the human body.
After a few years, the pathogen was isolated in a pure culture. This discovery was made by a Japanese doctor and microbiologist Kiyoshi Shiga (in some sources his name is written a little differently - Shiga). Later, specialists became interested in dysentery, symptoms, treatment and prevention of this disease. Studies have identified other pathogens. They were named after their discoverers (Flexner, Sonne, Stutzer-Schmitz, etc.)
Prevalence of the disease at present
Modern medicine knows all about dysentery. Specialists have found drugs that kill pathogens. However, the prevalence of the disease is still high. Even deaths continue to be recorded. Official statistics show that approximately 200 million people experience dysentery each year. About 1.1 million people die from this disease.
Dysentery is encountered in all modern countries. However, the most common disease in developing countries, where the population lives in unsatisfactory sanitary conditions:
- with low quality drinking water;
- unsanitary housing;
- the presence of strange customs and prejudices, etc.
Shigellosis is recorded throughout the year. However, the largest number of patients regarding the treatment of dysentery begins to turn in the summer-autumn period. This seasonality is explained by several factors - the ripening and consumption of vegetables, fruits, berries, bathing in ponds that are contaminated with sewage.
Dysentery, as can be seen from statistics, is not an absolutely fatal disease. Fatalities are mainly recorded in developing countries. In developed countries, death from this ailment is a relatively rare occurrence, because measures have been developed for the prevention and treatment of dysentery. It is worth noting that the likelihood of death increases in people with malnutrition. Also at high risk include:
- children and adults over 50;
- babies who are breast-fed;
- immunocompromised patients;
- persons who develop dehydration, loss of consciousness is observed.
The causative agent of dysentery
Shigellosis can cause a whole group of related microorganisms. Pathogens belong to the Enterobacteriaceae family and the genus Shigella. They are gram-negative motionless sticks. Specialists distinguish 4 types of these microorganisms:
- Shigella dysenteriae, serogroup A, 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.
The causative agent of dysentery is inherent in the external environment. As a rule, sticks remain viable from 3 days to 2 months. Specialists know that in soil pathogens can be active for up to several months, in sewage waters - from 25 to 30 days. Microorganisms, when ingested, and in the presence of favorable conditions, actively reproduce, are stored 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, a 1% solution of phenol.
Source of infection, transmission mechanism 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 bacteriocarrier. It is important to note that insects (cockroaches, flies) play an important role in the spread of infection, which carry sticks on their paws from soil, feces.
The mechanism of Shigella transmission is fecal-oral. It is implemented in several ways:
- food;
- water;
- contact household.
The cause of infection by food is the use of products that are not subjected to heat treatment. Pathogens may be present in milk, dairy and meat products, vegetables, berries and fruits. With 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 in their mouths.
Sexual transmission of shigella is still described in the literature. It was first mentioned in 2000. Previously, specialists did not encounter this transmission method. In 2000, there was an outbreak in New South Wales - in one of the clubs in this city. She touched gay men (homosexuals).
Classification of the disease and signs of classical dysentery
For many years, specialists studied dysentery, adult symptoms, and treatment at home and in the hospital. The work carried out in the past made it possible to compile several classifications of shigellosis. Depending on the severity of the disease, there are:
- light form;
- moderate form;
- severe form.
According to the duration of the course of dysentery, acute, protracted and chronic forms are distinguished. At the first of them, symptoms can torment a whole month. For a protracted course, the presence of signs of the disease for 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 options - colitic, gastroenterocolitic, gastroenteric. The colitic variant is considered a classic (most common) manifestation of dysentery. It is caused by pathogens such as Shigella dysenteriae and Shigella flexneri. It is characterized by a certain clinical picture:
- The incubation period lasts from 1 to 7 days. Symptoms do not appear at this time.
- After the incubation period, the prodromal period sometimes begins with a slight chill, headache, discomfort in the abdomen.
- Most often, after the end of the incubation period, the height of the disease begins. Symptoms are observed 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), urges to defecate.
- With proper treatment of dysentery at home or in the hospital, the period of convalescence begins, when the body is freed from the pathogen, all previously impaired functions are restored.
Features of the digestive tract in classic dysentery
The disease causes a violation of the functions of all parts of the gastrointestinal tract. The salivary glands are inhibited, dry mouth begins to be felt. The stomach also suffers from a disease. Firstly, the secretion of gastric juice changes. Many people with dysentery are diagnosed with low acidity. In some patients, achlorhydria is observed - a condition in which hydrochloric acid is absent in the gastric juice. Secondly, the motility of the stomach is perverted.
The chair with dysentery is frequent up to 3-5 times a day. In severe cases, bowel movements can occur 20-30 times a day. In the early hours, the chair is fecal, plentiful, liquid or semi-liquid. Further, he loses his fecal character. The stool becomes mucous. Later, blood and pus appears in them.
Gastroenterocolitic and gastroenteric variants of dysentery
The gastroenterocolitic variant of dysentery usually causes Shigella sonnei. In the initial period, the disease resembles foodborne toxicosis. At the same time, syndromes of general intoxication and gastroenteritis develop. Later enterocolitis syndrome comes to the fore. This variant of dysentery is characterized by a short incubation period - only 6-8 hours, and in some cases it is even shorter.
After the incubation period, body temperature rises, pain in the epigastric region appears. Patients who turn to specialists about the treatment of dysentery at home or in the hospital complain of nausea, vomiting. A rumbling is heard in the stomach. Later, pains begin to be felt throughout the abdomen. There are frequent urge to the toilet. Feces are characterized by a light yellow or greenish color. They may contain pieces of undigested food, mucus. On day 2-3, a colitic 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 desires. Some in the bowel movements appear blood. Vomiting stops. On examination, spasm and moderate soreness of the sigmoid colon are revealed.
In the gastroenteric variant, the causative agent is most often Shigella sonnei, less commonly, Shigella flexneri. The initial period of the disease is similar to the gastroenterocolitic variant. Differences appear later. In late terms, the dominance of enterocolitis is not observed. Throughout the illness, signs of gastroenteritis and dehydration are leading. These features bring the gastroenteric variant of dysentery closer to foodborne toxic infections.
Chronic dysentery
In about 4% of cases, acute dysentery becomes chronic. This happens if there are special factors - due to some characteristics of the pathogen, diseases of the digestive system, improper diet. The transition of the acute form of dysentery to chronic with treatment carried out incorrectly or untimely is still possible.
Chronic dysentery is divided into 2 forms - recurrent and continuous. The first of them is characterized by alternating periods of exacerbation and periods of complete well-being. With relapses, health 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 abdominal pains, false desires disturb.
For continuous dysentery, periods of remission are not inherent. The pathological process is progressing. The condition of a person suffering from continuous dysentery worsens. The patient during the disease develops deep and trophic changes in the colon. All digestive organs are involved in the pathological process. Intestinal dysbiosis 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" refers to 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. For this ailment, a fecal-oral transmission mechanism is also characteristic. 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 that belongs to the simplest. The causative agent is completely different, therefore, the treatment of dysentery is required differently. If there are signs of a bacterial form, a differential diagnosis is performed to exclude infection with amoeba and other diseases.
Amebiasis is characterized by certain distinctive signs, features. Here is a list of them:
- gradual onset of the disease;
- a tendency to a protracted, chronic and undulating course;
- pain in the abdomen (most often they torment on the right side);
- thickening of the cecum and enlargement of the liver;
- the presence in the stool of blood and mucus (for such a stool, one characteristic is suitable - "raspberry jelly");
- weight loss;
- anemia;
- stay at the time of infection in the Central Asian region, tropics, subtropics.
The diagnosis of amoebiasis is made only after the tissue form of amoeba is found in the feces. All patients must be hospitalized. In the treatment of amoebic dysentery, mainly drugs such as Tinidazole and Metronidazole are used. These are antiprotozoal agents.
Disease treatment
Dysentery is treated at home or in the 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. Drugs are selected for each patient, taking into account contraindications, tolerance of the components. The principle of comprehensiveness includes:
- bed rest in severe forms of the disease during the high season, prolonged physiological sleep, therapeutic exercises, elimination of the effects of all negative irritants on the body;
- diet
- etiotropic, pathogenetic and symptomatic treatment of dysentery.
Regarding nutrition, it is worth noting that for serious intestinal disorders, table No. 4 is assigned, and shortly before recovery - table No. 2. After the body is restored, they switch to a common table. During treatment, as well as within a month after recovery, fatty and fried foods, spicy seasonings, smoked meats, and alcoholic beverages are not included in your diet.
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, Ofloxacin, Ciprofloxacin are used to treat dysentery. Pathogenetic treatment includes the appointment of heavy drinking, solutions for oral rehydration, infusion-detoxification therapy. Symptomatic therapy is prescribed to eliminate the tormenting signs of the disease. For example, antispasmodics are used to relieve spasm of the colon.
Preventative measures
If you always follow the measures to prevent dysentery, you will not have to face treatment. General preventive measures include compliance with sanitary standards in the home. Firstly, before cooking and eating food, after going to the toilet, you should always wash your hands with soap. Secondly, vegetables, fruits and berries should always be washed with running water before use. It is recommended that the fruit be doused with boiling water, because pathogens die from high temperature. Thirdly, all perishable products should be stored in the refrigerator. Fourth, all raw foods must undergo heat treatment (for example, meat needs to 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 the hospital. Self-medication is unacceptable, because without diagnosis and without the availability of medical knowledge it will not work to choose an effective drug. An improperly selected product will cause harm.