Dysentery is infectious disease occurring mainly affecting the colon and in some cases phenomena of General intoxication.
Etiology. The pathogens of dysentery - bacilli with rounded ends, motionless, gram-negative. (Amoebic dysentery - see Amebiasis.) Main types of bacterial dysentery (Grigorieva-Shigi, Fitting-Shmitta, Large-Sachs, Flexner, Sonne) differences in biochemical and antigenic properties. Currently on the territory of our country is dominated by bacteria Sonne and Flexner. The pathogens of dysentery sensitive to sunlight, high temperatures and disinfectants (bleach, carbolic acid and others).
Epidemiology. The source of infection is a sick dysentery and smear. The patients with acute dysentery particularly contagious during the first days of the disease. Patients with chronic dysentery support the incidence of dysentery in the off-season (winter). The external environment pathogen in faeces. The way of transmission - contact, food and water. Contact by transmission occurs through dirty hands, food and water as a result of eating infected food (e.g. milk and water. Mechanical carriers of infection can be flies. The incidence of dysentery higher in areas of the warm and hot climates. Lifts are observed in summer and autumn, especially in cities with high density of population and unfavorable sanitary-domestic conditions. The susceptibility of the population to dysentery high, especially in children. I had been ill formed a short-lived immunity to certain type of pathogen.
Pathogenesis. Sick more often weakened people suffering from various diseases of the gastrointestinal tract (chronic gastritis, cholecystitis , and others), parasitic infection. Bacteria dysentery, not destroyed in the stomach and past the small intestine, embedded in the lymph education colon, multiply and produce toxins, causing inflammation of the mucous membrane of the colon and General intoxication. The severity of the local process decreases in ascending order-before and most of all affected direct and sigmoid colon, then falling, transverse colon, rising, blind, and in severe cases, sometimes the small intestine. There are catarrhal-diferitele inflammation, ulceration and their regeneration; the development of intestinal dysbacteriosis (changes of the intestinal microflora). In dysbacteriosis of the number of coliform bacteria is reduced, increasing the number of conditionally pathogenic microbes (Proteus, staphylococci, fungi, and enterococci and others). The development of dysbacteriosis complicates and delays the progression of the disease. In dysentery oppressed enzymatic and motor activity of the gastrointestinal tract, reduces the absorption and synthesis of vitamins. May be a violation of protein, water-salt and carbohydrate metabolism.
The clinical picture. Acute dysentery. The incubation period of 2-5 days, sometimes 12 - 24 hours.
In typical cases of dysentery begins acutely. Temperatures rise to 38-39°, the patient complains of pains in muscles and joints, chilling, headache. Already in 1-3rd day of illness, pain in the abdomen cramping in nature, usually localized in the left half of the abdomen, frequent stools. Cal - liquid, soon becomes scarce, it appears mucus and blood in veins, in severe cases, pus and film fibrin. Retching painful defecation (tenesmus), characteristic false desires. The number of bowel movements is 10-20 times a day and more. In some cases (most often with dysentery caused by Bacillus sonnei) initially, there may be vomiting, profuse diarrhea, right-sided localization abdominal pain, and when dehydration is cramps. Tongue coated. Belly zapasy, painful during feeling along the colon, most in the left iliac region, where palpable short and painful sigmoid colon. Fever lasts 2-5 days, sometimes more. In severe intoxication marked tachycardia, drop in blood pressure, deafness tones heart. In the blood of possible leukocytosis, neutrophilic shift formula white blood to Palocco-core forms a moderate acceleration ROHE. Full development of the clinical picture is observed to 2-4-th day of illness, then, especially during the treatment, the patient's condition improves, decrease of abdominal pain, tenesmus, becomes less chair, disappears admixture of mucus and blood in the stool. Clinical recover to 8-15 th day, when most of the patients usually stops and bakterovi division. Complete recovery with recovery of all functions in 1-2 months, sometimes later. Incomplete recovery possible relapses, a protracted course, the transition into a chronic form. Apart from the typical cases of dysentery may erased, few expressed a mild case, as well as patients without clinical manifestations. The severity of dysentery decreased in the last 10-15 years. The percentage of heavy toxic forms small. On the contrary, has increased the number of forms of dysentery, which in Calais appears only admixture of mucus.