Dysentery in children

In recent years, dysentery in children is most often caused by bacteria Sonne and Flexner, and Grigorieva - Shiga lost etiological significance. In connection with this increased number of lung and rubbed forms of the disease.
Postmortem found fibrinous-necrotic changes in the intestinal wall and toxic-dystrophic changes in most organs caused by intoxication and disturbance of water-salt metabolism.
The duration of the incubation period 1-7 days, usually 2-3 days. Distinguish mild, moderate and severe dysentery. Mild forms of dysentery proceed without toxicity, with the rise of temperature to 37,5-38o, rising chair up to 4-8 times a day. The admixture of blood in the stool and tenesmus may be missing.
In moderate form of the disease marked intoxication, the temperature in the beginning of the disease is promoted to 39-40°, cramping abdominal pain, cal streaked with blood, the impurity green and mucus, chair quickens up to 15-20 times a day.
In severe cases, the disease progresses rapidly strongly pronounced intoxication or political syndrome, with a temperature of 40 degrees and above. Frequent uncontrollable vomiting, continuous tenesmus. From the rectum stand out mucus, herbs, blood. Can cause paralysis of the anal sphincter, gaping anus. Belly first, swollen, then falls in, probed spasticeski condensed sigmoid colon. As a result large loss of fluids, salts and alkalis with vomit and liquid stools deterioration of the water-saline and acid-base balance with the development of exitosa, acidosis, which leads to lesion of the Central nervous system and cardiovascular system (collapse).
Difficulties for diagnosis are atypical forms of dysentery, when there are no leading symptoms. Atypical forms of dysentery diverse. In some cases, dysentery develops gradually, without toxicity, fever, diarrhoea nature of the chair, In other cases - with lightning speed. In first place are severe toxicity, lesion of Central nervous system (convulsions, loss of consciousness); and the cardiovascular system (collapse). The clinical picture resembles shock. Lethal outcome may occur prior to the development of intestinal symptoms. Dysentery in children of the first year of life flows in 90-95% of cases typically, however, some characteristic features - tenesmus are replaced with their equivalent (crying, anxiety, skin person when urinating), chair does not lose fecal nature and the blood may not be in every package. For any form of dysentery in children of the first year of life is characterized by the appearance of secondary abortion on 2-3rd week of the disease.
The course and outcome of dysentery depend on many factors: the child's condition before the disease, timely and correct treatment, etc. there are acute for (2-3 weeks), subacute (1-1 .5 months), long (1.5-2 months.) and chronic. Currently, with the right treatment transition dysentery in the chronic form is not more than 2-3% of cases. The transition of the disease into a chronic form promote rickets, deficiencies, malnutrition, giardiasis and other
Treatment of dysentery. Children from preschool institutions subject to compulsory hospitalization, even with suspected dysentery, diagnostic departments for further diagnosis and correct treatment in order to avoid recurrent, persistent and chronic forms.
Treatment of dysentery provides for a comprehensive use of the methods of detoxification, antibiotic therapy, diet and symptomatic funds. With the aim of detoxification and re-hydration (restore water balance in the body of the child impose isotonic solution of sodium chloride, the solution Ringera, 5 - 10% glucose solution based 150-180 ml per 1 kg of weight per day. The method of introducing of these solutions depends on the state of the child: in severe dysentery-parenteral. To combat toxicosis enter plasma 5-10 ml per 1 kg of weight (under medical supervision), as well as gemodez (Peniston, neocompsa) in the amount of 8 - 10 ml per 1 kg of weight.
At the height of toxic manifestations in dysentery child, you must assign water-tea diet within 12-24 hours. With the decrease of toxic effects children up to 1 year gently appoint expressed breast milk or kefir. The older children in the acute period of the disease should receive liquid dairy-vegetarian food with subsequent translation into age-appropriate diet. Use one of the following antibiotics: tetracycline, terramycin inside (per 1 kg of weight per day) for 20 000-25 000 UNITS, monomitsin inside of 25 000 IU, polymyxin into 100 000 IU, streptomycin 15 000-20 000 IU intramuscularly, neomycin inside of 8000 UNITS. Antibiotics 7-10 days. In the treatment of dysentery are widely used vitamins, intramuscular immunoglobulin ( from 1.5 to 3 ml 3 times a day. In severe toxemia and dehydration designate potassium chloride 40-100 mg/kg / day. When I take a 5% solution of potassium chloride and plant it in 5% glucose solution at the rate of 10 ml solution of potassium chloride in 100 ml glucose solution. Enter in the vein slowly drip way with the speed of 1/5 of the daily requirement in 1 hour. In severe toxicosis shows the use of prednisolone at the rate of 1 mg/kg in the morning, with a gradual reduction of the dose at 2-or 3-day treatment and elimination of the drug on the 10-12-th day.