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Dysentery is an infectious disease characterized by a lesion of the gastrointestinal tract, mainly of the large intestine.
The disease is caused by bacteria of the genus Shigella. When the microbes are destroyed, a toxin is released, which plays a major role in the development of the disease and causes its manifestation.
The causative agents of dysentery are distinguished by high survival in the external environment. Depending on the temperature and humidity conditions, they persist from 3-4 days to 1-2 months, and in some cases up to 3-4 months and even more. Under favorable conditions shigella are able to reproduce in food products (salads, vinaigrette, boiled meat, minced meat, boiled fish, milk and dairy products, compotes and kissels).
Dysentery is transmitted only from a person through fecal contaminated food, water, and also on contact.
The source of the causative agent of infection in dysentery are patients, as well as bacterial carriers, which secrete shigella into the external environment with feces. Patients with dysentery are infectious with the onset of the disease. Duration of excretory excretion by patients, as a rule, does not exceed a week, but can be delayed up to 2-3 weeks.
The greatest sensitivity to infection in individuals with blood group A (II).
The leading factor in the development of the disease is the entry of bacterial poisons into the blood. First of all, the nervous, as well as the cardiovascular system, the adrenal glands and digestive organs are affected.
Shigella can be in the stomach from several hours to several days (in rare cases). Overcoming the acid barrier of the stomach, shigella enter the intestine. In the small intestine, they attach to the intestinal cells and secrete a toxin that causes increased secretion of fluid and salts into the lumen of the intestine. Shigella actively move, causing inflammation in the small intestine, which is maintained and aggravated by the action of the shigella-produced toxin. Toxin shigell, gets into the blood and causes the development of intoxication.
In the large intestine shigella fall somewhat later, but massively. This leads to a more significant effect of toxins.
Recovery in dysentery is usually accompanied by the release of the organism from the pathogen. However, when the immune system is inadequate, the organism is cleansed of the pathogen up to 1 month or more. A carrier is formed, and in a part of those who have recovered, the disease acquires a chronic course.
After the transferred disease short immunity is formed.
The incubation period is 1-7 (2-3 days on average), but it can be reduced to 2-12 hours.
The form, variant and severity of the course of dysentery depend on the ways and methods of infection, the number of microbes that have entered the body, the level of immunity of the organism.
The disease begins quickly. In the beginning, a syndrome of general intoxication develops, characterized by fever, chills, a feeling of heat, weakness, decreased appetite, headache, and lowering of blood pressure.
The defeat of the gastrointestinal tract is manifested by pain in the abdomen, at first blunt, poured throughout the stomach, having a permanent character. Then they become more acute, cramping, localized in the lower abdomen, more often on the left. Pain usually intensifies before emptying the intestine.
With a mild illness, fever is short-term, from several hours to 1-2 days, body temperature, as a rule, rises to 38 ° C.
Patients are concerned about mild abdominal pain, mainly before the act of bowel movement.
Exercises have a mushy or semi-liquid consistency, the frequency of defecations up to 10 times a day, an admixture of mucus and blood is not visible. Intoxication and diarrhea persisted for 1-3 days. Full recovery comes in 2-3 weeks.
The beginning of this form of dysentery is rapid. The body temperature with chills rises to 38 ~ 39 ° С and keeps at this level from several hours to 2-4 days.
Patients are concerned about general weakness, headache, dizziness, lack of appetite. Intestinal disorders, as a rule, join in the next 2-3 hours from the onset of the disease.
Patients appear periodic cramping pains in the lower abdomen, frequent false urges for defecation, a feeling of incompleteness of the act of defecation. The stool frequency reaches 10-20 times a day. Stools are scanty, often consist of one mucus with streaks of blood.
There is increased irritability, pale skin. The tongue is covered with a thick white coating, dryish. Intoxication and diarrhea last from 2 to 4-5 days. Complete healing of the intestinal mucosa and normalization of all body functions occur no earlier than 1-1.5 months.
The severe course of dysentery is characterized by a very rapid development of the disease, pronounced intoxication, profound disturbances in the cardiovascular system.
The disease begins very quickly. The temperature of the body with chills rises rapidly to 40 ° C and above, patients complain of severe headache, severe general weakness, increased chilliness, especially in the limbs, dizziness when getting out of bed, complete lack of appetite.
Often there are nausea, vomiting, hiccough. Patients are concerned about abdominal pain, accompanied by frequent urge to defecate and urinate. Stool more than 20 times a day, often the number of stools is difficult to count ("stool without an account"). The period of the height of the disease lasts 5-10 days. Recovery is slow, up to 3-4 weeks, complete normalization of the intestinal mucosa occurs after 2 months or more.
The diagnosis of chronic dysentery is established in case the disease lasts more than 3 months.
Treatment of patients with dysentery should be complex and strictly individualized. Bed rest is necessary, as a rule, only for patients with severe forms of the disease. Patients with moderate forms are allowed to go to the toilet. Patients with mild forms are prescribed a ward regime and therapeutic exercise.
One of the most important components in the complex therapy of intestinal patients is therapeutic nutrition. In the acute period, with significant intestinal disorders, table No. 4 is prescribed; With the improvement of the condition, the reduction of bowel dysfunction and the appearance of appetite, the patients are transferred to the table number 2, and 2-3 days before discharge from the hospital - on the general table.
Prescribe an antibacterial drug to the patient, taking into account the information about the "territorial landscape of drug resistance", i.e. Sensitivity to it shigellas, isolated from patients in this area recently. Combinations of two or more antibiotics (chemopreparations) are prescribed only in severe cases.
The duration of the course of treatment for dysentery is determined by improving the patient's condition, normalizing body temperature, reducing intestinal disorders.
With a moderate form of dysentery, the course of therapy can be limited to 3-4 days, with severe - 4-5 days. The mild dysfunction of the intestine (mushy stool up to 2-3 times a day, moderate phenomena of flatulence) that persists during early recovery should not serve as an excuse for continuing antibacterial treatment.
Patients with mild dysentery in the midst of a disease that occurs with an admixture of mucus and blood in the bowel movement, one of the following drugs is prescribed:
For moderate dysentery, doses are prescribed for fluoroquinolones:
In severe dysentery prescribed: