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Treatment of patients with shigellosis

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GIT infections

 

  1. Main syndromes:
    1. Gastritis
    2. Enteritis
    3. Colitis
    4. Gastroenteritis
    5. Enterocolitis
    6. Gastroenterocolitis

 

  1. Syndrome of intoxication
    1. Fever
    2. Chills
    3. Headache
    4. General malaise

Can occur without intoxications; Cholera

Food poisoning

Botulism

 

  1. Syndrome of dehydration:

3 (4) stages of dehydration (isotonic type in GIT infections)

 

· Thirst

Dryness of oral cavity

2 – 3 % loss of water

These are the 1st signs

 

· Tachycardia

Virtigo

Cramps (↓ K, ↓ Ca)

Oliguria

These are the 2nd signs

 

· Severe muscle cramps

Hoarse voice (aphonia)

Anemia

The 3rd signs

 

Cholera

Syndrome of cholera - Enteritis or gastroenteritis

Diarrhoea not due to inflammation

Toxins by vibrio cholera affect adenocyclase system

Increased peristalsis gives diarrhea

Without intoxication

 

 

Shigellosis (bacterial shigellosis)

 

2 main clinical forms according to syndromes

1. Gastroenteritic form

2. Colitic form

 

Also intoxication syndrome can occur; Collapse

Weakness

Fever

Headache

Diarrhea

 

These symptoms are in colitic form

Dehydration syndrome cannot occur in colitic form

 

Therefore criteria of severity in colitic form

 

  1. Frequency of stool: > 30 times / day – severe

10 – 30 times / day – moderate

< 10 times / day – light

 

  1. According to intoxication: Temperature > 39 – 40 *C – Severe

< 38 * C – Light

 

Gastroenteritic form; syndrome of dehydration can occur

 

Other clinical forms of shigellosis

 

  1. Acute (above 2 forms)
  2. Chronic; gastroenteritic form with relapses or colitic form with constant diarrhea

 

Atypical forms of shigellosis;

 

Etiology; Shigella Zonei

Shigella Flexnor

Shigella Gigori Shiga

 

Most severe is dysentery with Flexinor

 

Source of infection is man (affected or ill person)

 

 

Way of spread: Faecal – oral

Unwashed fruits and vegetables, milk

 

Transmission; In water (unboiled), food

 

Intoxication period; 1 – 7 days

(depends on amount of microbe)

With direct contact incubation is prolonged

 

Methods of investigation:

 

Amoebic dysentery difference with shigella dysentery

 

Amoeba Shigella
Normal temperature (Subfebrile) Caecum involvement Tenesmus is not typical Raspberry jelly faeces (mucous and blood mixed) Extra intestinal manifestations Abscess of different regions (liver, lungs) Therefore increased liver size Can transform to chronic form often Acute Blood and mucous separate in faeces  

 

 

Treatment of patients with shigellosis

 

Intravenous: Asesol solution

Glucose solution

Vatrosol

Disol (without K)

Phillips solution No. 1 and 2 (without K)

 

Per os: Mineral water

Regidrone

Sitroglucasalone

Oralith

 

Light – Nutrofurans

Moderate – Tocirolones or Siplocks PO and Aminoglycosides - Gentamycin IM 80 mg 3 x /5 days

Severe – Tocinolones IV 10 – 13 days treatment

 

These leads to disbacteriosis

Therefore after antibiotic treatment restore useful microbes;

Bactisuptide remedies

Bifidum

Holibacterine (only adults)

Lactobaterine

 

10 days for 1 month

 


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