Treatment of patients with shigellosis

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 1^st signs

· Tachycardia

Virtigo

Cramps (↓ K, ↓ Ca)

Oliguria

These are the 2^nd signs

· Severe muscle cramps

Hoarse voice (aphonia)

Anemia

The 3^rd 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;

• Subclinical form (all clinical signs are absent. Changes in mucosal membrane revealed in endoscopy)
• Healthy carrier states (all clinical and morphological signs are absent. Not dangerous for carrier but dangerous for others and can be the source of infection)

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:

• Culture of feaces (without blood) on Ploskiref medium
• No bacterium; in dysentery – thus cannot receive shigella in blood culture
• Serological method – indirect haemagglutination (Antibodies to shigella)
• Cuprological investigation of faeces
• Rectoromanoscopy (for differential diagnosis in non specific colitis, Crohns disease, Tumors. And also to see decreased inflammation because that is the way to we will know that he has recovered because signs will be absent due to medicines

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

• Rehydration therapy (electrolytes and fluid)

Intravenous: Asesol solution

Glucose solution

Vatrosol

Disol (without K)

Phillips solution No. 1 and 2 (without K)

Per os: Mineral water

Regidrone

Sitroglucasalone

Oralith

• Detoxication; Asorbants – Microcrystaleized sellelos

• Atriotropic therapy – Antibiotics (dose depends on stage on severity)

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

• Herbal treatment; to stimulate mucosal membrane

Дата добавления: 2015-10-29