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Diagnosis of dysentery

Dysentery — the acute infectious disease proceeding with symptoms of the general intoxication and defeat of bodies of the alimentary system, mainly distal department of a large intestine. Occasionally the illness can pass into the long and chronic current.

Etiology. Activators belong to Enterobacteriaceae family, the sort Shigella. Grigoriev's bacteria — Shiga emit exotoxin, at destruction of microbic cells of other types endotoxin is formed. Ekzo-and endotoxins strike generally nervous and vascular systems. Zonne and Fleksner's sticks are steady in external environment. In the soil of a shigella remain till 30 — 45 days, in water — months. In milk, compote, kissel of a shigella of Zonne can breed. The etiological structure of shigelloses constantly changes. In Russia Grigoriev's dysentery — Shiga is not registered. Now the majority of svezhevydelenny strains of activators of a rezistentna to levomycetinum, tetracycline and streptocides.

Epidemiology. Shigelloses — antroponozny diseases. The reservoir and a source of an infection is the patient with any form of dysentery or the bacillicarrier. In distribution of an infection the greatest danger is constituted by patients with a lung and the erased course of dysentery and bacillicarriers. The mechanism of a transmission of infection — fecal and oral, the main ways — food and water, smaller value has a contact and household way. The main factor of transfer of dysentery of Zonne is the infected food, in particular milk, sour cream and other dairy products, compotes, salads, at Fleksner's shigellosis — water. Grigoriev's dysentery — Shiga and Fleksnera can be transmitted in the contact and household way. Immunity after the postponed illness short-term. Aestivo-autumnal seasonality is characteristic of dysentery.

Pathogeny. Infection and a course of a disease is possible only at hit of activators through a mouth. In a stomach and, intestines the part of activators perishes. Existence of invasive properties allows shigellas to be implemented into epithelial cells of a mucous membrane and to breed in them that conducts to death and rejection of the last. At Zonne and Fleksner's shigellosis short-term bacteremia is sometimes observed. The leading value in a pathogeny of an illness has endo-and an ekzotoksemiya, defeat of parenchymatous bodies, vascular and nervous systems. The death of an epithelium of a small bowel and involvement in pathological process of a pancreas and a liver is followed by disturbance of processes of band and pristenochny digestion, a metabolism and development of an intestinal dysbiosis. Weight and duration of a current, clinical forms and outcomes of the disease can be to a certain extent explained from positions of the infectious and immunogenetic concept of a pathogeny.

Clinic. The incubation interval averages 2 — 3 days, but can fluctuate from 1 to 7 days, at Zonne's dysentery can be estimated in 3 — 4 h. Beginning of a disease acute. The prodromal stage in the form of loss of appetite, weakness and a headache is sometimes observed. The disease begins with a fever with the subsequent temperature increase, emergence of a headache, an adynamia and symptoms of defeat of the alimentary system, generally large intestine. Patients complain of the colicy pain in a stomach mainly in the left ileal area amplifying at defecation. From the first days of an illness disorder of intestines is observed. Excrements gradually lose fecal character, impurity of slime and a streak of blood appear. False desires and tenesmus, nausea and vomiting disturb. Skin is pale, language is laid over. The palpation of a stomach is painful, especially on the course of a large intestine and in the field of an epazmirovanny sigmoid gut. Tachycardia and hypotonia are noted. At children meningeal signs and kloniko-tonic spasms are possible. At a rektoromanoskopiya it is noted catarral, the catarral and erosive or catarral and hemorrhagic and ulcer proctosigmoiditis is more rare. At most of patients with heavy and medium-weight disease the leukocytosis with a deviation to the left to band neutrocytes is observed. At microscopic examination the calla is, as a rule, noted the increased quantity of leukocytes and erythrocytes. The working scheme of clinical classification of dysentery can be presented in the following form.

I \acute dysentery, a kolitichesky form, on weight: erased, easy, moderately severe and heavy. The Gastroenterokolitichesky form, on weight: erased, easy, moderately severe and heavy.
II. Bacteriocarrier.
III. Long dysentery.
IV. Chronic dysentery (recurrent or continuous).
V. Post-dysenteric dysfunctions of digestive organs. Allocation of a bacteriocarrier in clinical classification is conditional.

At clinical laboratory and tool research the changes allowing to speak about infectious process which proceeds at the subclinical level are found. At 3 — 5% of patients transition of acute dysentery to long is observed, the chronic course of a disease is sometimes noted. Now dysentery proceeds generally in an easy and medium-weight form. At an easy shigellosis the moderate colicy pain in a stomach, in excrements small impurity of slime, sometimes blood streaks is noted. At a third of patients temperature does not exceed 38 °C, the moderate headache, weakness, an indisposition and loss of appetite disturbs. The spasm and morbidity of various departments of a large intestine are expressed poorly. The mucous membrane of a large intestine is hyperemic, erosive, hemorrhagic and ulcer changes are noted seldom.

Directed by the diagnosis of the erased dysentery results of the epidemiological anamnesis, bacteriological research a calla and THRESHING BARN matter. At Zonne's dysentery it can be observed disease
as a gastroenterokolitichesky form of food toxicoinfection with a short 3 — 12-hour incubation interval. At long or chronic dysentery are considered the instruction on the postponed acute form of an illness, existence of characteristic clinical manifestations and data of a rektoromanoskopiya, allocation of activators and positive immunological shifts. Disease till 1 — 2 months is considered acute, till 3 — 4 months — long, more than 6 months — chronic. The diagnosis of dysentery is made on the basis of listed kliniko-epidemiological yielded and results of tool and laboratory researches. Crucial importance has allocation of activators from a calla. THRESHING BARN is considered positive in credits 1: 160 and above or at 4-fold increase of an antiserum capacity in dynamics.

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