痢疾英文—內(nèi)科學(xué)

1、Bacillary Dysentery (shigellosis),,Definition,Acute infectious disease of intestine caused by dysentery bacilli(genus shigella) Place of lesion: sigmoid & rectum Pathological feature: diffuse fibrious exu

2、dative inflammation,Definition,Clinical manifestation: fever, abdominal pain, diarrhea, tenesmus , stool mixed with mucus blood, & pus. even companied with shock, toxic-

3、encepholopthy.,Etiology,Causative organism: dysentery bacilli, genus shigella, gram-stained negative, non-motile short rod, Groups: 4 serogroups &47 serotypes,Etiology,S. dysenteria

4、e: the most severeS. flexneri: the epidemic group and easily turn to chronicS. boydii: tropical and subonS. sonnei: the most mild,Etiology,Pathogenicity: - virulence endotoxin - exotoxin

5、- invasiveness (attach-penetrate-multiply) Resistance: Strong, 1-2week in fruits,vegetable and dirty soil, heat for 60℃ 30 min,Epidemiology,Source of infection: patients and carriersRoute

6、of transmission: fecal-oral routeSuceptibility of population: immunity after infection is short and unsteady, no cross-immune,Epidemiology,Epidemic features:season

7、: summer & fallFlexneri, Soneii, dysenteryage: younger children,Pathogenesis,number of bacteria toxicity invasivenessattachmentpenetrationmultiplication immunity,,common,Bacteria,,intestine,,,,normal intestin

8、al florasIg A,,prevent attaching,penetrate mucus,,multiply in epithelia cell & proper lamina,,,,,,endotoxin,,endogenous pyrogen,,fever,inflammationvessel contraction,,superficial mucosal necrosis and ulcer,,diarrhe

9、a mixed with blood & pus, abdominal pain,Pathogenesis-toxic,strong - allergy to endotoxin,,demethyl-adrenaline DIC,,micro-circulatory failure,,,shock, cerebral edema cerebral hernia,,,Pathology,site of

10、 lesion: entire large bowel- sigmoid colon & rectum feature:acute: diffuse fibrinous exudative inflammation,,Pathology,hyperemia, edema, leukocyte

11、 infiltration, superficial necrosis, ulcer.chronic: edema, polypoid hyperplasia,toxic: colon: hyperemia, edema, micro- capillary was invaded,Clinical manifest

12、ation,Incubation period: 1-2 day, (hours to 7 days)Acute dysenterycommon type mild typetoxic type,Clinical manifestation,common type: (typical type)acute onset , shiver, high feverabdominal pain(tender

13、ness)diarrhea: stool mixed with mucus, blood & pustenesmus, 1 week,Clinical manifestation,mild type: ( atypical type)caused by S. sonneilow fever or no feverabdominal pain is mildstool mixed with mucu

14、s, without blood & pusdiagnosis by isolation of bacteria3~7d,,Clinical manifestation,toxic type: age: 2 to 7 yrs.abrupt onset, high fever, T 40oCdysphoria, lethargy, convulsion repeatedly,coma.circu

15、latory & respiratory collapsediarrhea mild or absent at beginning,Clinical manifestation,shock form: septic shock brain form: dysphoria,lethargy,convulsion repeatedly,coma, brain hernia.

16、 respiratory failure mixed form,Clinical manifestation,chronic dysentery: > 2 monthschronic delayed type:chronic obscure typeacute attack type,Clinical manifestation,chronic delayed type: long-time a

17、nd repeated abdominal pain, diarrhea, stool mixed with mucus, blood & pus. with fatigue, anemia, malnutrition.,Clinical manifestation,chronic obscure type: acu

18、te history in 1 year, no symptoms, stool culture positive or sigmoidscopyacute attack type: same as common acute dysentery,Laboratory Findings,Blood picture: WBC

19、 count increase, (10~20×109/L) neutrophils increase Stool examination:gross examination: stool mixed with mucus, blood & pus.,Labora

20、tory Findings,direct microscopic examination: WBC, RBC, pus cellsbacteria culture:PCR:DNASigmoidoscopy: chronic patients shallow ulcer scar

21、 polyp,Differential diagnosis,acute dysenteryamebic dysentery Entamoeba histolytica stool: reddish brown, like jam flask-shaped ulcer,

22、 amebic trophozoite,Differential diagnosis,enteritis caused by E. Coli, salmonella, virus.intussusception: jam-like stools, abdominal mass absence of fever,,Differential diagnosis,chronic dysen

23、teryrectal & colonic carcinoma: no cure for long-term, drop of weight of body non-specific ulcer colitis: no cure for long-term, culture of stool is negative,,Differential diagn

24、osis,sigmoidoscopy: hemorrhage, ulcer, lead pipe.chronic schistosomiasis Japonica contact with the contaminated water hepatomegaly and splenomegaly

25、 founding the ovum of schistosomiasis Japonica,Differential diagnosis,toxic dysentery encephalitis B: highfever,convulsion,coma.<24hcirculatory failurestool examinationCSFmeningeal irri

26、tationSpecific IgM,Treatment,Common dysenteryToxic dysentery general treatmentpathogenic treatment : ofloxine Ampicillin given by IV,Treatment,symptomatic treatment:control of high fever,convulsion:

27、 subhibernation treatment of shock: same as ECMtreatment of cerebral edema: 20% mannitol,Treatment,chronic dysenterygeneral therapy: live diet, nurishing avoid overwork exercise.,etiologi

28、c therapy: sensitive antibiotics used in turn or combined use according to results of culture enema expectant treatment.,Treatment,Prevention,Control the source of infection: