Classification and clinical manifestations of bacillary dysentery
Posted on | November 1, 2009 | No Comments
The incubation period is generally 1 to 3 days (a few hours to 7 days). Premorbid history of more than a dirty food. Based on their clinical course and is divided into acute and chronic illness, as well as two of six clinical types.
(1) acute dysentery can be divided into three types.
1. Acute typical rapid onset, chills, fever, mostly 38 ~ 39 ℃ above, accompanied by dizziness, headache, nausea and other symptoms of systemic poisoning, and abdominal pain, diarrhea, fecal slurry paste, or dilute the beginning was water up to, following the then it was mucus or mucus pus and blood, the amount of small, daily bowel movements 10 times to dozens of varied, accompanied by tenesmus. The left lower quadrant tenderness obvious, palpable spasm of the intestinal cord. Course of about a week or so. A small number of patients with severe vomiting may be due, rehydration is not timely dehydration, acidosis, electrolyte disorder, occurs secondary shock. In particular, patients with previous cardiovascular disease in elderly patients and children with weak resistance, can have life-threatening. A very small number of patients with exacerbations possible; turn into a toxic bacillary dysentery.
2. Acute atypical type generally do not heat or low-grade fever, abdominal pain, light, diarrhea, the number of small, 3 to 5 times a day, mucus and more general non-visual sepsis will, no tenesmus. Course is usually 4 to 5 days.
3. This type of acute poisoning-type prevalent in the 2 to 7 years old able-bodied children, rapid onset, rapid progress in critical condition, a high fatality rate. A sudden onset of high fever, intestinal symptoms was not obvious, according to their clinical presentation into three clinical types.
(1) shock (peripheral circulatory failure type): the more common type, to the major manifestations of septic shock: ① pale lips or grant Violet purple; upper damp and cool, the skin was shaped pattern, the skin that positive pressure (oppression of the skin and then filling time “2 seconds). ② fall in blood pressure, usually <10.7kpa (80mmHg), pulse pressure smaller, <2.7kpa (20mmHg). ③ breakdown pulse, heart rate fast ( “100 times / min), children up to 150 ~ 160 times / min, heart sounds weak. ④ oliguria (<30ml / h) or no urine. ⑤ appeared disoriented. The above items are also five kinds of indicators to determine whether their condition is better. Difficult to reverse shock in severe cases, concurrent DIC, pulmonary edema, can cause respiratory failure, or peripheral trunk MSOF, but life-threatening. Pulmonary edema, X-ray suggested that near the point of flake density increased hilar shadows, accompanied by increased bronchial texture. Showed a typical acute onset of individual cases are available at 24 ~ 48 hours into a toxic bacillary dysentery, should take it seriously.
Clinical features of a toxic bacillary dysentery, for systemic symptoms of poisoning and diarrhea symptoms were severe, frequent diarrhea, mostly bloody will, or even fecal incontinence. Due to dehydration and acidosis, often in the short-term shock.
(2), brain type (respiratory failure type) as a serious a serious clinical types. Early may have severe headache, frequent vomiting, and showed a typical jet-like vomiting; pale lips hair gray; may be slightly elevated blood pressure, breathing and pulse may be slightly slow; sleepiness or irritability associated with different levels of consciousness, intracranial hypertension, cerebral edema and early clinical manifestations. Late showed repeated seizures, blood pressure, pulse small speed, respiratory rhythm is incomplete, uneven shades such as central respiratory failure; pupils ranging from time and other large circle, or suddenly big suddenly small, light, slow or disappeared; muscle tension increased tendon hyperreflexia, there may be pathological reflex; consciousness obviously deepened, until he lost consciousness. Into a coma, all the reflex.
(3) mixed simultaneously or successively for more than two types exist, is the most serious type of a clinical case fatality rate is very high (90% above). This type of substance, including circulatory, respiratory and central nervous system damage and multiple organ failure (MOF).
2. Persistent unhealed chronic dysentery disease more than 2 months or more is called chronic dysentery, and acute phase of treatment is more timely or not thorough, bacterial resistance, or a decline in body resistance, often due to poor diet, cold, fatigue or mental factors induced. Based on the clinical manifestations are divided into the following three types:
(1) acute onset type of this type accounts for about 5%, its main clinical manifestations typical of acute dysentery with, but to a lesser extent, recovery is not complete, usually a six-month history of diarrhea or recurrence of history, while the group of dysentery bacteria with the exception of re-infection , or a different group of dysentery diarrhea caused by bacteria or other bacterial infection.
(2) The persistent occurrence rate of about 10% of the type often have abdominal discomfort or pain, bloating, diarrhea, pus and blood viscosity and other gastrointestinal symptoms will light when the heavy, persistent unhealed can then secrete alternating diarrhea and the emergence of a long duration of the may have insomnia, dreaminess, forgetfulness, etc. neurasthenia-like, as well as fatigue, weight loss, loss of appetite, anemia and other manifestations. Left lower abdominal tenderness, palpable, and sigmoid colon, showed cord-like.
(3) The hidden evil thought this type of incidence of Type 2 ~ 3%, within a year there bacillary dysentery history, clinical symptoms disappeared two months or more, but the train can be detected in fecal dysentery bacteria, sigmoidoscopy examination showed mucosal lesions. This type in the epidemiology of great significance.
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