Identification and diagnosis of bacillary dysentery
Posted on | November 1, 2009 | No Comments
Of acute bacillary dysentery should work with other causes of acute diarrhea caused by differential phase
(1) amebic dysentery (also known as intestinal amoebiasis)
(B) Salmonella enteritidis Salmonella typhimurium enteritis, often for their pathogenic bacilli, its main clinical symptoms of gastrointestinal type of atypical acute bacillary dysentery with similar, but feces diversification, the general efficacy of antimicrobial agents is poor, a detachable stool cultures Salmonella bacteria, or from the disease in patients with sepsis-type cultivate pathogens.
(C) Vibrio parahaemolyticus enteritis such enteritis by vibrio parahaemolyticus (halophilic bacteria) cause. Of bacterial food poisoning in the common type. Its clinical characteristics: a history of eating seafood or pickled foods; meals are simultaneously or successively with the rapid onset; the main symptoms are paroxysmal abdominal cramps, nausea, vomiting, multi-non-tenesmus; stool was mucus bloody, bloody, or wash the meat water samples, there are special smell; get vomiting and diarrhea in patients with suspicious objects or foods have confirmed the value of bacterial culture.
(D) of cholera and cholera infected areas from the previous week, or with the patients and their history of exposure to pollutants. A sudden onset, first, after diarrhea vomit, often without symptoms such as nausea, abdominal pain, fecal samples showed m Gan or yellow water. Severe cases can result in peripheral circulatory failure. Fecal matter or vomit froth or Ai Ertuo detected in Vibrio cholerae.
(E) of Campylobacter jejuni enteritis in the developed countries, a high incidence of this disease, surpassing even dysentery, the main clinical manifestation and bacillary dysentery are similar yet with sore throat, muscle pain, joint pain, back pain and other symptoms. Stool in micro-aerobic or anaerobic environment, can be detected in cultured bacteria, or the double serum specific antibody titers increased 4-fold or more, and diagnostic value.
(Vi) more than viral enteritis by rotavirus, Norwalk virus-induced acute intestinal infection year has its own self-limiting, gastrointestinal symptoms of light, no special stool microscopy, electron microscopy, or immunological methods investigations and virus or virus-like particle can be confirmed, double serum specific antibody titers four times higher than growth of diagnostic significance.
In addition, acute bacillary dysentery should work with intussusception, Yersinia pestis disease, enterotoxigenic Escherichia coli enteritis, class adjacent to the single-cell bacteria Shigella diarrhea, hydrophilic Aeromonas differentiated from diseases such as diarrhea.
Bacillary dysentery with toxic symptoms should be differentiated from the following:
(A) febrile seizures this disease more common in infants, past more than a history of febrile seizures and repeated episodes can often find out the cause the cause of febrile seizures and triggers. 1 The fever subsided after treatment convulsions that followed.
(B) toxic pneumonia in this patient has traveled more than a cold pre-history of pneumonia and septic shock with multiple symptoms and signs, appeared earlier, chest X-ray evidence of lung infection prompted. Without typical clinical manifestations of intestinal infection. Faeces (including rectal examination) to check the absence of exceptional discovery.
(C) Japanese encephalitis (JE for short) took place in the summer and fall season, toxic bacillary dysentery be differentiated from the same Japanese encephalitis. Japanese encephalitis symptoms of central nervous system has a process, which also required a very heavy 2 to 3 days, compared with late toxicity of Health bacillary dysentery. Faeces (including rectal examination and enema) microscopy no abnormal; bacterial culture negative. CSF examination showed changes in viral meningitis; Japanese encephalitis virus-specific IgM antibody-positive have diagnostic value.
(D) of cerebral malaria and cerebral be differentiated from toxic dysentery. From infected areas, combined incidence of the season in order to intermittent sudden chills, fever, sweating hot back the clinical features, blood film or bone marrow may be the film to find the parasite diagnosis.
(V) dehydration shock mainly due to the history of frequent vomiting and diarrhea caused by hemorrhagic shock. First, dehydration, after the shock. Once the correct shock or dehydration was subsequently corrected.
(Vi) severe heat stroke in a history of exposure to high temperatures. Rectal temperature and high fever, skin hot and sweat-free can be accompanied by convulsions, coma and other neurological symptoms, but no location signs. Patients were moved to a cool well-ventilated place, the condition can quickly ease. Peripheral blood, stool and cerebrospinal fluid examination no abnormalities.
Chronic bacillary dysentery with the following diseases should be differentiated from
(A) The differential diagnosis of chronic amoebic dysentery and acute phase of their roughly the same.
(B) of chronic non-specific ulcerative colitis poor general condition in patients with the disease, symptoms persistent unhealed, antibiotic treatment ineffective. Repeated stool cultures no pathogens. Intestinal bleeding points, crisp, easy access to bleeding. Barium enema or barium thoroughly check the whole digestive tract, intestinal wrinkles disappear, the late colon bag disappeared, colon shorter, characterized by a narrow lumen.
(C) more than secondary to intestinal tuberculosis tuberculosis, sputum acid-fast staining or 24-hour sputum concentration method to be investigated, see Mycobacterium tuberculosis, intestinal lesions more in ileocecal, so the right lower abdominal tenderness or a palpable mass, barium enema X-ray examination helps diagnose.
(D) of rectal cancer, colon cancer more common in the elderly, the concurrent local infection resembles bacillary dysentery is required pursuant to the anus rectal examination, colonoscopy and diagnosed by means of intestinal biopsy.
(E) intestinal flora imbalance due to abuse of anti-drug, or broad-spectrum anti-drug use a longer time, it can lead flora. Enteric bacilli mainly reduced or disappeared, replaced by golden grapes, fungi (mainly Candida albicans) and some Gram-negative bacteria, or anaerobic infections, diarrhea, inflammation show unhealed, stool may vary due to pathogens, with nipples very young, the elderly and the infirm are more common.
Comments
Leave a Reply