Diagnosis of shigellosis (bacterial dysentery)
Last reviewed: 23.04.2024
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Clinical diagnosis of dysentery is based on a typical colitis variant of the course of the disease. To clarify the diagnosis in unconfirmed laboratory cases, a sigmoidoscopy is performed, which in all cases of shigellosis reveals a picture of colitis (catarrhal, hemorrhagic or erosive-ulcerative) with lesions of the mucous membrane of the distal colon, often sphincteritis. Gastroenteric and gastroenterocolitis variants are diagnosed only in case of laboratory confirmation. The most reliable method of laboratory diagnosis of shigellosis is the allocation of copra culture Shigella. For the study, particles of feces containing mucus and pus (but not blood) are collected, a rectal tube can be taken from the rectum. For sowing, use 20% bile broth, Kaufman's combined medium, selenite broth. The results of bacteriological examination can be obtained no earlier than 3-4 days after the onset of the disease. The isolation of the hemoculture is important in the shigellosis of Grigoriev-Shigi. In some cases of gastroenteritis, presumably shigellosis etiology, a bacteriological study of the gastric washings is carried out. The diagnosis can also be confirmed by serological methods. Of these, the most common method is with standard erythrocyte diagnosticums. The growth of antibodies in paired sera taken at the end of the first week of the disease and after 7-10 days is considered diagnostic. And an increase in the titer by four times. Also used ELISA, RCA, it is possible to use the reactions of the hemagglutination unit and the RSK. Auxiliary diagnostic method - coprological study. In which an increased content of neutrophils, their accumulations, the presence of red blood cells and mucus in the smear.
Of the instrumental methods, the endoscopic diagnosis of dysentery (sigmoidoscopy and colonoscopy) is of primary importance, which confirms the characteristic changes in the mucous membrane of the colon.
Ultrasound and X-ray methods of investigation are used for the purpose of differential diagnosis.
[Indications for consultation of other specialists
Urgent consultation of a surgeon and / or gynecologist in case of suspected acute surgical and gynecological pathology of the abdominal organs, urgent consultation of the resuscitator - with signs of an infectious-toxic shock, consultations of other specialists - with exacerbation of concomitant diseases.
Indications for hospitalization
- Clinical: severe and moderate course of the disease, the presence of severe concomitant diseases.
- Epidemiological: persons of decreed groups.
Differential diagnosis of dysentery
Most often, they are carried out with other diarrheal infections, acute surgical abdominal pathology, ulcerative colitis, tumors of the distal part of the colon.
Salmonellosis presents difficulties for differential diagnosis in the presence of a colitis syndrome, acute appendicitis - in atypical course (diarrhea, unusual localization of pain), mesenteric thrombosis - if there is - blood in the bowel movement, acute or subacute variants of ulcerative colitis - in cases of fever, rapid increase in diarrhea and the appearance of blood in feces, cancer of the distal part of the colon - in the malosymptomatic course of the disease, if diarrhea and intoxication develop due to infection of the tumor.
Example of the formulation of the diagnosis
Acute shigellosis, a colitis variant, a course of moderate severity.