Shigellosis (bacterial dysentery) symptoms

Dysentery has an incubation period, which in most cases is limited to 2-5 days, after which symptoms of dysentery appear. The duration of the disease is from several days to 3 months, shigellosis lasting more than 3 months is regarded as chronic.

Classification shigellosis, adopted at the present time, takes into account the severity of the main syndromes, the nature of the disease, the type of pathogen.

[1], [2], [3], [4], [5], [6], [7],

Symptoms of dysentery with a colitis option

This variant of the disease course is diagnosed most often in clinical practice. When it is determined by the characteristic signs of shigellosis, especially with severe and moderate flow. Dysentery, as a rule, begins acutely, in some patients it is possible to establish a short-term prodromal period, manifested by a short feeling of discomfort in the abdomen, a slight chill, a headache, weakness. After the prodromal period (and more often against a background of complete health), characteristic symptoms of the disease appear. First of all, the following symptoms of dysentery occur: cramping pains in the lower abdomen, mainly in the left ileal region; Sometimes the pain has a diffuse character, atypical localization (epigastric, umbilical, right iliac region). The peculiarity of the pain syndrome is its decrease or short-term disappearance after defecation. The urge to defecate appears at the same time as pain or a little later. The stool is initially fecal, gradually the volume of feces decreases, an admixture of mucus and blood appears, the frequency of defecations increases. At the height of the disease, stools can lose their stool and have the form of a so-called rectal spitting, i.e. Consist only of a scant amount of mucus and blood. Defecation can be accompanied by tenesmus (pulling convulsive pains in the anus), often there are false desires. The admixture of blood is most often insignificant (in the form of blood points or veins). When palpating the abdomen, spasm is noted, less often - soreness of the sigmoid colon, and sometimes - flatulence. From the first day of the disease, there are signs of intoxication: fever, malaise, headache, dizziness. Possible cardiovascular disorders closely associated with the syndrome of intoxication (extrasystole, systolic murmur at the apex, muffled heart sounds, fluctuations in blood pressure, the presence of changes in the electrocardiogram, indicative of diffuse changes in the left ventricle of myocardium, overload of the right heart).

The duration of clinical symptoms in the uncomplicated course of acute shigellosis is 5-10 days. The majority of patients first normalize the temperature and disappear other signs of intoxication, and then normalizes the stool. Longer lasting pain in the abdomen. Criterion of severity of the flow in patients with shigellosis is the severity of intoxication, lesions of the gastrointestinal tract, as well as the state of the cardiovascular, central nervous system and the nature of the lesion of the distal part of the colon.

Symptoms of dysentery with a gastroenterocolitis option

Symptoms of dysentery of this variant consist in the fact that the onset of the disease resembles a food poisoning, and at the height of the disease the symptoms of colitis appear and come to the fore. The gastroenteric variant of acute shigellosis downstream corresponds to the initial period of the gastroenterocolitis variant. The difference is that in later terms the symptoms of enterocolitis do not dominate and clinically this variant of the current is more similar to foodborne disease. With sigmoidoscopy, less pronounced changes are usually observed.

Symptoms of dysentery with erased current

This form of the disease has short-term and unexplained symptoms of dysentery (1-2-fold disorder of the stool, short-term abdominal pain), no symptoms of intoxication. Similar cases of the disease are diagnosed in the determination of sigmoidoscopic changes (usually catarrhal) and the isolation of shigella from feces. The protracted course of acute shigellosis is said to occur when the main clinical symptoms do not disappear or resume after a short-term remission within 3 weeks to 3 months.

Bacteriosis of dysentery

This form of infectious process includes cases when there are no clinical symptoms of dysentery at the time of examination and in the previous 3 months, with sigmoidoscopy and isolation of shigella from feces do not reveal changes in the mucosa of the colon. The bacteriocarrier can be convalescent (immediately after the acute shigellosis has been transferred) and subclinical if the shigella isolates streets that have no clinical manifestations and changes in the mucosa of the distal colon.

[8], [9], [10], [11], [12]

Symptoms of chronic dysentery

Chronic disease is recorded in cases where the pathological process lasts more than 3 months. Chronic shigellosis in the clinical course is divided into two forms - recurrent and continuous. With a relapsing form, periods of exacerbation are replaced by remission. The exacerbations are characterized by clinical symptoms characteristic of the colitis or gastroenterocolitis variant of acute shigellosis, but with a weak expression of intoxication. With continuous flow of the colitis syndrome does not subside, note hepatomegaly. In chronic shigellosis, sarcomas and moderate atherosclerotic and atrophic changes are also observed on sigmoidoscopy.

Features shigellose Grigoriev-Shigi

Symptoms of dysentery of this form are mainly severe, characterized by a sharp onset, intense cramping pains in the abdomen, chills, an increase in body temperature to 40 ° C. The chair in the first day in appearance resembles meat slops, then the volume of feces decreases, there is an admixture of blood and pus. Mark tenesmus. In a number of cases, infectious-toxic shock is observed, sepsis with sowing of the pathogen from the blood, hemolytic-uremic syndrome may develop. Hypovolemic shock occurs with copious stool and early vomiting.

Complications of dysentery

ITH, serous (swelling of the intestinal wall) or perforated (with circular necrosis or deep ulcerous defects) peritonitis, acute pancreatitis. Motor disorders can lead to intussusception. Described intestinal and gastric bleeding, myocarditis, polyarthritis, nephritis, iridocyclitis, polyneuritis, toxic hepatitis. In patients with an unfavorable premorbid background and severe shigellosis, pneumonia and acute cardiovascular insufficiency develop, which is one of the main causes of death.

[13], [14], [15], [16]

Mortality

Mortality in Russia in the 70-80-ies. The last century did not exceed 0.2%, in the 90s. Due to the predominance of the highly pathogenic agent Shigella Flexner 2A, lethality increased fivefold, and during individual flares reached 6%. Since the late 90's. Note a decrease in mortality.