Shigellosis (dysentery) in children

Shigellosis (dysentery) is an acute infectious disease of humans with an enteric mechanism of infection caused by bacteria of the genus Shigella. Clinically, the disease manifests itself as a colitis syndrome and symptoms of general intoxication, often with the development of primary neurotoxicosis.

ICD-10 code

• A03.0 Shigellosis caused by Shigella dysenteriae.
• A03.1 Shigellosis caused by Shigella jlexneri.
• A03.02 Shigellosis caused by Shigella boydii.
• AOZ.Z Shigellosis caused by Shigella sonnet
• A03.8 Other shigellosis.
• A03.9 Shigellosis, unspecified.

There are more than 50 known species of Shigella in humans and animals (monkeys).

Epidemiology of shigellosis in children

Shigellosis is one of the most common acute intestinal infections in children, causing both sporadic cases and epidemic outbreaks. The proportion of children among all those who fall ill with shigellosis is 60-70%, mainly children aged 2-7 years old, especially those attending preschool institutions and schools. Children in the first year of life suffer from shigellosis much less often.

The source of infection can only be a person - a sick person or a carrier of bacteria, especially patients with mild and latent forms of the disease.

Depending on the transmission factors (hands, water, food products, flies, etc.), contact, food, water, milk and other routes of infection are distinguished.

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Causes of shigellosis in children

Shigella are morphologically indistinguishable from each other - they are gram-negative, non-motile rods, do not have capsules or flagella, do not form spores, easily reproduce on ordinary nutrient media, and are facultative anaerobes.

The disease develops only when the pathogen enters the gastrointestinal tract through the mouth. The introduction of a live culture of Shigella directly into the rectum does not cause the disease.

What causes dysentery (shigellosis)?

Symptoms of dysentery in children

The incubation period depends mainly on the route of infection and the amount of the pathogen. It usually ranges from 6-8 hours to 7 days, averaging 2-3 days.

The disease almost always begins acutely, with an increase in body temperature to 38-39 °C and above, which lasts no more than 3-5 days. Often during the first day of the disease, a single and repeated vomiting is noted, which usually does not recur in the following days. Vomiting that lasts 3 days or more is not typical for shigellosis.

Symptoms of dysentery (shigellosis)

Classification of shigellosis (dysentery)

The classification is based on the division of shigellosis by etiology (Sonne's shigellosis, Flexner's shigellosis, etc.), as well as by type, severity and course.

In typical cases of shigellosis, the main clinical manifestations are clearly expressed, and first of all, the colitic syndrome with the phenomena of "distal colitis" and the syndrome of neurotoxicosis. Depending on the presence and severity of the manifestations of infectious toxicosis and the depth of the gastrointestinal tract lesion, mild, moderate and severe forms of the disease are distinguished. The severity of the disease can be determined by the prevalence of various symptoms:

• type A - predominance of symptoms of infectious toxicosis;
• type B - severity of local manifestations (frequency and nature of stool, pain syndrome, tenesmus, etc.);
• Type B - mixed type - equal severity of general toxic and local syndromes.

The division of shigellosis into types A, B, C is given only for typical moderate and severe forms.

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Diagnosis of shigellosis in children

The diagnosis is established on the basis of clinical and epidemiological data with mandatory laboratory confirmation.

PCR, as well as bacteriological and serological methods of research are used. The coprological method, as well as the results of rectoscopy, are of auxiliary importance.

Diagnosis of dysentery (shigellosis)

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Treatment of dysentery in children

Treatment can be carried out at home. Antibiotics are usually prescribed for severe forms and preferably taking into account the sensitivity of shigella circulating in a given area (region). Gentamicin, polymyxin M, ampicillin, amoxiclav, amoxicillin, nevigramon are used. For moderate and mild forms of shigellosis, it is better to prescribe nitrofurans (furazolidone, nifuroxazide), 8-oxyquinolines (chlorquinaldol, etc.). The course of treatment should not exceed 5-7 days.

Treatment of dysentery (shigellosis)

Prevention of shigellosis

Prevention of shigellosis (dysentery) is based primarily on strict adherence to the technology of preparation, storage and terms of sale of food and anti-epidemic regime in preschool and school institutions.

Early diagnosis and isolation of the patient (or shigella excretor) in a hospital or at home are important. An emergency notification to the SES (form No. 58) is filled out for all patients with shigellosis and shigellosis excretors. After isolation of the patient, final disinfection is carried out in the infection site. Contact children are placed under medical observation for 7 days, quarantine is not imposed. During the observation period, routine disinfection is carried out in the infection site, strict control of children's stool is carried out, and a stool chart is kept in the nursery groups of the kindergarten. Each child with intestinal dysfunction must be isolated and examined using a bacteriological method. The Sonne dysentery vaccine is also used.

Prevention of dysentery (shigellosis)