痢疾.ppt

BacillaryDysentery(shigellosis),Definition,Acuteinfectiousdiseaseofintestinecausedbydysenterybacilli(genusshigella)Placeoflesion:sigmoid&rectumPathologicalfeature:diffusefibriousexudativeinflammation,Definition,Clinicalmanifestation:fever,abdominalpain,diarrhea,tenesmus,stoolmixedwithmucusblood,&pus.evencompaniedwithshock,toxic-encepholopthy.,Etiology,Causativeorganism:dysenterybacilli,genusshigella,gram-stainednegative,non-motileshortrod,Groups:4serogroups&47serotypes,Etiology,S.dysenteriae:themostsevereS.flexneri:theepidemicgroupandeasilyturntochronicS.boydii:tropicalandsubonS.sonnei:themostmild,Etiology,Pathogenicity:-virulenceendotoxin-exotoxin-invasiveness(attach-penetrate-multiply)Resistance:Strong,1-2weekinfruits,vegetableanddirtysoil,heatfor6030min,Epidemiology,Sourceofinfection:patientsandcarriersRouteoftransmission:fecal-oralrouteSuceptibilityofpopulation:immunityafterinfectionisshortandunsteady,nocross-immune,Epidemiology,Epidemicfeatures:season:summer&fallFlexneri,Soneii,dysenteryage:youngerchildren,Pathogenesis,numberofbacteriatoxicityinvasivenessattachmentpenetrationmultiplicationimmunity,common,Bacteria,intestine,normalintestinalflorasIgA,preventattaching,penetratemucus,multiplyinepitheliacell&properlamina,endotoxin,endogenouspyrogen,fever,inflammationvesselcontraction,superficialmucosalnecrosisandulcer,diarrheamixedwithblood&pus,abdominalpain,Pathogenesis-toxic,strong-allergytoendotoxin,demethyl-adrenalineDIC,micro-circulatoryfailure,shock,cerebraledemacerebralhernia,Pathology,siteoflesion:entirelargebowel-sigmoidcolon&rectumfeature:acute:diffusefibrinousexudativeinflammation,Pathology,hyperemia,edema,leukocyteinfiltration,superficialnecrosis,ulcer.chronic:edema,polypoidhyperplasia,toxic:colon:hyperemia,edema,micro-capillarywasinvaded,Clinicalmanifestation,Incubationperiod:1-2day,(hoursto7days)Acutedysenterycommontypemildtypetoxictype,Clinicalmanifestation,commontype:(typicaltype)acuteonset,shiver,highfeverabdominalpain(tenderness)diarrhea:stoolmixedwithmucus,blood&pustenesmus,1week,Clinicalmanifestation,mildtype:(atypicaltype)causedbyS.sonneilowfeverornofeverabdominalpainismildstoolmixedwithmucus,withoutblood&pusdiagnosisbyisolationofbacteria37d,Clinicalmanifestation,toxictype:age:2to7yrs.abruptonset,highfever,T40oCdysphoria,lethargy,convulsionrepeatedly,coma.circulatory&respiratorycollapsediarrheamildorabsentatbeginning,Clinicalmanifestation,shockform:septicshockbrainform:dysphoria,lethargy,convulsionrepeatedly,coma,brainhernia.respiratoryfailuremixedform,Clinicalmanifestation,chronicdysentery:2monthschronicdelayedtype:chronicobscuretypeacuteattacktype,Clinicalmanifestation,chronicdelayedtype:long-timeandrepeatedabdominalpain,diarrhea,stoolmixedwithmucus,blood&pus.withfatigue,anemia,malnutrition.,Clinicalmanifestation,chronicobscuretype:acutehistoryin1year,nosymptoms,stoolculturepositiveorsigmoidscopyacuteattacktype:sameascommonacutedysentery,LaboratoryFindings,Bloodpicture:WBCcountincrease,(1020109/L)neutrophilsincreaseStoolexamination:grossexamination:stoolmixedwithmucus,blood&pus.,LaboratoryFindings,directmicroscopicexamination:WBC,RBC,puscellsbacteriaculture:PCR:DNASigmoidoscopy:chronicpatientsshallowulcerscarpolyp,Differentialdiagnosis,acutedysenteryamebicdysenteryEntamoebahistolyticastool:reddishbrown,likejamflask-shapedulcer,amebictrophozoite,Differentialdiagnosis,enteritiscausedbyE.Coli,salmonella,ussusception:jam-likestools,abdominalmassabsenceoffever,Differentialdiagnosis,chronicdysenteryrectal&coloniccarcinoma:nocureforlong-term,dropofweightofbodynon-specificulcercolitis:nocureforlong-term,cultureofstoolisnegative,Differentialdiagnosis,sigmoidoscopy:hemorrhage,ulcer,leadpipe.chronicschistosomiasisJaponicacontactwiththecontaminatedwaterhepatomegalyandsplenomegalyfoundingtheovumofschistosomiasisJaponica,Differentialdiagnosis,toxicdysenteryencephalitisB:highfever,convulsion,coma.24hcirculatoryfailurestoolexaminationCSFmeningealirritationSpecificIgM,Treatment,CommondysenteryToxicdysenterygeneraltreatmentpathogenictreatment:ofloxineAmpicillingivenbyIV,Treatment,symptomatictreatment:controlofhighfever,convulsion:subhibernationtreatmentofshock:sameasECMtreatmentofcerebraledema:20%mannitol,Treatment,chronicdysenterygeneraltherapy:livediet,nurishingavoidoverworkexercise.,etiologictherapy:sensitiveantibioticsusedinturnorcombinedu