传染病学课件yuzebo1bacillary

Bacillarydysentery Shigellosis Infectiousdiarrhea 2020 3 3 Shigellosis 2 Patientxxx female 25 year old nursemaid Suddenlyonset2daysagowithgeneralmalaise chill fever fatigue headacheandcrampingabdominalpain especiallyinleftinferiorabdomen thenfolloweddiarrheawithwaterstoolinitially andthenbloodypurulentstools 10 20timesperday accompaniedwithburningsensationatAnus tenesmus Fivedaysagothiswomanhadnursedadiarrheapatient Casereport Termexplanation Tenesmusistheconstantfeelingoftheneedtopassstool accompaniedbypain crampingbecauseofinflammatoryofthebowel butlittlestoolispassed 2020 3 3 Shigellosis 3 PE T39 5 R30 m P110 m BP110 80mmHg Press painontheleftinferiorabdomenBloodtest WBC12 5 109 L neutrophilicleukocyte85 Stooltest WBC50 60 HP RBC20 30 HP Questions1 Whatdiseaseisthepatientsufferedfrom 2 Whatistheprincipleoftreatmentforthispatient 3 Howtopreventthisdisease 2020 3 3 Shigellosis 4 Contents GeneralconditionEtiologyEpidemiologyPathogenesisClinicalmanifestationLaboratoryexaminationDiagnosisDifferentialdiagnosisTreatmentPrevention 2020 3 3 Shigellosis 5 1 Generalcondition Definition Shigellosisisalsocalledbacillarydysentery thisisanacutebacterialdiseasecharacterizedbyfever nausea vomiting cramps diarrheaandfeelingoftenesmuscausedbyShigellaspecies Inmostcases thestoolscontainbloodandmucus Tenesmusistheconstantfeelingoftheneedtopassstool accompaniedbypain crampingbecauseofinflammatoryofthebowel butlittlestoolispassed 2020 3 3 Shigellosis 6 TypicalclinicalfeaturesShigellaistransmitteddirectlyorindirectlyviathefecal oralrouteandmayoccurduetotheingestionofcontaminatedfoodorwater Wholebodysymptoms feverandtoxemia chill fatigue headache Localsymptoms diarrhea bloodypurulentstools abdominalpain tenesmus Signs Press painontheleftinferiorabdomen Laboratoryexamination Bloodtest WBC neutrophilStooltest WBC RBC 2020 3 3 Shigellosis 7 2 Etiology Shigella Gram facultativeanaerobic withorwithoutoxygen rodbacteriaVerysimilartoE colipH survivesinneutralpH resistanttostomachacidsTemperature dependsonserotype Cansurviveat4 Cfor21daysincheese potato saladandmayonnaiseCansurviveandgrowatunder25 Cfor50daysinflour milk eggs shrimps oysters 2020 3 3 Shigellosis 8 Etiology 4serogroups A S dysenteriaeMostsevere Bacillarydysentery developingcountriesinAfrica LatinAmerica AsiaB S flexneriMostcommonShigellaindevelopingcountries becomingmorecommonindevelopedcountriesC S boydiiD S sonneiLeastsevere developedcountries Inchina BandD 2020 3 3 Shigellosis 9 2020 3 3 Shigellosis 10 Shigellabacteriainastoolsample Underhighpowermicroscope 2020 3 3 Shigellosis 11 Gramstain Shigella 2020 3 3 Shigellosis 12 SeveralmediahavebeendesignedtoselectivelygrowentericbacteriaandallowdifferentiationofSalmonellaandShigellafromE coli Theprimaryplatingmediashownhereareeosinmethyleneblue EMB agar MacConkeyagar ENDOagar Hektoenenteric HE agarandSalmonella Shigella SS agar 2020 3 3 Shigellosis 13 3 Epidemiology Worldwide majorcauseofdiarrhea165millioncases year 99 indevelopingc Isabout5 15 ofallcasesofdiarrhea mostlykids 4yrs600 000to1 1milliondeaths yearChina 32 36cases 100 000peopleNepal India Thereisnoaccuratedata 2020 3 3 Shigellosis 14 Epidemiology Inindiansubcontinent Shigellaflexneriisthemostcommonserogroupisolated antibioticresistancetonalidixicacidishigh andciprofloxacinresistanceisemerging ChangingEpidemiologyofShigellosisandEmergenceofCiprofloxacinResistantShigellaeinIndia JOURNALOFCLINICALMICROBIOLOGY Feb 2007 p 678 679 2020 3 3 Shigellosis 15 ChangingEpidemiologyofShigellosisandEmergenceofCiprofloxacinResistantShigellaeinIndia JOURNALOFCLINICALMICROBIOLOGY Feb 2007 p 678 679 ShigellaisolatesofNepal Changesintheincidenceofshigellasubgroupsandtrendsofantimicrobialsusceptibilitypattern KathmanduUniversityMedicalJournal 2007 Vol 5 No 1 Issue17 32 37 2020 3 3 Shigellosis 16 Epidemiology SourceofinfectionAcuteorchronicpatientsandcarriersRouteoftransmissionFoodorwatercontaminatedbyfecesSusceptibilityMostpeople especiallyinchildrenCanacquiretemporaryimmunityafterinfection 2020 3 3 Shigellosis 17 Shigella Transmission OnlyinfectshumansLowinfectiousdose 200organismsPrimarilyperson to person fecal oralspread Outbreaks foodandwaterborneDevelopedcountry militarybases travelersDevelopingcountry refugeecamps followingnaturaldisaster 2020 3 3 Shigellosis 18 4 Pathogenesis Smallintestine LittlereproductionProduces Shiga toxin LikecholerawaterstoolsLargeintestine Colonization attaches invadesandmultipliesincellsinflammatoryresponseandcelldeathBloodymucusstools 2020 3 3 Shigellosis 19 2020 3 3 Shigellosis 20 animation ShigellaPassingThroughtheMucousMembraneandInvadingMucosalEpithelialCells 2020 3 3 Shigellosis 21 Pathogenesisoftoxicdysentery Overall themechanismisnotclear Itmayberelativetosuper allergyreactioncausedbyendotoxin particularlyinchildrenwithspecialimmunity Toxicencephalopathyisresponsiblefordeathofchildren 2020 3 3 Shigellosis 22 5 Clinicalmanifestation Incubationperiod 1to2days upto7days Duration courseofdisease 4daysto2weeks 2020 3 3 Shigellosis 23 Clinicaltype TypicaltypeMildtypeToxictype 2 ChronicShigellosis 1 AcuteShigellosis 2020 3 3 Shigellosis 24 Clinicaltype TypicaltypeSymptoms SuddenlyonsetWholebodytoxemia chill fever fatigue headache Crampingabdominalpain especiallyinleftinferiorabdomenDiarrhea waterstoolinitially thenbloodypurulentstools 10 20timesperday BurningsensationatAnus tenesmus duetonervesofrectumbeingstimulatedbylocalinflammation asymptomcharacterizedbyincompletesenseofevacuationwithrectal anus painSigns Press painontheleftinferiorabdomen appendicitis ontheright 2020 3 3 Shigellosis 25 Clinicaltype MildtypeMildtoxemia nosignificantfeversometimesWithouttypicalbloodypurulentstools thefrequencyofthestoolsislessthan10timesperday Mostcasescanrecovercompletelyandtherestmaybedevelopedintochronic 2020 3 3 Shigellosis 26 Clinicaltype ToxictypeUsuallyfoundinhealthychildrenwith2 7yearsold Onsetsuddenlywithfever 400C andserioustoxemiaToxinencephalopathyMentaldisorder lethargy comaandconstrictions Toxinencephalopathyrespiratoryfailure Infectiousshock BPdecrease skinbecomecold multiorganfailureinvolvesthekidney lungs andliver DIC disseminatedintravascularcoagulation andheartfailuremayalsooccur Withoutdiarrheaorabdomenpainusually 2020 3 3 Shigellosis 27 Clinicaltype ChronictypeHavingapasthistoryofacutebacillarydysenteryHavingrecurrentorpersistentabdominalpain accompaniedbydiarrheaoralternationofdiarrheaandconstipation Intermittentappearanceofmucopurulentandblood stainedstools 2020 3 3 Shigellosis 28 6 Laboratoryexamination Generallyspeaking Virusinfectiousdiseases WBCisnormalBacterialinfectiousdiseases WBCisveryhigher EpidemicencephalitistypeB WBCishigher Infectiousmononucleosis WBCishigher Tuberculosis WBCisnormalTyphoidfever WBCislower Specialcircumstances virus Bacterial 2020 3 3 Shigellosis 29 Laboratoryexamination H a ematology Bloodtest WBC 10 20 109 LStooltest Bloodypurulentappearance Leukocytescanbefound 15 HPBacteriaculture thedysenterybacillusofthecultureisagoldenstandardofdiseasediagnosis Early frequently freshlycollectsample inoculatedculture canimproveculturepositiverate Bloodculture unnecessary 2020 3 3 Shigellosis 30 Shigellosis Possiblecomplications Intestinalperforation RarelyoccursSepticemia usuallycausedbyBserogroups S flexneri ReactiveArthritis Reiter ssyndrome after2weeksofShigellosis Severaljointsareusuallyaffectedatonce especiallytheknees Italsooccursaftergenitaltractinfection suchasgonorrhea HUS HemolyticUremicSyndrome causedbyS dysenteriaeorEHEC enterohemorrhagicE coliO157 hemolyticanemia andacuterenalfailure 2020 3 3 Shigellosis 31 7 Diagnosis Epidemicdata exposedtopatients Clinicalfeature typicaltype LaboratoryfindingsAimingtotoxicdysentery checkingstoolsbydigitalrectalexamination DRE orcoldsaltliquidenemaisthemostimportantdiagnosismethod 2020 3 3 Shigellosis 32 8 Differentialdiagnosis Acutedysentery Amebicdysentery seebelowtable Chronicdysentery colitis corn disease tumorDependoncolonendoscopeandbiopsyToxicdysentery encephalitis suchasencephalitisB TheonsetoftoxicdysenteryismorequicklythanencephalitisB Toxicdysenteryisaccompaniedwithcirculationfailureorshock checkingstoolsbycoldsaltliquidenemacanprovidevaluableclue 2020 3 3 Shigellosis 33 2020 3 3 Shigellosis 34 9 Treatment AcutedysenteryAntibioticsmedicationisveryimportant Toseverecases treatmentwithantibioticscanshortenthedurationoftheillness andcanreducetheperiodofexcretionoftheorganism Tomildcases treatmentwithantibioticsisunnecessary 2020 3 3 Shigellosis 35 Selectionofantibiotics Thefirstlinemedicationshouldbequinolones suchasnorfloxacin 0 4tidforadult orCiprofloxacin 0 2tidforadult orOfloxacin 0 2tidforadult Thedurationis3 5daysfortypicalcases Forseverecases Quinoloneor3rdcephalosporin suchasCeftriaxoneorcefotaximewerechosenwithveinroute Becauseofhighdrug resistanceandunsafety sulphonamidesorchloramphenicolwerenotrecommended 2020 3 3 Shigellosis 36 RehydrationTreatment Althoughdehydrationisnotacommonfeatureofshigellosisinfection butifitoccursorthestoolsarewatery patientsshouldbegiventheoralrehydrationsalt ORS recommendedbyWHO UNICEF UnitedNation sInternationalChildren sEmergencyFund Inseveredehydration intravenousfluidsisrecommendedHowever clinicalexperienceindicatesthatORSisbeneficialinallcasesofshigellosisifgivenasroutinefluidintake 2020 3 3 Shigellosis 37 NursesisencouragingpatienttodrinkanORS OralRehydrationSolution toimprovedehydration 2020 3 3 Shigellosis 38 Symptomatictreatment Abdomenpain atropine0 5mg ImHighfeverortoxemia dexamethasone DXM Shock HigheffectandbroadspectrumantibioticsSupplyenoughfluidintravenouslyDrugsthatconstrictthebloodvesselsmaybegiventoboostbloodflowtothebrainorheart dopamine 10 20 g kg min Glucocorticoid suchasDXMtoreducesymptomoftoxemia 2020 3 3 Shigellosis 39 Toxicbacillarydysentery AntibioticsadministerintravascularlyAnti shockPreventandcurehydrocephalusDehydrationwith20 mannitol125ml 250ml q4 12hInhaleoxygenKeeprespiratoryfunctionnormal 2020 3 3 Shigellosis 40 10 Shigellosis Prevention 1 Controlthesourceofinfecti