(Bacterial dysentery)

A Shigellosis is an acute intestinal infection caused by Shigella sp. is caused. It comes u. a. fever, nausea, vomiting, tenesmus and usually bloody diarrhea. The diagnosis is clinical and confirmed by stool cultures. The treatment of a minor infection is supportive, mostly with rehydration; Antibiotics (e.g., as ciprofloxacin, azithromycin, ceftriaxone) is added with bloody diarrhea or immunodeficiency moderat- to critically ill and high-risk patients and may shorten the duration of disease and reduce the risk of infection.

The genus Shigella is distributed worldwide and is the typical cause of inflammatory dysentery, responsible for 5-10% of diarrheal diseases in many areas. Shigella is divided into 4 main groups:

A Shigellosis is an acute intestinal infection caused by Shigella sp. is caused. It comes u. a. fever, nausea, vomiting, tenesmus and usually bloody diarrhea. The diagnosis is clinical and confirmed by stool cultures. The treatment of a minor infection is supportive, mostly with rehydration; Antibiotics (e.g., as ciprofloxacin, azithromycin, ceftriaxone) is added with bloody diarrhea or immunodeficiency moderat- to critically ill and high-risk patients and may shorten the duration of disease and reduce the risk of infection. The genus Shigella is distributed worldwide and is the typical cause of inflammatory dysentery, responsible for 5-10% of diarrheal diseases in many areas. Shigella is divided into 4 main groups: a. S. dysenteriae) B1S. flexneri) C (S. boydii) D (S. sonnei) Each subgroup is further divided into serologically-defined sub-groups. S. flexneri and S. sonnei are more widespread than S. boydii and the particularly virulent S. dysenteriae. S. sonnei is the most common in the US species detected. As a source of infection chair acts of infected humans or shedders in the recovery phase; Humans are the only natural reservoir for Shigella. A direct transfer takes place on the fecal-oral route, indirectly, the pathogen can be transmitted through contaminated food and objects. Flying serve as vectors. Because Shigella are relatively resistant to gastric acid, the uptake of only 10 to 100 organisms can cause a disease. In cramped living conditions with inadequate sanitary hygiene can cause epidemics. A Shigellosis is particularly among younger children more frequently, living in endemic areas. In adults, it usually comes in less severe cases. Patients in convalescence and subclinical shedders can represent significant sources of infection, but real Dauerausscheider are rare. A resolved infection leaves no or little immunity. Shigella penetrate the colonic mucosa and lead to a mucous secretion, hyperemia, leukocyte infiltration, edema, and often superficial mucosal ulcerations. Shigella dysenteriae type 1 (except for travelers returning from endemic areas, not indigenous to the United States) is shiga toxin, which leads to a pronounced aqueous diarrhea and sometimes causes hemolytic uremic syndrome. Symptoms and signs The incubation period for Shigella is 1-4 days. The most common manifestation is a watery diarrhea that is indistinguishable from other bacterial, viral and protozoal infections that induce secretory activity of epithelial cells. In adults, symptoms can start from shigella be episodes of abdominal pain flu urgency to defecate (urinary urgency) Passage of mushy feces that temporarily relieves the pain The episodes are becoming more frequent and severe. There is a pronounced diarrhea, with soft or liquid stools that are slimy, purulent, sometimes bloody. Severe tenesmus can lead to rectal prolapse with the following fecal incontinence. In adults, however, can also be the fever are missing and there are a non-bloody diarrhea and non-fluidal with little or no tenesmus. The complaints are mostly in adults spontaneously decline – in mild cases, in 4-8 days, in severe cases within 3-6 weeks. A significant dehydration and electrolyte loss with circulatory collapse and death occur mainly in debilitated adults and children <2 years. Rarely a shigellosis starts suddenly with rice-water-like or serous (occasionally bloody) chairs. The patient may vomit and dehydrate quickly. An infection can also manifest itself with delirium, seizures and impaired consciousness and only slightly more pronounced or no diarrhea. It may come within 12-24 hours to deaths. In young children, the disease begins suddenly with fever, irritability or drowsiness, anorexia, nausea or vomiting, diarrhea, abdominal pain and distension and tenesmus. Within three days, it comes to the appearance of blood, pus and mucus in the stool. There may be ? 20 stools / day, with a heavy weight and fluid loss. In the absence of therapy, children can die within the first 12 days. Survive the children to regress the symptoms until the second week. Complications in children can dysenteriae type 1 caused by S. Shigellosis by a hemolytic uremic syndrome are complicated. There may be secondary bacterial infections, particularly in debilitated and dehydrated patients. Severe mucosal ulcerations can cause significant blood loss. Patients (particularly those with the HLA-B27 genotype) can develop (and other enteritis) reactive arthritis (arthritis, conjunctivitis, urethritis) after shigellosis. Other complications are not common, but include seizures in children, myocarditis and rarely intestinal perforations. The infection does not become chronic and is not a risk factor for the development of ulcerative colitis. Diagnosis stool cultures Diagnosis of shigellosis is facilitated if an urgent due to an outbreak events, a stay in endemic areas and the presence of fecal leukocytes in methylene blue or Wright-stained smears suspected. Stool cultures are diagnostic and should be included; in critically ill or high-risk patients an antimicrobial susceptibility test is performed. In patients with signs of dysentery (bloody and mucous stools) Clostridium difficile infection and viral diarrhea should be a differential diagnosis also thought of infections caused by Escherichia coli, Salmonella, Yersinia, and Campylobacter as well as amebiasis. The mucosal surface is diffusely erythematous proctoscopy changed with numerous small ulcers. Although leukopenia or leukocytosis pronounced may be present, the white blood cell count average of 13,000 / ul. There is often a hemoconcentration and a diarrhea-induced metabolic acidosis. Therapy Supportive care for seriously ill or risk patients, a fluoroquinolone, azithromycin or a cephalosporin of the third generation of a loss of water caused by shigellosis is treated with oral or intravenous fluid symptomatically. Medicines for diarrhea (z. B. loperamide) may prolong the disease and should not be used. Antibiotics can reduce the symptoms and excretion of Shigella, but are not required with mild disease in healthy adults. It should, however, certain patients, including the following, are usually treated: Children Elderly Weakened patients patients with moderate to severe disease For adults, the following antibiotic regimens can be used: A fluoroquinolone (such as ciprofloxacin 500 mg PO every 12 h for 3 to 5 days) azithromycin 500 mg po on day 1 and 250 mg of 1 times a day for 4 days ceftriaxone 2 g / day i.v. for four weeks Many Shigellenisolate tend to develop resistance to ampicillin, trimethoprim / sulfamethoxazole (TMP / SMX) and tetracyclines, but the resistance patterns vary by geographic region. Prevention before handling food should be carried out hygienic hand disinfection, soiled clothing and linens should be soaked in closed buckets with an aqueous soap solution before it is cooked. Patients and providers should be adequately insulated, in particular regarding the transfer of Enteritiserregern. An oral live vaccine has been developed that has shown promise in field trials in endemic areas. However, the immunity is usually type specific. Important points Shigella sp is a highly contagious cause of dysentery; Humans are the only reservoir. Watery diarrhea may be accompanied by abdominal pain and a significant urgency to defecate; the stool may contain mucus, pus, and often blood. S. dysenteriae type 1 (occurs in the United States except in returning travelers do not frequently) produces the Shiga toxin, which can cause a hemolytic uremic syndrome. A significant dehydration and electrolyte loss with circulatory collapse and death occur mainly in debilitated adults and children <2 years. A supportive care is usually sufficient, but children, the elderly, debilitated UDN seriously ill patients are given antibiotics (a fluoroquinolone, azithromycin, ceftriaxone); resistance to ampicillin, TMP / SMX and tetracyclines is common.

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