痢疾Bacillary Dysentery课件ppt课件

1、Bacillary Dysentery (shigellosis) DefinitionlAcute infectious disease of intestine caused by dysentery bacilli(genus shigella)l Place of lesion: sigmoid & rectuml Pathological feature: l diffuse fibrious exudative l inflammationDefinitionl Clinical manifestation: l fever, abdominal pain, diarrhe

2、a, l tenesmus , stool mixed with l mucus blood, & pus. l even companied with shock, l toxic-encepholopthy.Etiologyl Causative organism: l dysentery bacilli, genus shigella, l gram-stained negative, l non-motile short rod, lGroups: 4 serogroups &47 serotypesEtiology S. dysenteriae: the most s

3、evere S. flexneri: the epidemic group and easily turn to chronic S. boydii: tropical and subon S. sonnei: the most mildEtiologylPathogenicity:l - virulencel endotoxin - exotoxinl - invasivenessl (attach-penetrate-multiply) lResistance: l Strong, 1-2week in fruits,vegetable l and dirty soil, heat for

4、 60 30 minl EpidemiologylSource of infection:l patients and carrierslRoute of transmission: l fecal-oral routelSuceptibility of population:l immunity after infection is short l and unsteady, no cross-immuneEpidemiologyl Epidemic features:lseason: summer & falllFlexneri, Soneii, dysenterylage: yo

5、unger childrenl Pathogenesisl number of bacterial toxicityl invasivenesslattachmentlpenetrationlmultiplicationl immunityl commonBacteriaintestinenormal intestinal florasIg A prevent attachingpenetrate mucusmultiply in epithelia cell & proper laminaendotoxinendogenous pyrogenfeverinflammationvess

6、el contractionsuperficial mucosal necrosis and ulcerdiarrhea mixed with blood & pus, abdominal painPathogenesis-toxicstrong - allergy to endotoxindemethyl-adrenaline DICmicro-circulatory failure shock, cerebral edema cerebral herniaPathologyl site of lesion:l entire large bowel-l sigmoid colon &

7、amp; rectuml feature:lacute: diffuse fibrinous l exudative inflammation, Pathology hyperemia, edema, leukocyte infiltration, superficial necrosis, ulcer.chronic: edema, polypoid hyperplasia,toxic: colon: hyperemia, edema, micro- capillary was invadedClinical manifestationlIncubation period: l 1-2 da

8、y, (hours to 7 days)lAcute dysenterylcommon type lmild typeltoxic typeClinical manifestationcommon type: (typical type)acute onset , shiver, high feverabdominal pain(tenderness)diarrhea: stool mixed with mucus, blood & pustenesmus, 1 week Clinical manifestationmild type: ( atypical type)caused b

9、y S. sonneilow fever or no feverabdominal pain is mildstool mixed with mucus, without blood & pusdiagnosis by isolation of bacteria37dClinical manifestationtoxic type: age: 2 to 7 yrs.abrupt onset, high fever, T 40oCdysphoria, lethargy, convulsion repeatedly,coma.circulatory & respiratory co

10、llapsediarrhea mild or absent at beginning Clinical manifestation shock form: septic shock brain form: dysphoria,lethargy,convulsion repeatedly,coma, brain hernia. respiratory failure mixed formClinical manifestationl chronic dysentery: 2 monthslchronic delayed type:chronic obscure typelacute attack

11、 typeClinical manifestationchronic delayed type: long-time and repeated abdominal pain, diarrhea, stool mixed with mucus, blood & pus. with fatigue, anemia, malnutrition. Clinical manifestationchronic obscure type: acute history in 1 year, no symptoms, stool culture positive or sigmoidscopyacute

12、 attack type: same as common acute dysenteryLaboratory Findingsl Blood picture: l WBC count increase,l (1020109/L) l neutrophils increasel Stool examination:lgross examination: stool mixed with l mucus, blood & pus. l Laboratory Findingsldirect microscopic examination: l WBC, RBC, pus cellslbact

13、eria culture:lPCR:DNAlSigmoidoscopy: l chronic patientsl shallow ulcerl scarl polypDifferential diagnosisl acute dysenterylamebic dysenteryl Entamoeba histolytical stool: reddish brown, like jaml flask-shaped ulcer, l amebic trophozoiteDifferential diagnosisuenteritis caused by E. Coli, u salmonella

14、, virus.uintussusception: u jam-like stools, u abdominal mass u absence of fever Differential diagnosisl chronic dysenterylrectal & colonic carcinoma:l no cure for long-term,l drop of weight of body lnon-specific ulcer colitis: l no cure for long-term,l culture of stool is negative, Differential

15、 diagnosis sigmoidoscopy: hemorrhage, ulcer, lead pipe.chronic schistosomiasis Japonica contact with the contaminated water hepatomegaly and splenomegaly founding the ovum of schistosomiasis Japonica Differential diagnosisl toxic dysentery lencephalitis B: highfever,convulsion,coma.l24hlcirculatory

16、failurelstool examinationlCSFlmeningeal irritationlSpecific IgMl TreatmentlCommon dysenterylToxic dysentery lgeneral treatmentlpathogenic treatment :l ofloxine l Ampicillin given by IVTreatmentusymptomatic treatment:ucontrol of high fever,convulsion:u subhibernation utreatment of shock: same as ECMutreatment of cerebral edema: u 20% mannitolTreatmentl chronic dysenterylgeneral therapy:l livel diet, nurishingl avoid overworkl exercise.uetiologic therapy: u sensitive antibiotics u used in turn or comb