痢疾Bacillary-ysentery教学讲解课件-.ppt（34页）

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

2、xed with mucus blood,&pus.even companied with shock,toxic-encepholopthy.Etiologyl Causative organism:dysentery bacilli,genus shigella,gram-stained negative,non-motile short rod,lGroups:4 serogroups&47 serotypesEtiology S.dysenteriae:the most severe S.flexneri:the epidemic group and easily turn to ch

3、ronic S.boydii:tropical and subon S.sonnei:the most mildEtiologylPathogenicity:-virulence endotoxin-exotoxin -invasiveness (attach-penetrate-multiply)Resistance:Strong,1-2week in fruits,vegetable and dirty soil,heat for 60 30 min EpidemiologylSource of infection:patients and carrierslRoute of transm

4、ission:fecal-oral routelSuceptibility of population:immunity after infection is short and unsteady,no cross-immuneEpidemiologyl Epidemic features:season:summer&fall Flexneri,Soneii,dysentery age:younger children Pathogenesisl number of bacterial toxicityl invasiveness attachment penetration multipli

5、cation immunity commonBacteriaintestinenormal intestinal florasIg A prevent attachingpenetrate mucusmultiply in epithelia cell&proper laminaendotoxinendogenous pyrogenfeverinflammationvessel contractionsuperficial mucosal necrosis and ulcerdiarrhea mixed with blood&pus,abdominal painPathogenesis-tox

6、icstrong-allergy to endotoxindemethyl-adrenaline DICmicro-circulatory failure shock,cerebral edema cerebral herniaPathologyl site of lesion:entire large bowel-sigmoid colon&rectuml feature:uacute:diffuse fibrinous exudative inflammation,Pathology hyperemia,edema,leukocyte infiltration,superficial ne

7、crosis,ulcer.uchronic:edema,polypoid hyperplasia,utoxic:colon:hyperemia,edema,micro-capillary was invadedClinical manifestationlIncubation period:1-2 day,(hours to 7 days)lAcute dysenteryucommon type umild typeutoxic typeClinical manifestationcommon type:(typical type)Hacute onset,Hshiver,high fever

8、Habdominal pain(tenderness)Hdiarrhea:stool mixed with mucus,blood&pusHtenesmus,H1 week Clinical manifestationmild type:(atypical type)Hcaused by S.sonneiHlow fever or no feverHabdominal pain is mildHstool mixed with mucus,without blood&pusHdiagnosis by isolation of bacteria37dClinical manifestationt

9、oxic type:Hage:2 to 7 yrs.Habrupt onset,high fever,T 40oCHdysphoria,lethargy,convulsion repeatedly,coma.Hcirculatory&respiratory collapseHdiarrhea mild or absent at beginning Clinical manifestation shock form:septic shock brain form:dysphoria,lethargy,convulsion repeatedly,coma,brain hernia.respirat

10、ory failure mixed formClinical manifestationl chronic dysentery:2 monthsuchronic delayed type:chronic obscure typeuacute attack typeClinical manifestationchronic delayed type:long-time and repeated abdominal pain,diarrhea,stool mixed with mucus,blood&pus.with fatigue,anemia,malnutrition.Clinical man

11、ifestationchronic obscure type:acute history in 1 year,no symptoms,stool culture positive or sigmoidscopyacute attack type:same as common acute dysenteryLaboratory Findingsl Blood picture:WBC count increase,(1020109/L)neutrophils increasel Stool examination:ugross examination:stool mixed with mucus,

12、blood&pus.Laboratory Findingsldirect microscopic examination:WBC,RBC,pus cellslbacteria culture:lPCR:DNAlSigmoidoscopy:chronic patients shallow ulcer scar polypDifferential diagnosisl acute dysenteryuamebic dysentery Entamoeba histolytica stool:reddish brown,like jam flask-shaped ulcer,amebic tropho

13、zoiteDifferential diagnosisuenteritis caused by E.Coli,salmonella,virus.uintussusception:jam-like stools,abdominal mass absence of fever Differential diagnosisl chronic dysenteryurectal&colonic carcinoma:no cure for long-term,drop of weight of body unon-specific ulcer colitis:no cure for long-term,c

14、ulture of stool is negative,Differential diagnosis sigmoidoscopy:hemorrhage,ulcer,lead pipe.uchronic schistosomiasis Japonica contact with the contaminated water hepatomegaly and splenomegaly founding the ovum of schistosomiasis Japonica Differential diagnosisl toxic dysentery uencephalitis B:highfe

15、ver,convulsion,coma.24hcirculatory failurestool examinationCSFmeningeal irritationSpecific IgM TreatmentlCommon dysenterylToxic dysentery ugeneral treatmentupathogenic treatment:ofloxine Ampicillin given by IVTreatmentusymptomatic treatment:control of high fever,convulsion:subhibernation treatment o

16、f shock:same as ECMtreatment of cerebral edema:20%mannitolTreatmentl chronic dysenteryugeneral therapy:live diet,nurishing avoid overwork exercise.uetiologic therapy:sensitive antibiotics used in turn or combined use according to results of culture enema expectant treatment.TreatmentPrevention Control the source of infection:until culture negative Interrupting the route of transmission:Protecting the susceptible population:F2a-secretary IgA protect 80%-6-12mon