Dysentery stool

Introduction Bacillary dysentery is a common acute intestinal infectious disease caused by dysentery bacilli. It is characterized by colonic suppurative inflammation, with symptoms of systemic poisoning, abdominal pain, diarrhea, urgency, and pus and blood. Because of the different clinical manifestations and diseases, medical scientists divide dysentery into common dysentery, poisoning dysentery and chronic dysentery. Although there are many types of dysentery, only heavy and poisonous types are threatening to children's lives. Most of the children with poisoning dysentery have sudden onset, high fever, and the intestinal symptoms are often not obvious at the beginning of the disease. Some patients have dysentery-like stools after a day or so. Anal canal or 2% saline enema is helpful for early diagnosis before the discharge of typical dysentery. In the peak season of dysentery, the child suddenly had a high heat and was very weak, and his face was gray.

Cause

Bacterial dysentery (abbreviated as bacillary dysentery) is caused by Shigella. Shigella dysenteria is a Gram-negative facultative bacterium. It is not motivated and grows well in common medium. The optimum temperature is 37 ° C. It can survive for about 10 days in fruits, vegetables and pickles. It can survive in milk for 24 days. For a long time; survive for several weeks in dark, damp and frozen conditions. Direct sunlight has a killing effect. When heated at 60 ° C for 10 minutes, it will die. Generally, the disinfectant can kill it.

All dysentery bacilli produce endotoxin, cytotoxin, and enterotoxin (exotoxins), and Shigella dysenteriae can still produce neurotoxins. Shigella has bacterial antigen O and surface antigen K, and has its group and type specificity. According to biochemical reaction and antigen composition, Shigella is divided into four groups: group A (Shigella dysenteriae), B group (B. faecalis), gamma group (B. baumannii), Ding group (M. sinensis). Endotoxin can be produced in all four groups, and exotoxin can also be produced in group A. Four kinds of dysentery bacilli can cause common dysentery and poisoning dysentery. The pathogens of dysentery in China are mainly Shigella dysenteriae, and there are increasing trends in Song and Bower's disease: 1A group: including Shigella and its serotypes 1-15. Group 2B: including Fusarium and its serotypes: 1a to c, 2a to b, 3a to c, 4a to c, x, y and the like. 3C group: including Bacillus and its serotypes 1-18. 4D group: S. genus: clinically specific serum can be used for agglutination for stereotyping. Currently, F. and S. sinensis predominate, and Shigella is still prevalent in some areas. The infection of Fusarium is easy to turn into chronic, and the infection of Song's bacteria is mostly atypical. The virulence of Shigella is the strongest and can cause serious symptoms.

Shigella dysenteria has an adsorption and invasion effect on colonic mucosal epithelial cells, and strains that are invasive to intestinal mucosal epithelial cells can cause typical lesions of the colon, while strains that are not invasive to epithelial cells do not cause lesions. The short-chain fatty acids, hydrogen peroxide, and colicin produced by gastric acid and intestinal flora have a killing or antagonizing effect on Shigella. Specific antibodies such as secretory IgA produced by the human intestinal mucosa have an important rejection effect on Shigella. Certain factors that are sufficient to reduce the body's systemic and gastrointestinal local defense functions, such as chronic diseases, excessive fatigue, overeating, and digestive tract disorders, are beneficial to the invasion of intestinal mucosa by dysentery bacilli.

Shigella bacillus invades the intestinal mucosa epithelium and has a layer and multiplies in it, causing inflammation of the intestinal mucosa. The lamina propria has capillary and venous congestion, and there is exudation and infiltration of cells and plasma, and even the lamina propria can be small. Vascular circulatory failure, resulting in degeneration or even necrosis of epithelial cells, necrotic epithelial cells can form small and superficial ulcers, resulting in abdominal pain, diarrhea, pus and bloody stools. The rectal sphincter is stimulated and has a sense of urgency, and endotoxin can cause systemic fever.

an examination

Related inspection

Fecal pH (fecal pH) dysentery bacillus detection fecal phagocyte feces microscopic examination of fecal cells

In the epidemic season, abdominal pain, diarrhea and pus and bloody stools should be considered. Patients in the acute phase have more fever and more often appear before the symptoms of digestive tract. The history of past seizures in patients with chronic disease is very important. Stool smear microscopy and bacterial culture contribute to the establishment of diagnosis. Sigmoidoscopy and X-ray barium examination have certain value in identifying chronic bacillary dysentery and other intestinal diseases. In the season of bacillary dysentery, children with sudden fever, convulsions and no other symptoms must consider the possibility of poisonous bacillary dysentery. It should be taken soon or later with anal test specimens or saline broth for smear microscopy and bacterial culture.

Differential diagnosis

It should be identified with the following conditions:

(a) amoebic dysentery

The onset is generally slow, with few symptoms of toxemia. The urgency is less severe, the stool frequency is less, the abdominal pain is mostly on the right side, and the typical stool is jam-like and rancid. Microscopic examination only saw a small number of white blood cells, red blood cells condensation group, often with Charcot-Ryden's crystal, you can find the amoeba trophozoite. Sigmoidoscopy, see most of the mucosa is normal, there are scattered ulcers. The disease is easy to complicated with liver abscess.

(2) Epidemic encephalitis B

The disease manifestation and epidemic season are similar to those of dysentery (heavy or poisoned). The latter is more acute, rapid progress, and easy to have shock. It can be warmed by saline enema and microscopic examination and bacterial culture. In addition, the disease should be differentiated from Salmonella infection, Vibrio parahaemolyticus food poisoning, Escherichia coli diarrhea, Campylobacter jejuni enteritis, viral enteritis. Chronic bacillary dysentery should be differentiated from chronic schistosomiasis, rectal cancer, and non-specific ulcerative colitis.

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