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1、医学痢疾医学痢疾DefinitionlAcute infectious disease of intestine caused by dysentery bacilli(genus shigella)l Place of lesion: sigmoid & rectuml Pathological feature: l diffuse fibrious exudative l inflammationPathogenesisl number of bacterial toxicityl invasiveness attachment penetration multiplication imm
2、unityl commonBacteriaintestinenormal intestinal florasIg A prevent attachingpenetrate mucusmultiply in epithelia cell & proper laminaendotoxinendogenous pyrogenfeverinflammationvessel contractionsuperficial mucosal necrosis and ulcerdiarrhea mixed with blood & pus, abdominal painPathogenesis-toxicst
3、rong - allergy to endotoxindemethyl-adrenaline DICmicro-circulatory failure shock, cerebral edema cerebral herniaPathologyl site of lesion:l entire large bowel-l sigmoid colon & rectuml feature:uacute: diffuse fibrinous u exudative inflammation, Pathology hyperemia, edema, leukocyte infiltration, su
4、perficial necrosis, ulcer.uchronic: edema, u polypoid hyperplasia,utoxic: colon: hyperemia, edema, micro- capillary was invadedClinical manifestationlIncubation period: l 1-2 day, (hours to 7 days)lAcute dysenteryucommon type umild typeutoxic typeClinical manifestationcommon type: (typical type)Hacu
5、te onset , Hshiver, high feverHabdominal pain(tenderness)Hdiarrhea: stool mixed with H 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 H blood & pusHdiagnosis by is
6、olation of bacteriaH37dClinical manifestationtoxic type: Hage: 2 to 7 yrs.Habrupt onset, high fever, T 40oCHdysphoria, lethargy, convulsion H repeatedly,coma.Hcirculatory & respiratory collapseHdiarrhea mild or absent at beginning Clinical manifestation shock form: septic shock brain form: dysphoria
7、,lethargy,convulsion repeatedly,coma, brain hernia. respiratory 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 wi
8、th mucus, blood & pus. with fatigue, anemia, malnutrition. Clinical manifestationchronic obscure type: acute history in 1 year, no symptoms, stool culture positive or sigmoidscopyacute attack type: same as common acute dysenteryLaboratory Findingsl Blood picture: l WBC count increase,l (1020109/L) n
9、eutrophils increasel Stool examination:ugross examination: stool mixed with mucus, blood & pus. Laboratory Findingsldirect microscopic examination: WBC, RBC, pus cellslbacteria culture:lPCR:DNAlSigmoidoscopy: l chronic patients shallow ulcer scar polypDifferential diagnosisl acute dysenteryuamebic d
10、ysentery Entamoeba histolytica stool: reddish brown, like jam flask-shaped ulcer, amebic trophozoiteDifferential diagnosisuenteritis caused by E. Coli, u salmonella, virus.uintussusception: u jam-like stools, u abdominal mass u absence of feverDifferential diagnosisl chronic dysenteryurectal & colon
11、ic carcinoma:u no cure for long-term,u drop of weight of body unon-specific ulcer colitis: u no cure for long-term,u culture of stool is negative, Differential diagnosis sigmoidoscopy: hemorrhage, ulcer, lead pipe.uchronic schistosomiasis Japonica contact with the contaminated water hepatomegaly and
12、 splenomegaly founding the ovum of schistosomiasis Japonica Differential diagnosisl toxic dysentery uencephalitis B: highfever,convulsion,coma.24hcirculatory failurestool examinationCSFmeningeal irritationSpecific IgM TreatmentlCommon dysenterylToxic dysentery ugeneral treatmentupathogenic treatment
13、 :u ofloxine u Ampicillin given by IVTreatmentusymptomatic treatment:control of high fever,convulsion: subhibernation treatment of shock: same as ECMtreatment of cerebral edema: 20% mannitolTreatmentl chronic dysenteryugeneral therapy:u liveu diet, nurishingu avoid overworku exercise.uetiologic ther
14、apy: u sensitive antibiotics u used in turn or combined useu according to results of cultureu enemau 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 34 结束语结束语