《醫(yī)學(xué)痢疾》課件

BacillaryDysentery

(shigellosis)Dept.OfInfectiousDiseaseHuangFenDefinitionAcuteinfectiousdiseaseofintestinecausedbydysenterybacilli(genusshigella)

Placeoflesion:sigmoid&rectum

Pathologicalfeature:

diffusefibriousexudative

inflammationDefinition

Clinicalmanifestation:fever,abdominalpain,diarrhea,

tenesmus,stoolmixedwithmucusblood,&pus.evencompaniedwithshock,toxic-encepholopthy.Etiology

Causativeorganism:dysenterybacilli,genusshigella,gram-stainednegative,non-motileshortrod,Groups:4serogroups&47serotypesEtiologyS.dysenteriae:

themostsevereS.flexneri:theepidemicgroupandeasilyturntochronicS.boydii:

tropicalandsubonS.sonnei:themostmildEtiologyPathogenicity:-virulence

endotoxin

-exotoxin

-invasiveness

(attach-penetrate-multiply)

Resistance:Strong,1-2weekinfruits,vegetableanddirtysoil,heatfor60℃30min

EpidemiologySourceofinfection:

patientsandcarriersRouteoftransmission:fecal-oralrouteSuceptibilityofpopulation:immunityafterinfectionisshortandunsteady,nocross-immuneEpidemiology

Epidemicfeatures:season:summer&fallFlexneri,Soneii,dysenteryage:youngerchildren

Pathogenesis

numberofbacteriatoxicityinvasivenessattachmentpenetrationmultiplicationimmunity

commonBacteriaintestinenormalintestinalflorasIgApreventattachingpenetratemucusmultiplyinepitheliacell&properlaminaendotoxinendogenouspyrogenfeverinflammationvesselcontractionsuperficialmucosalnecrosisandulcerdiarrheamixedwithblood&pus,abdominalpainPathogenesis-toxicstrong-allergytoendotoxindemethyl-adrenalineDICmicro-circulatoryfailureshock,cerebraledemacerebralhernia

Pathology

siteoflesion:

entirelargebowel-sigmoidcolon&rectumfeature:acute:diffusefibrinousexudativeinflammation,Pathology

hyperemia,edema,leukocyteinfiltration,superficialnecrosis,ulcer.chronic:edema,

polypoidhyperplasia,toxic:

colon:hyperemia,edema,

micro-capillarywasinvadedClinicalmanifestationIncubationperiod:1-2day,(hoursto7days)Acutedysenterycommontype

mildtypetoxictypeClinicalmanifestationcommontype:

(typicaltype)acuteonset,shiver,highfeverabdominalpain(tenderness)diarrhea:stoolmixedwithmucus,blood&pustenesmus,1week

Clinicalmanifestationmildtype:(atypicaltype)causedbyS.sonneilowfeverornofeverabdominalpainismildstoolmixedwithmucus,withoutblood&pusdiagnosisbyisolationofbacteria3~7dClinicalmanifestationtoxictype:

age:2to7yrs.abruptonset,highfever,T40oCdysphoria,lethargy,convulsion

repeatedly,coma.circulatory&respiratorycollapsediarrheamildorabsentatbeginning

Clinicalmanifestation

shockform:septicshockbrainform:

dysphoria,lethargy,convulsionrepeatedly,coma,brainhernia.respiratoryfailuremixedformClinicalmanifestationchronicdysentery:>2monthschronicdelayedtype:chronicobscuretypeacuteattacktypeClinicalmanifestationchronicdelayedtype:

long-timeandrepeatedabdominalpain,diarrhea,stoolmixedwithmucus,blood&pus.withfatigue,anemia,malnutrition.

Clinicalmanifestationchronicobscuretype:

acutehistoryin1year,nosymptoms,stoolculturepositiveorsigmoidscopyacuteattacktype:

sameascommonacutedysenteryLaboratoryFindings

Bloodpicture:

WBCcountincrease,(10~20×109/L)

neutrophilsincrease

Stoolexamination:grossexamination:

stoolmixedwithmucus,blood&pus.

LaboratoryFindingsdirectmicroscopicexamination:

WBC,RBC,puscellsbacteriaculture:PCR:DNASigmoidoscopy:chronicpatients

shallowulcerscarpolypDifferentialdiagnosis

acutedysenteryamebicdysentery

Entamoebahistolytica

stool:reddishbrown,likejamflask-shapedulcer,amebictrophozoiteDifferentialdiagnosisenteritiscausedbyE.Coli,salmonella,ussusception:jam-likestools,abdominalmassabsenceoffeverDifferentialdiagnosis

chronicdysenteryrectal&coloniccarcinoma:

nocureforlong-term,dropofweightofbodynon-specificulcercolitis:nocureforlong-term,cultureofstoolisnegative,Differentialdiagnosis

sigmoidoscopy:hemorrhage,

ulcer,leadpipe.chronicschistosomiasisJaponicacontactwiththecontaminatedwater

hepatomegalyandsplenomegaly

foundingtheovumofschistosomiasis

JaponicaDifferentialdiagnosis

toxicdysentery

encephalitisB:highfever,convulsion,coma.<24hcirculatoryfailurestoolexaminationCSFmeningealirritationSpecificIgM

TreatmentCommondysenteryToxicdysenterygeneraltreatmentpathogenictreatment:

ofloxineAmpicillingivenbyIVTreatmentsymptomatictreatment:controlofhigh