志賀氏細(xì)菌性痢疾課件

志賀氏細(xì)菌性痢疾DefinitionShigellosisisanintestinalinfectioncausedbyagenusofbacteriaknownasShigellathatcausesdiarrhealdiseaseofthecolonorlargeintestines.234

Etiology

Agent:

genusShigella:non-motile,non-spore-forming,Gramnegativebacillus4species:AS.dysenteriae

:13BS.flexneri:6CS.boydii:18DS.sonnei:1Viability:

strong,1-3weeks,sensitivetomercuricchloride,

5EpidemiologySourceofinfection：Reservoir:Humans/primatesCarriers,chronicpatients,AtypicalpatientsModeofTransmissionFecal-oral,Person-to-person,oral-genitalIngestionofcontaminatedfoodand/ordrinkContactwithcontaminatedinanimateobjectsHousefliesEpidemiologySusceptiblepopulation:universe2nd,3rdyearEpidemicalfeaturesThepeakincidenceisinJulytoOctober67cellinvasionIntracellularmultiplyIntraandintercellularspreadHostcellkillingPathogenesiscolonicepithelialcellsEnterotoxin,cytotoxin,cytokine-mediatedinflammation,necrosis

Pathogenesis

8pathologicalfeaturesoftheSigmoidcolonandrectumAcuteperiod：FibrindiffuseexudativeinflammationSeverecases:pseudomembranes,Ulcerationspolymorphonuclearandmononuclearcellsinfiltration,Mildcases:

Diffuseedemaofcongestive,visiblemucusexudationofblood.Chronicperiod:

Mucosaledema,bowelwallthickening,scarformation,polypformation,intestinalstricturePathogenesisofshigellosisinhumans910PathologicalfeaturesoftheSigmoidcolonandrectum11ClinicalManifestationsIncubationPeriod Average:1-3(upto4)days Range:12to96hours,upto8daysDiseasepresentation,severity,andcasefatality-dependentupon:HostBacterialserotypeandnumbers

ClinicalManifestationDiseasetypicalPresentation:

Fever,nausea,vomiting,Dysentery(blood,mucus),frequent,small-volume,TenesmusAbdominalpain(lowerleftabdominalquadrants)12ClinicalManifestation

Typicaltype:Mildtype:mildtoxemia

Toxictype:shocktype,Cerebraltype,mixturetypeChronicBacillaryDysentery:≥2months

13ClinicalManifestationTypicaltype:Acuteonset,highfeverAbdominalpainDiarrhea:stoolwithblood,mucus,non-mixedwithfecalmaterial,littleamounteachtimeTenesmusLasts1-2weeks14Toxictype:2-7yearsoldchildrenHighfever,T>40℃,RestlessnessAbsenceofgastrointestinalsymptomsToxicity,sepsis,toxicshock,toxicencephalitisShocktype,cerebraltype,mixedtype15ClinicalManifestationMildtype:Lowfever,Diarrhea<10times/day,Mucoidbutnobloodystools,NourgencyandpainfuldefecationLasts3-6days16ClinicalManifestationChronicBacillaryDysentery:≥2monthsUncommonMalnourishedinfantsorAIDSAbdominalpain,diarrhea,stoolwithblood,mucus,constipation,malnutrition,anemia,fatigue17ClinicalManifestationComplicationsShigellasepticemiadehydration,hemolysis,anemia,hemolyticuremicsyndrome,renalfailure,DICArthritis19DiagnosisEpidemiologicaldata:Clinicalmanifestation:Laboratorycriteriafordiagnosis:Definitediagnosis---Isolationofshigellafromaclinicalspecimen.

Diagnosis

Epidemiologicaldata:TimePeopleHealthconditionHistoryHabits20Diagnosis

Clinicalmanifestation:Fever,nausea,vomiting,Dysentery(blood,mucus),frequent,small-volume,TenesmusAbdominalpain(lowerleftabdominalquadrants)2122Laboratoryexamination

BR:

AcutePhase:WBC↑(10-20×109/L),dramaticshiftChronicPhase:WBCN、N↑、anemiaSR:

Appearance：bloodyandmucoidstoolsMicroscopicexamination：pus

cell,WBC>15/HP,RBC,MacrophageSC:Beforeantibiotictreatment,Puscellandblood,freshmultiple,rapidtransport

Typicaltype:AmebicdysenteryColitiscausedbyotherbacterialBacterialfoodpoisoningIntussusceptionAcutenecroticenteritis

23DifferentiationdiagnosisToxictype:Shocktype:ShockcausedbyotherbacteriaCerebraltype:JapaneseBencephalitis24DifferentiationdiagnosisChronictype:RectalandcoloniccarcinomaChronicschistosomiasisCrohndisease

25DifferentiationdiagnosisTreatment---typicaltypeGeneraltreatment:IsolationhospitalizationCarefulmonitornursingSymptomatictreatment:

MaintainthebalancesoffluidandelectrolytesdefervescencePreventcomplication.

26Treatment---typicaltypeEtiologicaltreatment:Quinolones----firstchoiceCiprofloxacin,ofloxacin,gatifloxacinSMZ-TMPOthers:Cephalosporin,Azithromycin,Gentamicin,

27Treatment---toxictypeSymptomatictreatment----gofirstdefervescence,subhibernationtherapy,tranquilizeEtiologicaltreatment----ivbydrip

Adult

Quinolones

ChildCefotaxime28ShocktypeShockshouldbecorrectedpromptly:Volumeexpanded.Metabolicacidosiscorrected.Vasoactivedrugs.Adrenalcorticosteroids.Importantorgansprotected.29Cerebraltype

Alleviatecerebraledemaandprotection:20%MannitolVasoactivedrugsAdrenalcorticosteroids

PreventionandTreatmentinrespiratoryfailure:OxygeninhaleLobeline,coramineRespirator30Treatment---ChronictypeGeneraltreatment:Symptomatictreatment:antispasmodicsedativesEtiologicaltreatment:

longer,repeat,multi-typeretentione