Dysentery

　　Dysentery is an acute intestinal infectious disease caused by Shigella bacteria. Shigella bacteria are Gram-negative facultative anaerobes, all of which can produce endotoxins, cytotoxins, enterotoxins (exotoxins), and Shigella dysenteriae can also produce neurotoxins. They are non-motile, with the optimal temperature being 37°C, direct sunlight has a killing effect, and it dies after being heated to 60°C for 10 minutes. General disinfectants can kill it. Clinically, it is characterized by systemic toxic symptoms, abdominal pain, diarrhea, tenesmus, and mucopurulent blood stool.

　　Acute dysentery is transmitted through the oral route by susceptible individuals through contaminated hands, living contact, contaminated food or water, or through the spread of flies. This is the main route of transmission. In addition, Shigella can also multiply in animal food and some cooked vegetables, cold noodles, and other plant foods. Therefore, eating raw and cold foods and unclean fruits and vegetables can cause scattered dysentery; due to improper water source protection, leading to oral transmission. If attention is not paid to the selection of water sources and water disinfection, it is more likely to occur through water transmission, causing outbreaks. Flies live in feces and contaminated materials, and the bacterial carriage rate on flies can reach 8% to 30%. Under poor hygienic conditions, flies can contaminate food.

　　The clinical manifestations of dysentery include abdominal pain, diarrhea, tenesmus, purulent and bloody stools, accompanied by systemic symptoms such as 中毒. Infants have a weak response to infection, the onset is slower, and the stool is often loose and malabsorbed at the beginning, with a tendency for the course of the disease to prolong. Children over 3 years of age have an acute onset, with fever, diarrhea, and abdominal pain as the main symptoms, and can occur with convulsions and vomiting. Shigella or Flexneri infection leads to more severe illness, prone to toxic dysentery, more common in children aged 3 to 7. Artificially fed infants have weaker constitutions and are prone to complications, including:

　　1, Occasionally, complications such as intestinal perforation, appendicitis, and intussusception may occur.

　　2, In the convalescent or acute phase, polyarticular, exudative arthritis may occur occasionally, and joint redness and swelling can resolve spontaneously within a few weeks.

　　3, Although there are reports from both China and abroad of patients with concurrent sepsis, it is extremely rare. They often have both the general symptoms of dysentery and the symptoms of sepsis. The onset is like that of general acute dysentery, but the condition rapidly deteriorates. In addition, bacterial dysentery can also cause the following rare complications, such as rectal prolapse, parotitis, corneal ulcer, otitis media, osteomyelitis, vulvovaginitis in female infants, acute cystitis, pneumonia, and pleural effusion.

　　4, Leukemia-like reactions, dysentery hepatitis, and toxic myocarditis have also been reported occasionally.

　　5, Besides occasionally occurring with sepsis, toxic dysentery can also present with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome, acute hemolytic uremic syndrome, cardiac insufficiency, and toxic myocarditis.

　　Long-term chronic diarrhea can affect the absorption of nutrition, leading to anemia and edema due to malnutrition.

　　The typical clinical manifestations of dysentery include abdominal pain, diarrhea, tenesmus, purulent and bloody stools, accompanied by systemic symptoms such as中毒. Infants have a weak response to infection, the onset is slower, and the stool is often loose and malabsorbed at the beginning, with a tendency for the course of the disease to prolong. Children over 3 years of age have an acute onset, with fever, diarrhea, and abdominal pain as the main symptoms, and can occur with convulsions and vomiting. Shigella or Flexneri infection leads to more severe illness, prone to toxic dysentery, more common in children aged 3 to 7. Artificially fed infants have weaker constitutions and are prone to complications.

　　Dysentery can occur throughout the year, but the incidence rate is high in summer and autumn. Dysentery patients and carriers are the sources of infection, and mild and chronic dysentery patients, as well as healthy carriers, are often overlooked. The main mode of transmission is fecal-oral infection, and children with poor hygiene habits are more prone to the disease. Chronic dysentery in children is often latent, atypical, and protracted, making it difficult to detect and easy to spread in the child population. After infection, the immunity is not long-lasting and can recur. Factors such as colds, fatigue, improper diet, malnutrition, and intestinal flora imbalance can all reduce the body's resistance to the disease. To prevent dysentery, the following points should be followed:

　　1, Improve the environment, strengthen the management of toilets and feces, eliminate the breeding ground of flies, and mobilize the masses to eliminate flies.

　　2, Strengthen dietary hygiene and water source management, especially for individuals and food vendors, to do a good job of health supervision and inspection work.

　　3, Staff in collective units and nurseries should have their stools regularly checked and bacterial cultures performed.

　　4, Strengthen health education, everyone should wash their hands before meals and after defecation, do not drink unboiled water, do not eat deteriorated and rotting food, and do not eat food touched by flies.

　　5, Do not overeat to avoid lowering the resistance of the gastrointestinal tract.

　　Dysentery is one of the acute intestinal infectious diseases, clinically characterized by fever, abdominal pain, tenesmus, and purulent stools. This disease can be checked with fewer examinations, and the commonly used ones in clinical practice include:

　　Blood routine: Acute dysentery patients may have an increased total white blood cell count and neutrophils, with possible left shift, while chronic patients may have anemia.

　　Stool routine: Typical patients may have a large number of pus cells and red blood cells, as well as phagocytes, in their stool examination. Atypical cases may only show a few white blood cells. Positive results can be obtained by selecting stools with pus and blood.

　　X-ray: It can be used for the examination and differential diagnosis of chronic bacillary dysentery.

　　Sigmoidoscopy: It can be used for the examination and differential diagnosis of chronic bacillary dysentery.

　　What should be paid attention to in the dietary taboos for dysentery patients? Briefly described as follows:

　　The diet of dysentery patients should be easy to digest, nutritious, well-hydrated, non-irritating, and should be taken in small meals. Dysentery patients in the acute phase may have significant abdominal pain and vomiting, and should adopt a light, liquid diet, such as thick rice gruel. Both acute and chronic dysentery patients should avoid the following foods:

　　1, Persimmon.It is cold in nature and sweet and astringent. Those with dysentery should avoid eating it.

　　2, Dog meat.It is a warming and nourishing food. Those with acute dysentery should not consume it to avoid exacerbating the pathogenic damp-heat in the large intestine and worsening the condition.

　　3, Mutton.It is warm in nature and sweet in taste, a food that benefits and invigorates.

　　4, Horse meat.It is cold in nature and sweet and sour in taste, those with dysentery should avoid it.

　　5, Sea cucumber.As sea cucumber is a nourishing and replenishing food, it can nourish yin and moisten dryness, so those with spleen deficiency and diarrhea should not eat it in large quantities.

　　6. Melon.Cold in nature, especially injures the Yang of the spleen and stomach, so people with chronic deficiency and cold dysentery should avoid eating them.

　　In addition, people with acute dysentery should avoid eating various meat products such as chicken, duck, and deer meat; avoid eating shellfish, clams, saury, seahorse, bream, etc.; avoid eating foods such as longan, lychee, jujube, pine nuts, ginseng, astragalus, and goji berries that tonify the body; avoid eating things such as chestnuts, lotus seeds, and water chestnuts that are astringent; also avoid spicy and刺激性 foods such as chili, cinnamon, Sichuan pepper, and white wine. People with chronic dysentery should also avoid eating things such as snails, crabs, clam, banana, cucumber, lettuce, sweet potato, etc. that are cold and cool in nature.

　　Dysentery is one of the acute intestinal infectious diseases. The methods of treating dysentery are divided into acute and chronic types:

　　First, the treatment of acute dysentery

　　1. Routine therapy

　　Children should rest in bed, be isolated, and adopt disinfection measures. The diet should be mainly liquid or semi-liquid food. Children with severe vomiting, diarrhea, and abdominal distension can be short-term fasting.

　　2. Antibiotic therapy

　　Fluorofenac, gentamicin, coptis, and复方新诺明 can be used in combination. The course of treatment is 7 to 10 days.

　　3. Adsorption therapy

　　Simenticon can be administered, which has a strong adsorption effect on bacteria and toxins, can inhibit bacterial growth, and can also bind and interact with mucoprotein, strengthening the intestinal mucosal barrier function.

　　4. Microecological therapy

　　Bifidobacterium preparations can be used. By binding to the intestinal mucosal epithelial cells, it plays a protective role, inhibits bacterial invasion, and maintains the balance of intestinal microecology.

　　5. Fluid replacement therapy

　　Determine the method and amount of fluid replacement according to the degree of dehydration.

　　Second, the treatment of chronic dysentery

　　1. Antibiotic therapy

　　The commonly used drugs and dosages are the same as those for acute dysentery, but the course of treatment should be longer. Intermittent therapy can be adopted, with medication for 7 to 10 days, rest for 4 days, then treatment for 4 days, rest for 4 days, and repeat for 4 days, with a total course of 3 to 4 weeks. It can also be treated with a mixture of coptis and garlic enema. However, it should be noted that long-term use of antibiotics can cause intestinal flora imbalance. It should be changed to traditional Chinese medicine, vitamins, probiotics, and Simeticon, etc. after the stool culture turns negative and the purulent stools disappear.

　　2. Diet therapy

　　In addition to antibacterial treatment for chronic dysentery, attention should also be paid to improving the nutritional status of patients.