Chronic bacterial dysentery

　　Chronic bacterial dysentery with a course of disease exceeding two months is called chronic dysentery. It is mostly caused by the transformation from acute dysentery, with a higher incidence in Fournier's bacteria infections. Some courses can last for several months or even years, during which intestinal lesions fluctuate, with existing ulcers not yet healed and new ulcers forming. Therefore, both old and new lesions coexist. Due to the repeated injury and repair of tissues, the edges of chronic ulcers are irregular, and the mucosa often overgrows to form polyps. The intestinal wall layers have chronic inflammatory cell infiltration and fibrous tissue proliferation, leading to scar formation, making the intestinal wall irregularly thickened, hardened, and in severe cases, leading to intestinal stricture.

　　Chronic bacterial dysentery is prone to complications, mainly due to malnutrition and low immune function. The most common are malnutrition and edema due to malnutrition, deficiencies of various vitamins and trace elements, manifested as dry eye disease, malnutrition anemia, rickets, and in severe cases, beriberi and scurvy. The latter is rarely seen in China. Deep ulcers in the intestinal tract can lead to massive intestinal bleeding, frequent diarrhea can lead to rectal prolapse, and long-term use of antibiotics can lead to intestinal flora disorder or combined fungal infection. Individual severe malnourished children with long-standing intestinal ulcers may develop intestinal perforation.

　　Chronic dysentery, with persistent, varying degrees of abdominal pain, diarrhea, urgency, and the symptoms of dysentery with mucus, pus, and blood stool, with a course of disease exceeding two months. Chronic dysentery is defined as dysentery that does not heal for more than 2 months, which is often related to inadequate or incomplete treatment during the acute phase, bacterial resistance, or decreased body resistance. It is also often triggered by improper diet, catching a cold, overwork, or mental factors. According to clinical manifestations, the symptoms of chronic dysentery are divided into the following three types:

　　(1) Acute attack type accounts for about 5%, and its main clinical manifestations are similar to acute typical dysentery, but with mild symptoms, incomplete recovery. Generally, there is a history or recurrence of dysentery within half a year, and excluding reinfection with the same group of dysentery bacteria, or infection with other groups of dysentery bacteria or other diarrhea-causing bacteria.

　　(2) Persistent type: The incidence rate is about 10%, and there are often abdominal discomfort or hidden pain, abdominal distension, diarrhea, mucopurulent stools, and other gastrointestinal symptoms that are mild or severe, persistent, and may alternate between diarrhea and constipation. With a long course, symptoms such as insomnia, dreams, forgetfulness, and neurotic symptoms such as fatigue, emaciation, decreased appetite, and anemia may appear. There is tenderness in the left lower abdomen, and the sigmoid colon can be palpated as a cord-like structure.

　　(3) Latent type: This type has an incidence rate of about 2-3%, with a history of dysentery within a year, clinical symptoms disappeared for more than 2 months, but the stool culture can detect dysentery bacteria. Sigmoidoscopy examination can show intestinal mucosal lesions. This type is of great significance in epidemiology.

　　To prevent dysentery, the following points should be followed: improve environmental hygiene, strengthen the management of toilets and feces, eliminate the breeding places of flies, and mobilize the masses to eliminate flies. Strengthen the management of food hygiene and water sources, especially to do a good job of health supervision and inspection work for individual and food stalls. The cooks and caregivers in collective units and nurseries should have regular stool examinations and bacterial cultures. Strengthen health education, and everyone should wash their hands before meals and after defecation, not drink unboiled water, not eat deteriorated and rotten food, and not eat food contaminated by flies. Do not overeat or drink, to avoid reducing the resistance of the gastrointestinal tract.

　　Chronic bacterial dysentery is often related to inadequate or incomplete treatment during the acute phase, bacterial resistance, or decreased body resistance. It is also often induced by improper diet, catching a cold, overwork, or psychological factors. The following examinations need to be done:

　　(1) Blood count: In acute cases, the total white blood cell count and neutrophils are moderately elevated. Chronic patients may have mild anemia.

　　(2) Stool examination: The typical dysentery stool has no fecal matter, is less in quantity,呈鲜红粘冻状, has no odor, and microscopic examination shows a large number of pus cells and red blood cells, as well as macrophages. Culturing can detect pathogenic bacteria. If the sampling is not done properly, the specimen is left for too long, or the patient has received antibacterial treatment, the culture results are often not ideal. Commonly used differential culture media are SS agar and MacConkey agar.

　　(3) Other examination methods include fluorescence antibody staining technique, which is one of the rapid examination methods, more sensitive than cell culture. China uses the immunofluorescent bacterial ball method, which is simple, highly sensitive, and specific. Diagnosis can be made 8 hours after sampling, and bacteria can be continued to be cultured and drug sensitivity tests can be performed. Sigmoidoscopy examination can show diffuse congestion, edema, and a large amount of exudation of the intestinal mucosa in the acute phase, with superficial ulcers and sometimes pseudomembrane formation. The intestinal mucosa in the chronic phase is granular, and ulcers or polyps can be seen. Secretions taken from the lesion site for culture can improve the detection rate. In addition, X-ray barium examination in chronic patients can show intestinal spasm, changes in motility, disappearance of pouches, narrowing of the intestinal lumen, thickening of the intestinal mucosa, or segmental changes. In recent years, some people have used staphylococcal协同agglutination test as a rapid diagnostic method for dysentery, with good sensitivity and specificity.

　　In order to prevent the spread of bacterial dysentery, in addition to paying attention to environmental hygiene and personal hygiene, and developing the habit of washing hands before and after meals, there are also the following taboos in diet, which are introduced in detail by infectious disease experts:

　　1. Avoid concentrated meat juices and animal internal organs. Because they contain a large amount of nitrogenous extracts, such as purine bases and amino acids, etc. Nitrogenous extracts have a stimulating effect on the secretion of gastric juice, and the stronger the juice, the stronger the effect, which increases the burden on the digestive tract. Moreover, patients with bacterial dysentery have intestinal lesions, with symptoms such as nausea and vomiting, and their digestion and absorption are worse.

　　2. Avoid coarse fiber and bloating foods. Such as vegetables with a lot of fiber, such as rapeseed, celery, and chives, which are not easy to digest, causing local congestion and edema, and inflammation is not easy to heal. Milk and sugar, and soy products are also prone to increase intestinal peristalsis, causing bloating.

　　3. Avoid刺激性 foods. Such as fried, baked, and salted and smoked large pieces of fish and meat, which have a direct stimulating effect on the intestinal wall, exacerbating the damage to the intestinal wall; these foods are also difficult to digest, causing bloating, fever, and prolonged stay, which will increase the burden on the digestive tract.

　　4. Avoid contaminated foods. Unsterilized fruits and vegetables not only carry bacteria but are also prone to cause poisoning, which is a pathogenic factor and can reduce the patient's resistance.

　　5. Avoid cold and slippery foods that damage the spleen and stomach, such as water chestnuts, turtle, pear, peanuts, etc., which are cold and slippery and easy to cause diarrhea, so they should be avoided.

　　In addition to antibacterial treatment for chronic bacillary dysentery, attention should also be paid to improving the nutritional status of patients. Find the causes and treat accordingly. Overexertion should be avoided, and the abdomen should not be exposed to cold or eat cold and raw foods. Immune enhancers should be used in a timely manner for those with weak physique. When intestinal flora imbalance occurs, it is imperative to avoid the abuse of antibacterial drugs and immediately stop the use of drug-resistant antibacterial drugs. Enzyme probiotics or lactobacillus should be used to promote the growth of anaerobic bacteria in the intestines. B vitamins, vitamin C, folic acid, or oral levamisole, or intramuscular transfer factors, etc., as immunomodulators, should be added to enhance the efficacy. For those with long-standing intestinal mucosal lesions that do not heal, the retention enema therapy should be used simultaneously, with 150ml of 1-5000 furazolidone solution, or 100mg of hydrocortisone, or 150ml of 5-10% garlic solution, 20mg of dexamethasone and 10ml of 0.25% procaine, retained enema, once a night, for 10-14 days as a course.