Acute bacterial dysentery

　　Shigella bacteria belong to the Gram-negative Shigella genus, which is divided into 4 groups (A, B, C, D), 37 types, namely 12 types in group A (Shigella dysenteriae), 6 types in group B (Shigella flexneri), 18 types in group C (Shigella boydii), and 1 type in group D (Shigella sonnei). Shigella flexneri and Shigella sonnei are the most common, and the bacteria have strong resistance to the external environment, can survive for about 10 days on fruits and vegetables, can survive for up to 3 months in river water, and can reproduce in large quantities at suitable temperatures. They are not resistant to high temperature and are sensitive to various chemical disinfectants. The main pathogenic factors of Shigella bacteria are invasiveness and toxins. After entering the digestive tract, invasive Shigella bacteria invade the colon mucosal epithelium, reproduce in the cells, and cause inflammation. Shigella genus can produce Shigatoxin (SHT) and Shigella-like toxin (SLT). SHT has cytotoxic, enterotoxin, and neurotoxic effects.

　　It is more common in summer and autumn, because of the hot weather and high temperature, which is suitable for the growth and reproduction of Shigella bacteria. In summer and autumn, there are many fresh fruits and vegetables on the market, and people like to eat fruits and vegetables raw, but they do not pay attention to cleaning and disinfection or rely on their strong physique, take them up without washing their hands and eat them, so that the bacteria enter their gastrointestinal tract with food. In summer and autumn, the human body needs to dissipate more heat through the skin to maintain body temperature; this keeps the skin blood vessels in a state of dilation, while the blood vessels of the gastrointestinal tract are relatively contracted, with a relative reduction in blood flow, and the body's resistance to gastrointestinal infectious diseases is also weakened. In addition, catching a cold, overfatigue, overeating, and suffering from various acute and chronic diseases, when the body's resistance is reduced, it is also easy to trigger dysentery.

　　The pathogenesis of toxic dysentery is mainly due to an abnormal strong reaction of the body to bacterial toxins, causing a series of pathophysiological disorders such as acute microcirculatory disorders. The lesions of dysentery involve the entire colon and even the ileum, with the sigmoid colon and rectum being the most serious. It can be divided into acute and chronic stages according to the course of the disease.

　　After Shigella bacteria enter the digestive tract, they can be quickly destroyed by normal gastric juice, and a small number of escaped bacteria will be further inhibited or rejected by the intestines. Once the human defense function is weakened, Shigella bacteria will take advantage of the opportunity to enter, causing chills, fever, often accompanied by headache and fatigue, and abdominal pain and diarrhea appear in a short time. The stool starts as watery, and quickly turns into mucous pus stool or purulent blood stool, with less stool volume, frequent stool, and significant tenesmus. In severe cases, toxic shock may occur, threatening life. Children under 7 years old are prone to toxic dysentery in summer and autumn, with main symptoms such as sudden onset of high fever, convulsions, and coma, which should not be taken lightly.

　　Acute bacterial dysentery often leads to the following diseases.

　　1. Acute bacterial dysentery often accompanied by varying degrees of dehydration acidosis and electrolyte disorder;

　　2. Chronic bacterial dysentery may have symptoms such as abdominal pain and distension. The stool frequency is high, with obvious mucous stool, but the systemic toxic symptoms are not obvious;

　　3. A small number of patients may develop joint swelling and pain 1-2 weeks after onset, which is non-suppurative and migratory. If accompanied by fever, urethritis, and conjunctivitis, it is called Reiter's syndrome, which is related to the immune response induced by infection.

      The symptoms of acute bacterial dysentery are briefly described as follows.

　　1. Acute dysentery

　　The incubation period of acute dysentery is different, ranging from a few hours to 7 days, with most being 1-2 days; it can generally be divided into the following three types:

　　1. Acute toxic type dysentery

　　More common in children aged 2-7 years, with occasional occurrence in adults. Generally, the onset is acute, the development is rapid, the toxic symptoms are severe, and the gastrointestinal symptoms may not be severe. High fever, occasionally with body temperature not rising. According to the prominent site of microcirculatory disorders, it can be divided into 4 types:

　　(1) Brain type

　　Occupies most of the toxic dysentery. In the early stage, there is restlessness, drowsiness, pale complexion, increased muscle tension, accompanied by convulsions, normal or slightly elevated blood pressure, and in the late stage, coma may occur, even brain hernia;

　　(2) Lung type

　　Mainly due to microcirculatory disorders in the lungs, also known as shock lung. The incidence is low, and the mortality is high, often occurring between 16-24 hours of the course, with progressive dyspnea, hypoxemia, and general oxygen inhalation cannot alleviate it;

　　(3) Shock type

　　More common in adults, with cyanosis of the limbs or extremities, coldness, fine pulse, low blood pressure, small pulse pressure difference, and reduced urine output. A few are of high output and low resistance type;

　　2. Acute common type dysentery

　　Also known as acute typical dysentery, the main symptoms are acute onset, aversion to cold, fever, nausea, vomiting, with abdominal pain appearing simultaneously or a few hours later, initially seen around the umbilicus or the whole abdomen, and then shifting to the lower left abdomen, with frequent diarrhea, initially yellow and loose stool, followed by mucus and pus, with less amount, accompanied by tenesmus;

　　3. Mixed type dysentery

　　Among the above 3 types, the occurrence rate is low when any two types exist simultaneously or sequentially;

　　2. Chronic dysentery

　　Mostly due to incomplete treatment of acute dysentery or spontaneous remission leading to chronic dysentery, with a course of more than 2 months, with anorexia, abnormal stool, sometimes dry and sometimes loose, with little mucus. Generally without abdominal pain, only with lower abdominal pain or intestinal colic before defecation, which disappears after defecation. Some patients may have symptoms such as insomnia, dreaming, forgetfulness, neurasthenia, and so on, and can be mainly divided into 3 types in clinical practice:

　　1. Persistent type

　　Acute dysentery does not heal after recurrence, with a course of more than 2 months;

　　2. Acute recurrence type

　　History of dysentery within the past six months, this time the symptoms are the same as acute common type, and the stool culture bacteria type is the same as the previous one;

　　3. Latent type

　　History of dysentery within the past six months, symptoms persist for less than 2 months, but the stool culture is still positive for Shigella, or colonoscopy shows chronic phase changes of dysentery;

　　3. Toxic type dysentery

　　The onset is acute, with sudden high fever, and shock, convulsions, and disturbance of consciousness appear rapidly within 24 hours. The frequency of stool is not high, often occurs in children, with a severe condition and extremely high mortality. It is divided into different types according to the severity of symptoms and the urgency of the condition:

　　4. Mild dysentery

　　No toxic symptoms, normal or slightly elevated body temperature, mild abdominal pain and diarrhea, with more than 10 times of stool per day,呈糊状或水样，containing a small amount of mucus, with no significant tenesmus, and may have nausea and vomiting;

　　2. Common type (medium type) dysentery

　　The onset is acute, with symptoms such as aversion to cold, fever, and toxicosis, with body temperature around 39℃, accompanied by nausea, vomiting, abdominal pain, diarrhea, tenesmus, with stool frequency of 10-20 times a day, with less pus and blood in the stool, a few patients are characterized by watery diarrhea, with no significant dehydration;

　　3. Severe type

　　The onset is acute, with aversion to cold, high fever, nausea and vomiting, severe abdominal pain, mucous bloody stools, and frequent defecation, more than 20 times a day, tenesmus, cold extremities, and confusion of consciousness.

　　To prevent acute bacterial dysentery, there are mainly the following aspects:

　　(1) Improve the environmental hygiene, strengthen the management of toilets and feces, eliminate the breeding places of flies, and mobilize the masses to eliminate flies;

　　(2) Strengthen the management of dietary hygiene and water sources, especially for individuals and food stalls, and do a good job of health supervision and inspection work;

　　(3) Staff in collective units and kindergartens should have regular fecal examinations and bacterial cultures;

　　(4) Strengthen health education, everyone should wash hands before and after meals and defecation, do not drink raw water, do not eat deteriorated and rotten food, do not eat food contaminated by flies. Do not overeat and overdrink to avoid reducing the resistance of the gastrointestinal tract.

　　Examination and differentiation of acute bacterial dysentery.

　　1. Examination

　　1. Immunofluorescence bacteriophage method is positive;

　　2. Fecal examination

　　Under the microscope, there are more red blood cells and white blood cells, a few with phagocytes. Fecal culture is positive for Shigella;

　　3. Blood picture

　　Peripheral blood white blood cell count and neutrophils increase during the acute stage;

　　4. Rapid diagnostic methods

　　The invasion plasmid antigen H (ipaH) gene of Shigella is amplified by polymerase chain reaction (PCR) method, the positive rate is higher than that of bacterial culture, but there may be false positives, and this method cannot distinguish Shigella from invasive Escherichia coli.

　　2. Distinguish

　　1. Acute Shigella common type

　　Mainly should be distinguished from infectious diarrhea, including Salmonella enteritis, Campylobacter jejuni enteritis, pathogenic Escherichia coli enteritis, etc., and the fecal culture should show the corresponding pathogenic bacteria;

　　2. Acute toxic type Shigella

　　It should be distinguished from fever convulsions, epidemic encephalitis B, and water loss shock;

　　3. Chronic Shigella

　　It should be distinguished from chronic non-specific ulcerative colitis, chronic amebic dysentery, and colorectal cancer; amebic dysentery generally has mild systemic toxic symptoms, feces are dark red jam-like, and amebae trophozoites or cysts can be seen under a microscope, which can be used for differentiation;

　　4. Distinguish from acute enteritis

　　Generally without tenesmus, often with a history of improper eating or unclean diet, and no growth of Shigella in fecal culture;

　　5. Distinguish from acute necrotizing enteritis

　　Mainly with hematochezia, microscopic examination shows mainly red blood cells, with fewer white blood cells, and blood culture shows no growth of pathogenic bacteria;

　　6. Distinguish from epidemic encephalitis B

　　Generally, it can be similar to symptoms of toxic bacterial dysentery, but cerebrospinal fluid examination in patients with epidemic encephalitis B can show increased cells and protein changes, and fecal examination is normal.

　　Dietary principles and therapeutic methods for acute bacterial dysentery.

　　1. Dietary Principles

　　Diet should be easy to digest, rich in nutrition, with sufficient water content, and free from stimulation. Eat small and frequent meals.

　　Dietary Taboos:

　　1. In the acute phase, there is significant abdominal pain and vomiting. Light, liquid food should be used, such as thick rice gruel, 5-10% fried flour paste, lotus root starch, light fruit juice, vegetable juice, light tea water, etc. Avoid eating milk, soy milk, and sweetened drinks.

　　2. In the improving period, vomiting stops, the number of bowel movements decreases, and you can eat nutrient-rich liquid food or low-fat, non-fiber semi-liquid food, such as milk, soy milk, custard, egg soup, oil-free liver puree soup or meat puree soup, etc. Eat 4-5 times a day, drink yogurt, which is beneficial to the disease.

　　3. In the convalescent period, defecation is basically normal. It is advisable to eat easily digestible semi-liquid food or soft rice, and cooking should still be fine, small, soft, and tender for easy digestion. Eat more purple garlic skin, and you can eat raw apple puree, but other fruits should be limited. Avoid eating cold, hard, greasy, fried food, and spicy and irritating food too early. Avoid eating foods high in rough fiber and those that are easy to cause intestinal flatulence, such as celery, chive, soybean sprouts, coarse grains, sweet potatoes, potatoes, radishes, etc.

　　Two: Dietetic treatment for dysentery

　　1. Composition: Equal parts of single clove garlic and coptis. Usage: Grind together into a fine powder, make into pills with rice porridge. Take 3-6 grams each time, 3 times a day.

　　2. Composition: 30 grams of tannic acid from pomegranate peel, 50 grams of brown sugar. Usage: Boil the pomegranate peel to extract the juice, mix with brown sugar and take it warm. Take 1-2 times a day, for several days in a row.

　　3. Composition: 50 grams of purple garlic skin, an appropriate amount of syrup. Usage: Peel the garlic, crush it into a paste, soak in 100 milliliters of warm water for 2 hours, filter with gauze, and add half the amount of syrup. Adults take 80-100 milliliters a day, divided into 4 doses. Children take 15-40 milliliters a day, divided into 3 doses.

　　4. Composition: 10 grams of tea leaves, 60 grams of hawthorn, 3 slices of ginger. Usage: Boil and add sugar for consumption. Take one dose a day, divided into 2-3 times.

　　5. Composition: 15-20 grams of green tea leaves. Usage: Brew and drink as tea. For severe cases, add 30 grains of glutinous rice and a small amount of salt, stir-fry in a pot until golden, then boil with water to make the taste bitter and salty. Take the juice all at once. Take 1 time a day for mild cases, 2-4 times for severe cases.

　　6. Composition: 15 grams of tea leaves, 50 grams of portulaca oleracea, 30 grams of brown sugar. Usage: Boil and drink as tea, for 3-8 consecutive days.

　　7. Composition: 5 grams of green vegetables, 10 grams of ginger, 30 grams of black plum meat. Usage: Cut black plums into pieces, finely chop ginger, and put them together with tea in a thermal cup. Brew with boiling water for half an hour, then add an appropriate amount of brown sugar and take it while hot. Take 3 times a day. Note: It also has a therapeutic effect on amebic dysentery.

　　8. Composition: 10 grams of green tea, 10 grams of honeysuckle, 6 grams of rose and tangerine peel, 3 grams of jasmine and licorice. Usage: Brew with boiling water for 10-20 minutes, then drink. Take 3-5 times a day. For children, the dosage should be reduced accordingly.

　　9. Composition: 9 grams of tea leaves, 60 milliliters of white grape juice, 10 milliliters of ginger juice, 30 grams of honey. Usage: Boil tea leaves for 1 hour and collect 100 milliliters of juice, mix with other juices and take once.

　　10. Composition: 100 grams of green tea, 25 milliliters of白酒. Usage: Boil 700 milliliters of water with green tea for 20 minutes, remove the residue, concentrate to 75 milliliters, cool, then add白酒. Take 1-2 milliliters per time, 4-6 hours apart, until cured.

　　11. Composition: 2 sour pomegranates, 30g of honey. Usage: Muddle the pomegranate to extract juice, mix with honey, and take with warm water. Twice a day, for several days in a row.

　　12. Composition: Appropriate amounts of radish, rice vinegar, and sugar. Usage: Peel the radish, rinse with cool water, cut into thin slices, add appropriate amounts of rice vinegar and sugar, mix well and eat, twice a day.

　　A brief description of the treatment methods for acute bacterial dysentery.

　　1. Symptomatic treatment actively control high fever, use medication and physical cooling. During the convalescence, oral intestinal mucosal protective agent (Simeta) and microecological regulator (Peifengkang) can accelerate the control of diarrhea.

　　2. Continue eating and encourage normal diet.

　　3. The first choice of antibacterial treatment is the combination of berberine and norfloxacin, or ofloxacin, or ciprofloxacin. Oral, course 3-5 days.

　　(1) Berberine: 0.5g each time for adults, 2 times a day. 30mg/(kg·d) for children.

　　(2) Norfloxacin: 0.4g each time for adults, 2 times a day. Not recommended for children.

　　(3) Ofloxacin: 0.3g each time for adults, 2 times a day. Not recommended for children.

　　(5) Ciprofloxacin: 0.4g each time for adults, 2 times a day. Not recommended for children.

　　(4) Ceftriaxone: Adults 1g each time, once every 12 hours, intramuscular injection; children 50-100mg/(kg·d). ② Cefotetan and ceftriaxone, dosage as ①. ③ For those allergic to penicillin, amikacin can be used, 80mg each time for adults, once every 12 hours, intramuscular injection. For children, 2-5mg/(kg·d). Tobramycin, 80mg each time for adults (80,000U), once every 8-12 hours, 4mg/(kg·d) for children, administered twice intramuscularly or intravenously.

　　(6) Others: Phosphomycin, oral gentamicin, SMZ-TMP (more water should be drunk after taking) and others can be used.

　　For mild cases, oral sufficient liquid must be taken to prevent dehydration. For those with dehydration, oral rehydration salts should be used to correct dehydration (rice porridge with salt, salt sugar water, ORS). For severe dehydration, both intravenous fluid replacement and oral rehydration should be carried out simultaneously.