Dysentery in children

Dysentery is a disease from the group of intestinal infections. It is expressed in intoxication with internal organs damage, but the greatest changes occur in the area of ​​the sigmoid colon. So, 60% of patients - children from two to seven years.

Dysentery in young children leads to severe digestive damage, often accompanied by a fatal outcome. The cause of the disease can be 2 types of pathogenic microorganisms: bacteria( shigella) and protozoa( amoeba).Since the prevalence of bacterial dysentery( shigillosis) significantly prevails, we will consider this infection.

Why do children have high susceptibility to dysentery?

The undeveloped children's organism is completely dependent on adults providing care for the child. Independently toddlers can not provide adequate sanitary conditions, are not accustomed to washing their hands. The main ways of infection - through dirty hands, unwashed vegetables and fruits, contact with infected adults with household items, linens, dishes.

The number of sick children increases in summer and autumn, due to the period of fruit availability, ripening of berries. The incidence is constant in countries with a hot climate. Therefore, adults make a big mistake, allowing children to unwashed watermelons and melons from Central Asia.

40% of children are infected in family foci from an infectious family member. With unwashed hands, the sick person after the toilet transfers the dysentery bacteria to different objects, to which the child then touches and enters the infection in the mouth. Children most often sick before three years old. In children up to a year predisposing factors are artificial feeding, diathesis.

In infancy, babies do not have enough developed immunity to fight infection, after six months, congenital maternal protection disappears, so they are more prone to infection. Risk factors include hypovitaminosis, malnutrition( hypotrophy), intestinal infections and respiratory tract diseases.

What do you need to know about the causative agents of dysentery?

There is no separate "adult" and "child" dysentery. The disease in the child is caused by 4 species of bacteria of the genus Shigella:

• Grigorieva-Shiga;
• Flexner;
• Sonne;
• Boyd.

The names they received by the name of the scientists who described them. Epidemiologists associate the prevalence( circulation) of certain species with certain territories: the Grigoriev-Shiga wand is more often detected in the Far East and in Asian countries, Boyd in India and Pakistan, Sonne in Europe, the type of Flexner is now a rare find.

Shigella are stored in water bodies for up to a week, in the ground - almost 3 months, in infected products - up to 30 days. Destroyed by disinfectants, ultraviolet light. When boiling, the bacteria die instantly, so the infection occurs through foods that have not been boiled( fresh fruits, vegetables, dairy products, salads).

Shigella differ in their ability to absorb different substances( lactose, sucrose, mannitol), this is used for differential diagnosis and selection of media for tank culture analysis. An important feature of the pathogen is the presence of exotoxin, which sticks secrete in surrounding tissues, and endotoxin( acts on the patient's body during the death of shigella).

Exotoxin is commonly divided into subspecies:

• enterotoxin - is able to enhance the secretion of fluid and salts through the intestine;
• cytotoxin - the action is directed to the destruction of the cell membrane epithelium;
• neurotoxin - has an affinity for neurons in the brain, causes clinical symptoms of the type of encephalitis.

How does the disease develop?

Entered with food bacteria for a short time in the stomach. Those that overcome the acid barrier, pass into the small intestine. In the heat with a plentiful drink, the acidity is "diluted" with water, so the number of shigellas that reached the intestine is increased.

Endotoxin is released from the destroyed cells, it causes initial manifestations of the disease( temperature increase, chills).The small intestine practically does not suffer, since Shigella pass through it and stay in the large intestine. Here they settle and suck in to the cells of the epithelium, destroy them, themselves undergo phagocytosis, but manage to excrete exotoxin.

Intoxication is caused by increased permeability of blood vessels, intestinal wall, violation of all metabolic forms, damage at the level of the nervous system, reflex failure of the functioning of the pancreas, liver, bile ducts, myocardium.

The local process causes the most severe damage in the area of ​​the sigmoid and descending colon. The effect on the nerve endings contributes to the pain syndrome. The destruction of blood vessels in the area of ​​inflammation leads to the release of blood with feces. With mucus, pus contaminants emerge due to the addition of a secondary infection.

What are the stages of local changes in the intestine?

Changes in the intestinal wall develop parallel to the severity of the clinic's disease. Inflammation alternates with a change in character:

• is catarrhal - there is hyperemia of the mucosa, swelling, submucosal hemorrhages in the thick and part of the small intestine;
• is fibrinous-necrotic - there is a thickening of the wall, necrosis to the submucosal or muscular layer, it is represented by a film of dirty-gray color, can go to gangrene;
• ulceration - at the end of the first week of the disease, the lesions are suppressed, the film is opened and small, but rather deep ulcers appear, they increase with the rejection of fibrinous necrotic tissue.

In the healing stage, ulcers are tightened, while in other areas inflammation continues, so the picture is variegated.

Symptoms of dysentery in children

The main sign of dysentery is not diarrhea, as many think, but intoxication. The incubation( latent) period can last from 12 hours to a week from the time of infection, usually 2-3 days. To determine the source of the disease in a kindergarten or school outbreak, this period may be important. The more pathogenic microorganisms the child has, the brighter the clinic of dysentery and the more rapidly intoxication develops.

It is customary to distinguish between the following:

• acute form( lasts no more than two months);
• protracted( up to three months);
• chronic( more than three months).

Dysentery in children with acute course is divided:

• into the lung;
• medium-heavy;
• heavy;
• extremely severe( toxic);
• erased( atypical).

In addition, infectionists distinguish the course with complications and without them. Shigellosis in children differs in its symptoms, depending on the age, type of dysentery, the massiveness of infection, the severity of immunity, and other diseases. Easy and erased flow differs dysentery type Sonne, it does not cause necrosis of the intestinal mucosa.

The most difficult children suffer from flexner dysentery. The onset of dysentery can be seen by a sharp rise in temperature to 38-39 degrees, the appearance of signs of intoxication( refusal to eat, vomiting, lethargy and drowsiness).Older children complain of pain in the head, in the stomach, often ask for a pot, feel tenesmus( false urges).

The chair is first frequent( up to 25 times a day), liquid, plentiful, then it becomes lean in the form of "spit" with veins of blood, greens. After emptying, pains in the abdomen decrease. Tenesmus and pain causes affected innervation of the sites of the descending part of the large intestine. Strong straining in children can cause prolapse of the rectal mucosa.

On examination, the tongue of the patients is coated with a white coating. The abdomen rumbles, the palpation is painful in the iliac region to the left( zone of spasmodic sigmoid colon).In the case of light flow, the condition of the child changes little. The temperature is normal or slightly above 37 degrees. Stool frequency up to 8 times a day, contains a little mucus, without blood.

The medium-heavy form proceeds with pronounced intoxication, high fever( holds 2-3 days), vomiting, severe pain in the abdomen. Tenesmus hold up to a week, in liquid stool there is mucus, blood. In severe form, both intoxication and intestinal damage are expressed. The stool with impurities repeats more than 15 times.

Temperature, after 3 days, decreases, but keeps within 37-38 degrees. The child complains of weakness, headaches, refuses to eat. Toxic course manifests neurotoxicosis with a constant high temperature, repeated vomiting, co-morbid state. Sometimes a loose stool appears later, and the disease is taken for food poisoning.

There is a lot of mucus and blood in the stool. The abdomen is sharply painful in the left half, in the iliac region is palpated a roller-like spasmodic sigmoid colon. In severe toxicosis, the child has convulsions, loss of consciousness. The face pales, lips and ears become cyanotic.

The decrease in blood pressure, pronounced tachycardia, arrhythmia of the heart contractions is fixed. The patient needs emergency intensive care for life reasons. From the timeliness of treatment depends the outcome of dysentery and the consequences of the disease. Can a child develop chronic dysentery?

The chronic form of bacterial dysentery in children is formed even more often than in adults. It is able to pass any course of the disease, regardless of the type of pathogen. Contributing factors:

• hypovitaminosis, rickets;
• presence of worms;
• anemia;
• other diseases.

The most frequent cause of chronic illness is the child's getting after the dysentery transferred to the same unsanitary conditions, repeated infection from an adult carrier of a dysentery rod or a sick person. Chronic dysentery proceeds with weak signs of intoxication.

The child is constantly languid, poorly eats, quickly gets tired, and the temperature is normal. Abdominal pain and loose stools are fickle. Sometimes there are veins of blood and mucus. Usually, the enzymatic insufficiency of the pancreas, liver, and stomach is attached to the bowel disease.

Are there any features of dysentery in children of the first year of life?

For babies under 1 year, breastfeeding is very important. The earlier mothers switch to artificial mixtures, the higher the risk of infection. Factors are added: hypovitaminosis, rickets, anemia. In infants, the course of dysentery has features:

• , the defeat of the colon is combined with dyspepsia, so stools persist in the stool, there is a green color, a lot of mucus, stench, undigested lumps of food( blood veins are rare);
• the child expresses anxiety, cries at a defecation, at survey the anal aperture is constantly open( gaping);
• for the abdomen is characterized by bloating;
• the initial toxicosis is rare, more pronounced in later terms when the water-electrolyte balance is disturbed, the functions of the cardiovascular system;
• children are more likely to attach secondary infection with the development of pneumonia, otitis media;
• the course of the disease is more often chronic.

The cause of secondary toxicosis in infants is the adherence to dysentery of staphylococcal infection or salmonellosis. Mixed pathogenic flora produces severe severe intoxication with multiple vomiting, dehydration, impaired protein metabolism.

Doctors associate a chronic wavy course of dysentery in young children with late treatment of parents, shortcomings and interruption of the course of drugs against dysentery. Refusal of treatment leads to serious complications, the development of renal and heart failure.

What complications can a child have?

The most common infection in young children is an infection that causes stomatitis, otitis, and pneumonia. Virtually all children after prolonged diarrhea, there is a dysbacteriosis of the intestinal flora, which complicates the recovery processes.

In cases of localized intestinal changes, intestinal bleeding, rectal prolapse, perforation of the wall at the site of ulceration, peritonitis, formation of scars and adhesions with subsequent partial obstruction can occur. There are cases of complications after dysentery in extraintestinal manifestations. Their origin is unclear, perhaps due to the autoimmune mechanism:

• inflammation of the joints;
• irites and iridocyclitis( eye damage);
• neuritis;
• encephalitis.

Diagnosis

Complete diagnosis of dysentery requires confirmation of the type of pathogen, the form of the disease. Epidemiologists are involved in the investigation of cases. They take into account the general epidemic situation in the territory, symptomatology, conduct laboratory tests.

Laboratory results:

• Coprogram - feces microscopy allows to determine the number of leukocytes, undigested food residues, muscle fibers, fatty inclusions, bacteria, erythrocytes. By their number, one can judge the degree of damage to the intestinal functions.
• Method of bacteriological inoculation - the study of feces, vomit. The nature of growth in certain media indicates the type of pathogen. You can identify sensitivity to antibiotics and choose the most optimal drugs.
• Serological methods( enzyme-linked immunosorbent assay, indirect hemagglutination test) allow detecting specific antibodies in the patient's blood that have appeared on penetration of shigella as antigens. Their titre is important at a certain dilution.
• The polymerase chain reaction method is used in cases of difficulties in differential diagnosis. He gives information about the genetic material of a particular pathogen.

Rectoromanoscopy for children with dysentery is rarely used, if necessary, under anesthesia. The results of a blood test are not very specific, they may not appear at all, or if leukocytosis, ESR, is increasing during a severe course.

How is dysentery treated in children?

Doctors prefer to refer children to inpatient care, it is possible to be hospitalized with their mother. Treatment of dysentery in children outpatiently under the supervision of a medical worker is allowed to be carried out at home only if there is a light course, if the baby is over the age of the year, there are no other young children in the family and the parents are able to follow all the doctor's instructions.

To be treated in isolation is required for the child, if one of the adults works in the kitchens, in the central water supply facilities, in children's groups. The complex of therapeutic measures includes bed rest, restriction of mobile games, a special diet, drugs with a specific effect on the pathogen and symptomatic means.

The diet takes into account the age of the child. From starvation now doctors have refused. It is recommended to give the baby a drink of decoction of chamomile, raisins, rice, give water, acidified with apple cider vinegar. After stopping vomiting, give to drink a little after 5-10 minutes.

A one-year-old child can eat liquid boiled rice porridge, oatmeal, mango, mashed potatoes, jelly, minced meat, cooked or steamed. Portions should be reduced by half. The number of feedings is increasing. Babies of infants are shown acid-milk mixtures.

In the second week of illness, the diet is gradually expanded. During the recovery from the diet should be excluded for 3 months fried and fatty dishes, sweets, confectionery. Signs of dehydration require not only an intensification of the drinking regimen with drugs such as Regidron, Glucosolan, but also intravenous saline solutions.

Antibiotic agents include antibiotics( polymyxin M, Gentamicin, Ampicillin) or nitrofurans( furazolidone, Nifuroxazide).The dosage is determined by the doctor by age, weight and severity of the disease. To relieve pain, antispasmodics are recommended. Sometimes substituents of pancreatic enzymes are used to restore digestive functions.

. Children are prescribed a course of vitamins and probiotics( Bifiform, Bifidumbacterin, Lactobacterin), prebiotics for improved assimilation( Lactofiltrum).The criterion of cure is the normalization of the general condition, the disappearance of symptoms, a negative result of stool culture 3 days after the end of antibiotic intake. The infectious disease doctor must observe the child for a month during recovery.

Prevention of

To prevent infection of the child, adult surrounding people must follow the rules of individual sanitation, wash vegetables and fruits, do not feed the baby with products of doubtful shelf life and quality. Kids love to swim and wash their hands, this habit must be fixed. To teach to wash hands after walking, playing on the floor, other people's toys, toilet.

There is no special inoculation against dysentery, since the disease does not form a permanent immunity. All the rules of conduct and personal protection should be especially observed in the summer months, when traveling to hot countries, swimming in water. Infection of the child most often depends on insufficient attention of adults, poor care. Therefore, preventing dysentery in children is primarily the task of parents and close people.