Bacterial agitation
| Classification according to ICD-10 | |
|---|---|
| A03.0 | Shigellosis due to Shigella dysenteriae |
| A03.1 | Shigellosis due to Shigella flexneri |
| A03.2 | Shigellosis due to Shigella boydii |
| A03.3 | Shigellosis caused by Shigella sonnei |
| A03.8 | Other shigellosis |
| A03.9 | Shigellosis, unspecified |
| ICD-10 online (WHO version 2019) | |
The bacillary dysentery ( synonym : Shigellosis , Shigellendysenterie , Shigellenruhr , bacillary dysentery , bacilläre dysentery ) is one of several Shigella induced TYPES Dysenterieerkrankung with diarrhea and tenesmus (tenesmus) mainly the large intestine attacks. Proof of the pathogen is notifiable in Germany and Switzerland; in Germany, suspicion of the disease may also be required. For the origin of the word "Ruhr" see dysentery .
transmission
The infection occurs mostly fecal-orally, especially via the oral ingestion of traces of urine or feces from infected hosts . Humans are the only reservoir hosts , the spreading takes place among other things by flies . In contrast to the similar Salmonella , Shigella are acid-stable, so they are not killed in the stomach .
The bacterial dysentery usually occurs in areas of inadequate hygienic care, with more severe forms in the case of a weakened immune system or malnutrition .
Epidemiology
The cause is an infection with Shigella , of which four species are known:
- Group A, Shigella dysenteriae : tropics , subtropics , 10 serovariants, forms both an endotoxin and an ectotoxin ( Shiga toxin ), which leads to severe clinical pictures. The mortality is five to 15 percent.
- Shigella ambigua, Schmitz. B.kterium, also forms ectotoxins.
- Group B, Shigella flexneri: no exotoxin, distributed worldwide, i. A. milder form than in group A.
- Group C, Shigella boydii: Middle East and North Africa, rare, mild course.
- Group D, Shigella sonnei: Central Europe, v. a. in children, no exotoxin, mostly fleeting and harmless course ("summer diarrhea").
Pathogenesis
The pathogens are absorbed through the intestine and some of them are absorbed. The toxic pathogens in group A secrete endotoxins and ectotoxins which, in addition to general toxic damage, can also cause changes in the mucous membrane and ulceration. The more common non-toxic pathogen variants of groups B, C and D only produce endotoxins, although infections are generally easier.
course
The bacterial agitation has an incubation time of 2 to 7 days. A distinction is made between two forms, a toxic bacterial dysentery, which is similar to paratyphoid , and a lighter one, which is similar to infectious gastroenteritis .
The toxic bacterial dysentery is characterized by frequent bloody and slimy diarrhea , fever , loss of appetite , fatigue, abdominal pain / colic and violent tenesms . The great loss of fluids and electrolytes and the absorption of bacterial toxins are the greatest dangers that can lead to desiccosis , kidney failure , circulatory collapse , cramps and coma .
The milder form is associated with less toxic symptoms. The symptoms are fever, vomiting, tenesms and watery diarrhea with admixture of mucus and blood.
If the disease is severe, it can lead to intestinal bleeding and ulcer perforations, which carry the risk of peritonitis .
The consequence of the disease can be reactive arthritis (equestrian syndrome), which usually disappears spontaneously.
After surviving the illness, the person excretes pathogens for about four weeks. A survived shigellosis offers a certain immunity to pathogens of the same type.
Diagnosis
The diagnosis is made based on clinical symptoms . The pathogen is detected by cultural , bacteriological examination of a smear from the rectum .
Prevention and treatment
The basic prevention is hygiene measures such as cleanliness when preparing drinking water and food, regular hand disinfection and the removal of faeces.
The therapy consists of improving the patient's immune system, replacing water and electrolytes (e.g. WHO drinking solution ) and intravenous antibiotics such as quinolone antibiotics or ampicillin . Since some Shigellae are multi-resistant due to R-plasmids , a possible correction of the antibiotics according to the antibiogram is necessary. In the case of cramp-like abdominal pain, the administration of an antispasmodic such as N-butylscopolamine can be useful.
Constipating agents such as loperamide suppress the diarrhea , but delay the elimination of the pathogens from the body. Therefore, these funds can only be used for a short time.
forecast
In the lighter forms, the prognosis is relatively favorable; in the more severe forms, the mortality rate is 3–10%.
Reporting requirement
In Germany, bacterial dysentery (shigellosis) may be a notifiable disease (e.g. for employees in kitchens and restaurants) according to Section 6 (1) sentence 1 number 2 of the Infection Protection Act . Namely, is notifiable
"2. the suspicion and illness of microbial food poisoning or acute infectious gastroenteritis if a) a person is affected who carries out an activity within the meaning of Section 42 (1), b) two or more similar illnesses occur in which an epidemic connection is likely or suspected, [...] "
You are then required to report by name in the event of suspicion and illness. In Germany, the direct or indirect detection of the pathogen Shigella sp. Specifically subject to reporting in accordance with Section 7 of the Infection Protection Act , provided the evidence indicates an acute infection.
In Switzerland, the positive and negative laboratory analysis results for Shigella spp. notifiable according to the Epidemics Act (EpG) in conjunction with the Epidemics Ordinance and Appendix 3 of the EDI Ordinance on the reporting of observations of communicable diseases in humans .
literature
- Willibald Pschyrembel : Pschyrembel. Clinical Dictionary . Edited by the publisher's dictionary editor under the direction of Helmut Hildebrandt. 261st edition. De Gruyter, Berlin 2007, ISBN 978-3-11-018534-8 .
- Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9-223, here: pp. 136-140 and 145.
Web links
- Shigellosis - information from the Robert Koch Institute
- National Reference Center for Shigella. Austrian Agency for Health and Food Safety, AGES for short, January 10, 2020(Austrian German).
- Shigellosis (bacterial dysentery). In: bag.admin.ch. Federal Office of Public Health, 23 August 2019(Swiss Standard German).
Individual evidence
- ↑ Gerald T. Keusch, David WK Acheson: Shigella Infection. In: Lois J. Paradise, Mauro Bendinelli, Herman Friedman (Eds.): Enteric infections and immunity. Plenum Press, New York NY u. a. 1996, ISBN 0-306-45242-1 , pp. 79-100, doi : 10.1007 / 978-1-4899-0313-6_5 .
- ↑ Shigellosis. RKI advisor. In: rki.de. Robert Koch Institute, May 1, 2012, accessed on March 18, 2020 (reporting obligation according to IfSG).
