Dysentery

An acute infection of thft hnwel usually гяпярН by пгряпіятя of the Shigella group. Organisms may be spread from person to person by the direct fecal-oral route. " " ~ ' ¹

J^fvHllflry dyftn-t«"T ^ ^^r'ti"iilffTtrf7mmflTl І I? voungBr children. Tb^Jp^{m 1 Ья}onperiod is 1 to 4 days. In children nnggt jp яиННрп, with ffiypr^rril^hility prj^rowsiness. anorexia-^nauspa nr w>rni^tir?g. diarrhea, їШштйпаїраіп and distention, tenesmus. Within 3 days, blood, pus and mucus арреаТіїГїК^ШШіГП^^гШуТЇЬе stools increase rapidly to 20 or more daily, and weight loss and dehydration become severe. The untreat­ed child may die in the first 12 days; if not, acutes^aiptoms eubgide j)y the 2nd week.

Prognosis is good if treatment is prompt and adequate. Without ther- in Tnvpmia. peri-

tomjj£~aiTd~iTrafu^ death. Malnutrition not only

Increases susceptibility to the disease, but also increases the mortality rate.

Good sanitation, with elimination of flies and protection of food from contamination, is of the first importance. TheJ&llnwing precautions am- necessarv to pKevenrt-the-eoKead of milk-, water-, and fly-borne digeaseso-

Anti^Qftfarifli including the tetracyc!ines₂__<^EhlQ£anipbpriicQl_

and_jhe sulfonamides, have Ь§щ^Д5Є^ргорКуІас|1^1у in endemic areas ajsjvslllasjjjj^^ ejp^ejnigSi,

1. Read the text and choose the sentences describing the main symptoms of the disease.

2. Complete the following sentences.

   1. Good sanitation, with elimination of flies and protection of food from contamination is ... .

   2. Malnutrition not only increases susceptibility to the disease, but may lead to ... .

   3. Diagnosis of bacillary dysentery is confirmed by isolation of ... .

3. Put in the missing words from these given in the right column.

   1. Children under 2 years are more susceptible to ... infection than at any other age.

   2. Salmonella organisms produce mucosal ... and lodging disease by penetrating in the submucosa.

   3. E. coli strains capable of producing ... illness do so by their ability to elaborate ....

   4. invade

      Enteric

      Enterotoxins

      Diarrheal

      cells

      Following ingestion, organisms multiply in the upper small bowel but do not ... .

Diarrhea

Infectious diarrhea is a clinical syndrome of diarrhea of acute onset, often accompanied by fever and vomiting, which is of infective origin and not secondary to some primary disease process outside the gastrointesti­nal tract. It is usually a self-limited illness lasting less than 10 days. Acute infectious diarrhea is a disease of global importance and is one of the commonest causes of childhood illnesses. Children under 2 years are more susceptible to enteric infection than at any other age. Even in coun­tries with excellent health care, infectious diarrhea causes significant morbidity and unnecessary mortality in infancy.

Salmonella

In most developed countries typhoid fever is rare, but Salmonella organisms are the commonest bacterial pathogens isolated from cases of acute diarrhea. Most human Salmonella gastroenteritis occurs by way of contaminated food stuffs ingested by an individual.

Salmonella organisms produce disease by penetrating mucosal cells and lodging in the submucosa, where they stimulate an inflammatory reaction usually in the colon and distal small bowel. Infection rarely extends beyond the intestinal tract. Symptoms develop 24 to 48 h after ingestion. Severity of the disease is variable, but it is usually self-limit­ed and abates in 2 to 5 days.

Shigella

The route of infection is usually person-to-person, but spread can also occur by contaminated food or water. Following ingestion, organisms multiply in the upper small bowel but do not invade. Clinical disease appears later when bacteria invade ileal and colonic mucosal epithelium, causiftg necrosis and ulceration and producing the clinical picture of fever and diarrhea with blood and mucus. The typical bloody stools of bacillary dysentery are soon in approximately half the patients. Febrile seisures occur in 5 to 10 percent of cases.

Escherichia Coli

E. coli has long been recognized as a normal bowel inhabitant. Recent research has shown that E. coli strains capable of producing diarrheal ill­ness do so by their ability to elaborate enterotoxins or to invade the intestinal mucosa directly. Enterotoxin production appears to be the most important mechanism.

The single most important factor is preventing infectious diarrhea is a clean water supply. The beneficial effects of breastfeeding on morbidi­ty and mortality from diarrhea are well known and every encouragement should be given to mothers to give this benefit. Simple hygienic measures such as hand washing are frequently overlooked. Strict isolation proce­dures and enforcement of hygienic practices are necessary to protect sus­ceptible infants.