Why do people get infected so easily?
The infectious dose for shigellosis is one of the lowest among intestinal infections: the disease can begin after just dozens of bacteria enter the mouth. This changes the entire transmission logic. If salmonella needs food in which they have time to multiply, then shigella needs a microscopic amount on fingers, on a tap, on a toy or on a banknote. Hence the second name of the disease - “disease of dirty hands”, and the explanation of why in the family, after one sick person, the rest fell ill, although they ate everything different.
- Direct transmission from person to person through hands and objects is the main route in families and children's groups
- Street food and open trade without running water: the seller takes money and with the same hand serves a flatbread or ice cream
- Unwashed fruits, greens, berries, especially those sold in bulk and watered with water of dubious quality
- Water - from open sources, from a ditch, from an old water supply after an accident and shutdown
- Prepared salads, dairy and fermented milk products, prepared by hand and kept warm
- Flies as a mechanical vector - a significant factor in the summer months
A separate risk group is children from one to five years old. They put their hands and objects in their mouths, do not yet know how to wash their hands properly and are in constant contact with each other. In them, the disease is more severe: dehydration sets in faster, high fever occurs more often, and in some children, convulsions are possible at the peak of the temperature. The second vulnerable group is the elderly and anyone who has reduced stomach acidity: hydrochloric acid serves as a natural barrier, and when there is a shortage of it, more bacteria reach the intestines.
How to distinguish dysentery from other intestinal infections
Shigella affects the large intestine, and most other intestinal infections affect the small intestine. The whole clinical picture follows from this difference, which can be easily recognized by the description of the stool and the nature of the pain, without waiting for analysis.
- Stool is scanty, frequent, with a lot of mucus and streaks of blood; at the peak of the disease it may consist almost entirely of mucus
- The urge is frequent and painful, with a feeling that the intestines are not completely emptied, and with painful cramps in the lower abdomen
- The pain is concentrated on the lower left, along the sigmoid colon, and not around the navel
- Vomiting is rare and, as a rule, only on the first day - this distinguishes dysentery from food poisoning
- Dehydration develops more slowly than with cholera-like infections because the volume of stool is small
- The temperature rises early and lasts longer than with normal poisoning
Several other conditions give a similar picture, and it is important to distinguish them, because the treatment is different. Amoebic dysentery is milder, the temperature is often low, and the stool resembles “raspberry jelly”; It is treated with fundamentally different drugs and requires a separate stool examination. Campylobacteriosis also produces blood in the stool and is associated with poultry. Some E. coli have special toxin-forming strains, in which the stool becomes bloody, but the temperature remains normal - this situation is dangerous for kidney damage, and antibiotics can worsen the outcome. Finally, new bloody diarrhea in a young person without a fever that lasts for weeks makes one think of inflammatory bowel disease rather than an infection at all.
How it proceeds
The incubation period is short - usually from one to three days, occasionally up to a week. The onset of the disease is acute, and the sequence of events is quite typical.
- Первый день: общее недомогание, познабливание, головная боль, температура поднимается до 38–39, аппетит исчезает.
- Next присоединяется схваткообразная боль внизу живота слева, стул сначала обычный или кашицеобразный, но частый.
- Вторые сутки: объём стула уменьшается, зато частота растёт; появляются слизь и прожилки крови, позывы становятся мучительными.
- Третьи-пятые сутки: пик болезни, число дефекаций может достигать 10–20 в сутки, между ними сохраняются спазмы.
- С пятого-седьмого дня при лечении температура нормализуется, кровь исчезает, стул постепенно оформляется.
- Слабость и неустойчивый стул могут держаться ещё одну-две недели, у части людей формируется временная непереносимость молока.
The severity of the flow varies greatly. An adult often has an erased form, in which everything is limited to two or three days of frequent, pasty stools without blood and almost no fever - such people do not come to appointments and remain a source of infection for their family. At the other extreme are severe forms with high fever, severe intoxication and dehydration, more often in young children and weakened elderly people. Complications are rare but serious: dilation of the colon with the threat of rupture, kidney damage, reactive inflammation of the joints one to three weeks after infection.
Why you can't stop diarrhea with pills
The first desire when experiencing frequent painful bowel movements is to take a remedy that will stop it. In dysentery, this is one of the most dangerous mistakes. Diarrhea in this case is not a breakdown, but a way by which the body removes bacteria and their toxins from the colon. Drugs that slow down bowel function leave contents trapped, increase the amount of time toxins are in contact with the intestinal wall, prolong fever, and, if severe, can lead to severe enlargement of the colon, a condition that requires surgery.
- Drugs that inhibit intestinal motility are contraindicated for any diarrhea with blood and high fever.
- They are especially dangerous in young children, who easily experience respiratory depression and bloating.
- Painkillers “until clarification” blurs the picture if in fact we are talking about surgical pathology of the abdomen
- An antibiotic found at home or suggested by friends not only often turns out to be inappropriate, but also makes culture uninformative
- Enemas and rinses in the acute period additionally injure the inflamed mucosa
- Fasting does not speed up recovery and slows down the restoration of the mucous membrane
What you really need to do before visiting the doctor is to replace fluids and salts. With dysentery, stool loss is less than with watery infections, but fever and refusal to eat take their toll. A pharmacy rehydration solution, diluted strictly according to the instructions, or a homemade version with sugar and salt per liter of boiled water is suitable. You need to drink little and often. Reducing the temperature above 38.5 is reasonable, but trying to bring it down at any cost is not. Meals are not canceled: liquid porridge, rice, crackers, bananas, baked apple, weak broth are well tolerated; milk, fat and coarse fiber are put aside for several days.
Treatment: when an antibiotic is really needed
Dysentery is an exception to the general rule about intestinal infections. Here, antibacterial therapy shortens the duration of fever and diarrhea by about two days and, no less important, quickly stops the release of bacteria, breaking the chain of infection in the family and community. This is why treatment is prescribed for confirmed or clinically convincing shigellosis, and not delayed until culture results are obtained.
- Обследование начинают с посева кала с определением чувствительности; параллельно может использоваться ПЦР, дающая ответ быстрее.
- Антибиотик подбирает врач с учётом возраста, тяжести и данных о местной устойчивости возбудителя; препараты, которыми лечили дизентерию десятилетия назад, today во многих регионах уже не работают.
- Курс доводят до конца даже при быстром улучшении: прерванное лечение — прямой путь к затяжной форме и носительству.
- Одновременно продолжают восполнение жидкости и солей, при выраженном обезвоживании — внутривенно.
- Питание расширяют постепенно, ориентируясь на переносимость, а не на строгие списки.
- После выздоровления при необходимости выполняют контрольное обследование — для декретированных групп это обязательное условие допуска к работе.
The resistance of Shigella to antibiotics has grown so much over the past decades that self-medication has become not only useless, but harmful for everyone: an incorrectly selected or incomplete course selects the most resistant bacteria, and the next sick person in the same family receives a more complex version of the pathogen. Not everyone needs hospitalization: for mild to moderate cases in adults, treatment is possible at home. Young children, the elderly, people with severe illness and dehydration, as well as those who cannot be isolated at home - for example, living in a dormitory or working with food products - are sent to the hospital.
Hand hygiene and street food: what really works
Since the infectious dose for shigellosis is extremely small, prevention here comes down to simple and boring things, but they work better than any medicine. The key point is the quality of hand washing, not its frequency: a short rinse under running water is noticeably inferior to washing with soap and rubbing for 20-40 seconds, including the back of the hands, between the fingers and the area under the nails.
- Wash your hands with soap after using the toilet, after changing a diaper, before eating and before preparing food - and always after returning from the market or from transport
- Alcohol antiseptic is only a backup option when there is no water: if your hands are dirty, it works much worse than soap
- Wash fruits, vegetables and herbs with running water, greens - with soaking and then rinsing
- Boil water for drinking if there is any doubt about its quality, and do not take ice of unknown origin.
- Avoid street food that is prepared and served with the same hands without access to running water
- Give a sick person in the family a separate towel and dishes, and clean door handles, taps and flush buttons daily.
- At home in the summer season, fight flies and do not leave food open
Children's groups deserve special attention. A child with any diarrhea should not go to kindergarten or school, even if he feels well: with such a small infectious dose, one such child can start an outbreak in a group in two to three days. Return - with the permission of the doctor, and not after the cessation of complaints. The same rules apply to adults who work with food: an attempt to “finish a shift” with an intestinal infection results in the infection of dozens of people who will never associate their illness with this cafe or store.