Dysentery at children – sharp bacterial intestinal infection which causative agent are different types of shigellas. Dysentery at children is shown intoksikatsionny (fever, an indisposition, weakness, nausea) and kolitichesky by syndromes (diarrhea with impurity of blood and slime, belly-aches, tenezma). Dysentery at children is confirmed by data of a bacteriological research, PTsR, IFA, RNGA, koprogramma and rektoromanoskopiya. In treatment of dysentery at children apply a diet, antibacterial and dezintoksikatsionny therapy, immunocorrection, enzymes, a probiotics, physical therapy.
Dysentery at children
Dysentery () – the infectious disease which is characterized by damage of a mucous membrane of a large intestine (mainly, its lower department), diarrhea and the general intoksikatsionny syndrome. Dysentery occupies one of the leading places among the sharp intestinal infections, and to 60-70% which had it children make. Higher susceptibility to dysentery is observed at children from 2 to 7 years, much less often the disease meets in the first year of life of the child. Problems of decrease in incidence of dysentery among children, improvement of methods of diagnostics, improvement of results of treatment and rehabilitation are very urgent for pediatrics and an infektsiologiya.
The dysentery reasons at children
Dysentery in children is caused by the big group of antropofilny enterobakteriya of the sort Shigella including 4 types of activators (S. dysenteriae, S.flexneri, S.sonnei, S.boydii) and about 50 serotypes. Shigellas - the gramotritsatelny, not forming a dispute sticks morphologically similar among themselves, being facultative anaerobe bacterias and differing on biochemical and serological properties. Causative agents of dysentery at children are rather steady in the external environment: long remain in water and the soil (up to 3 months), food (15-30 days), well transfer low temperatures and drying; but are sensitive to heating (perish in 30 min. - at 60 °C, instantly – at 100 °C), a direct sunlight and disinfecting medicines.
The sick person is a source of infection, it is frequent with a lung and the erased course of dysentery, is more rare - . Children with dysentery are infectious for people around from the first day of a disease as they allocate a large number of shigellas with excrements.
The mechanism of infection with dysentery – fecal and oral; transmission of infection at children is carried out food, water (through a water supply system, when bathing in reservoirs and pools) and contact and household (through dirty hands, ware, linen, toys) ways. The risk of infection with dysentery at children increases at the use of the products which are not subjected to preliminary heat treatment, expired, dirty fruit and vegetables.
Dysentery at children arises in the form of sporadic cases or epidemic flashes which development is promoted by accidents of plumbing and sanitary, adverse meteoconditions (cyclones, floods, floods). Emergence of the family epidemic centers of dysentery is typical: from sick family members 40% of children catch. The peak of incidence of dysentery among children falls on the aestivo-autumnal period. Formation of chronic dysentery is observed at children with the reduced immunity, associated diseases, at accession of interkurrentny infections (a SARS, etc.).
Dysentery symptoms at children
Clinical features of dysentery depend on a type of the activator (Zonne, Fleksner, etc.), character of a current (sharp or chronic), expressivenesses of manifestations (easy, average weight or heavy forms), extensiveness of damage of a GIT (the gastroenteritis, colitis, gastroenterokolit), a premorbidny background and immunity of the child.
The incubatory period at dysentery at children proceeds from several hours to one week (usually 2-3 days) and passes into the characteristic sharp beginning of a disease. In the first days the infection is shown by the expressed indisposition, fever (from 37,5 to 40 °C), nausea, vomiting (single or repeated); in hard cases – consciousness oppression, spasms, cyanosis, tachycardia and hypotonia.
Intestinal dysfunction at dysentery at children is characterized speeded up (from 5-8 to 10-25 times a day) by a liquid chair with impurity of muddy slime, greens and a blood streak; on character at first plentiful and kalovy, for 2-3 days of a disease – very poor ("a rectal spittle"). Rumbling on the course of a thick gut, painful, often false, desires on defecation (tenezma) is noted. The expressed and frequent natuzhivaniye (especially at children of younger age) can lead to a pliability or a gaping of an anus, is more rare - to loss of a mucous membrane of a rectum.
At children of the first year of life dysentery is observed, as a rule, at rickets, anemia, diathesis, artificial feeding. Symptoms develop gradually, the chair remains to kalovy many slime and greens, is rare with blood impurity; specific toxicosis can be not sharply expressed, weight of a state is caused by violation of haemo dynamics and water and mineral exchange. The babies sick with dysentery, have a tendency to development of a secondary bacterial infection (pneumonia, otitises).
Zonne's dysentery at children has the subclinical, erased current with gastroenteritichesky damage of a GIT, without destructive changes of mucous more often. More intensive damage of intestines and heavier current is characteristic of Fleksner's dysentery at children.
At the uncomplicated course of dysentery at children clinical recovery occurs usually in 2–3 weeks, but complete morfo-functional recovery of a GIT lasts up to 2 - 3 months and more; there is a risk of an aggravation at violation of a diet.
Hard cases of dysentery at children can be complicated by formation of toxic megacolon, perforation of a thick gut, peritonitis; in rare instances - development of a gemolitiko-uraemic syndrome, renal and heart failure, toksiko-infectious shock, a lethal outcome.
Chronic dysentery at children quite often proceeds at a satisfactory general condition, weak intoxication, existence of a liquid or semi-fluid chair of kalovy character, sometimes with slime and streaks of blood. The long course of dysentery weakens children, leads to a hypotrophy, avitaminosis, anemia.
Diagnosis of dysentery at children
Children with suspicion of dysentery have to be isolated, examined by the pediatrician and the infectiologist. The diagnosis of dysentery at children is made on the basis of the epidemiological anamnesis, a clinical picture, laboratory data.
The causative agent of intestinal infection identify by a bacteriological research a calla and emetic masses with obligatory definition of sensitivity of the allocated microflora to antibiotics. In doubtful cases for identification of shigellas and specific anti-genes in excrements and blood use PTsR and serological methods (RNGA, RKA, IFA). Results of a koprogramma and rektoromanoskopiya at diagnosis of dysentery at children have auxiliary value.
Dysentery at children needs to be differentiated from infectious colitis, enterokolit and a gastroenteritis of other etiology: salmonellosis, enteropatogenny esherikhioz, iyersinioz, amebiaz, viral diarrhea, and also ekssudativny enteropatiya, nonspecific ulcer colitis and disease Krone.
Treatment of dysentery at children
Treatment of dysentery at children is defined by a form and disease severity, age and the general condition of the patient and depending on it can be carried out in a hospital or is out-patient. Complex treatment of children with dysentery includes the mode, clinical nutrition, antimicrobic and dezintoksikatsionny therapy, immunocorrection, restoration of function of a gastrointestinal tract.
During the sharp period of dysentery children have to observe a bed rest. The diet is appointed according to age of the child: in the first 1-3 days food fractional with reduction of daily volume of food and increase in frequency rate of reception. At the children about one year who are on artificial feeding enter fermented milk products (kefir, ). To children years are more senior also chemically sparing food (rice and semolina porridges, vegetable broth, vegetable puree, mincemeat, kissels, mucous soups, cottage cheese) is shown mechanically.
At toxicosis and dehydration of easy degree to the child allow to drink salt solutions; in hard cases infusional therapy is shown. The pain syndrome is stopped spazmolitichesky means (, a papaverine).
At severe and medium-weight forms of dysentery at children apply antibiotics (ampicillin, gentamycin, M, nalidiksovy to - that), nitrofurans (furasolidone) taking into account sensitivity of the strains circulating in this area. Purpose of a polyvalent dysenteric bacteriophage is expedient.
Anti-diarrheal cure for dysentery at children of chest and early age does not use. For restoration of function and a biocenosis of intestines at dysentery at children enzymes (), a probiotics and prebiotics are shown. In the rehabilitation period the medicines increasing immunity, vitamins A With, In, phytocollecting, fizio-and sanatorium treatment are recommended to the children who had dysentery.
Long and chronic forms of dysentery at children are treated as sharp process. Dysentery at children is considered the cured ambassador of normalization of a clinical picture and negative result of a control bacteriological research, but within 1 month observation from the children's infectiologist is necessary.
The forecast and prevention of dysentery at children
In case of performing full therapy dysentery at children completely recovers. At the heavy course of dysentery at children and the high level of a toksemiya the probability of complications is high.
It is possible to warn dysentery at children at obligatory observance of rules of personal hygiene; strict control of sources of water supply, norms of storage, preparation and realization of foodstuff; identification of patients in preschool and school institutions, among employees of dairy kitchens, catering establishments; holding quarantine and sanitary actions.