Dysentery is a common bacterial bowel infection that is diagnosed in children. This disease is most common among preschoolers.. This can be attributed to the fact that older children adhere to hygiene more, do not pull toys and fingers into their mouths. Of all the cases of dysentery, the main percentage is preschool children. In order not to confuse this dangerous disease with a simple indigestion, parents need to know the main symptoms of dysentery in children under one year old and older. This will help to quickly diagnose and start the right treatment.

Ways of infection

The disease is caused by bacteria of the genus Shigella. These pathogenic microorganisms multiply well in any environment - water, soil, on food products, they tolerate low-temperature conditions well. These bacteria are sensitive to heat, disinfectants, and exposure to direct sunlight. When boiled, Shigella die within a couple of seconds. The source of infection is a sick child, who is contagious from the first day of illness, since many pathogens are excreted with feces. The infection is transmitted in the following ways:

• Fecal-oral. By water - when swimming in open reservoirs and pools, as well as when consuming raw water. By food - by eating poorly washed vegetables or fruits;
• Contact household - transmitted through kitchen utensils, bedding, various toys and household items.

A large number of cases of dysentery are registered in the summer-autumn period when a lot of fruits, berries and vegetables are consumed. In addition, the warm period promotes the growth of bacteria on food products.

Causes of dysentery

Dysentery is caused by four types of Shigella, which are named after the scientists who first discovered them:

1. Sonne.
2. Flexner.
3. Grigorieva-Shiga.
4. Boyd.

The causative agents of dysentery differ in different areas. In European countries, Sonne's bacillus causes dysentery, and Flexner's dysentery is slightly less commonly diagnosed in children. In the countries of Central Asia and the Far East, the disease is caused by the Grigoriev-Shiga wand and is quite difficult.

Most often, infection occurs if raw water, unboiled milk and other products without heat treatment are used. The risk of infection also arises from the use of poorly washed vegetables, fruits and berries. The disease is often diagnosed during the ripening period of strawberries, raspberries and grapes, and some adults do not wash melons before offering them to the baby.

If a patient with shigella did not wash his hands after visiting the bathroom, then he transfers the causative agent of the disease to all the objects he touched on his hands. Dysentery in children will occur if the child takes an infected household item, and then pulls his hands into his mouth.

The susceptibility of children to dysentery is very high, regardless of age. But most cases are diagnosed before the age of 3 years. Provoking factors can be artificial feeding of a newborn, hypovitaminosis, diseases of the digestive organs and unsanitary conditions in housing.

General characteristics of the disease

Only shigella Grigorieva-Shiga produce toxins into the bloodstream while still alive, other pathogens release toxic substances when they die. Immunity after suffering dysentery does not remain, you can get sick again during your life more than once.

With dysentery, the whole body suffers, but the lower part of the large intestine is most vulnerable, where the sigmoid colon is affected. A small amount of the pathogen, when it enters the digestive tract, dies and at the same time throws in toxic substances. They are absorbed into the blood and, acting on the wall of blood vessels, increase their permeability. This causes pathological conditions in the intestines. Shigella reproduction occurs in the intestinal mucosa and in some lymph nodes.

Inflammatory processes in the intestines are classified depending on the degree of damage:

• Mild course of the disease - redness and swelling of the mucous membrane occurs, small hemorrhages are noticeable.
• Severe course of the disease - superficial necrosis of the mucosa occurs, ulcers appear in some places of the intestine after necrotic cells are rejected.
• A very severe course of the disease - ulcers appear in the intestinal walls, then scars appear on these places. Other pathogenic microorganisms, such as fungi, streptococci and staphylococci, can also provoke such ulcers.

Damage to the intestinal walls leads to disruption of the organ. This is manifested by increased peristalsis, increased stools, the appearance of mucus and bloody inclusions in the stool, and soreness of the affected parts of the intestine. The toxins released by the dysentery bacillus affect the vessels and nerve cells not only in the intestines, but also in the central nervous system.

Due to the infection, the work of all other digestive organs is disrupted, therefore, all metabolic processes in the body are disrupted. Toxic substances and under-oxidized products cause malfunctions in the cardiovascular system and pathological changes in various organs.

Therefore, if dysentery is diagnosed in a child or an adult, then this disease should not be taken lightly. Quite serious complications can occur, which will require more than one month of treatment.

Severe intoxication of the body can cause death in debilitated children. Of particular danger is dysentery in infants, with low body weight, dehydration quickly occurs, which leads to irreversible consequences.

Symptoms of dysentery

Signs of dysentery in a child usually appear more than in adults, and the disease itself is much more severe. The incubation period can be from three hours to a week - it depends on the amount of the pathogen that has entered the body. Shigellosis can occur usually or atypically, have a smooth course, or give severe complications. The duration of the disease is also different. In the acute form it lasts up to two months, in the protracted form up to three months, and more than three months in the chronic form.

Dysentery can be mild, moderate, severe and toxic. The disease, which was provoked by Sonne's stick, often proceeds easily, without severe damage to the intestinal mucosa. There is an erased course of the disease. Flexner's dysentery in children causes severe damage to the intestinal walls, so the disease is quite severe.

The onset of dysentery is usually very acute, the symptoms are quite specific:

• Body temperature reaches critical levels and lasts for about three days. This is accompanied by a headache.
• There is no appetite, nausea develops, repeated vomiting is possible.
• The child becomes lethargic, he has atypical drowsiness.
• The child complains of severe pain in the left side, which decreases immediately after defecation.
• The abdomen is painful on palpation along the intestine.

The baby defecates very often, from 5 to 30 times a day. From the very beginning of the illness, the stools are profuse and liquid, the next day they become scanty. You can see greens, mucus and streaks of blood in them. With a severe course of the disease, fecal masses are absent, only greenish mucus comes out in a small volume. Dysentery is characterized by false urge to go to the toilet.

Constant tension in toddlers can lead to anal gaping, most commonly seen in children who are 2 years old or younger. In rare cases, when straining, a prolapse of the rectum can occur, which will require the help of a specialist.

The severity of dysentery depends on the intoxication of the body and the degree of intestinal damage.

Light form

The child's condition hardly changes. Defecation becomes more frequent up to 8 times a day, but the bowel movements are not very rare and contain a little mucus. With this course, the condition improves in a few days, the temperature is rare.

Moderate form

Intoxication is manifested by mild symptoms. Body temperature rises during the first days to 39, then stabilizes. Vomiting occurs, the child complains of severe pain in the abdomen. Defecation occurs more than 10 times a day, there is mucus and blood blotches in the stools. The condition returns to normal after a week, but even in the formed feces, mucus may be present for a long time.

Severe form

Symptoms appear more from the intestines, although intoxication is also present.. Stools with abnormal impurities, the child goes to the toilet more than 15 times a day. There is a high temperature, which, with proper therapy, drops to a value of 37.5 and lasts for a long time, as well as weakness with poor appetite. The intestinal mucosa recovers for a very long time, diarrhea stops after a week.

toxic form

It is manifested by severe intoxication of the whole organism. There is repeated vomiting, general weakness and fever. Most often, with this form of the disease, a food infection is diagnosed, because there is no diarrhea. Loose stools occur a couple of hours after the first symptoms and quickly become scanty, with mucus and blood streaks. The baby's tummy sinks a little, you can feel the tense rectum.

Hypertoxic form

With this form, disturbances in the work of the cardiovascular system are characteristic.. There may be convulsions and fainting.

The skin becomes bluish, the limbs become cold and blood pressure drops.

The duration of the disease depends on the age of the baby and the time of treatment. Therefore, it is very important to quickly show the child to an infectious disease specialist.

With this form of dysentery, death often occurs even before the appearance of loose stools.

Chronic form

Any form of dysentery in children can become chronic. Other diseases can provoke this unpleasant process - rickets, anemia or helminthic invasion.. Re-infection with Shigella can lead to the chronic form of the disease. This form occurs with a slight intoxication of the body - the child is weakened, he has a poor appetite, there are pains in the lower abdomen and rare stools. But body temperature is normal. Other digestive organs are often involved in the disease, so metabolism is disturbed.

Features of the course of the disease in infants

In babies under 1 year old, an infectious disease has a number of features:

• Symptoms come on gradually. The stools are rare, very offensive and mixed with mucus.
• The abdomen does not retract, but swells.
• The baby is restless, crying a lot during defecation.
• Often a secondary infection develops - pneumonia or otitis media.

Indomitable vomiting and diarrhea quickly lead to dehydration of the baby. Absorption of proteins is disturbed, flatulence and malfunctions of the heart occur. Convulsions and fainting are possible. In severe cases, kidney and liver failure occurs.

Treatment of shigellosis

Treatment is carried out at home or in a medical facility, it depends on the age of the patient and the form of the disease, as well as some factors. Treatment of dysentery in children at home is allowed only with a mild course of the disease., and if there are no other children in the family who can become infected. Also, there should not be people in the house that work in the food industry and child care facilities. Comprehensive treatment is carried out, which consists of the following activities:

• compliance with the regime;
• treatment with medicines - antibiotics and others, depending on the symptoms;
• diet food.

In the acute phase of the disease, a child of any age is shown bed rest.

Antibiotic treatment is indicated for severe disease. Antibiotics of different groups are used, to which Shigella are sensitive - gentamicin, ampicillin. But most often they use nitrofurans, which belong to antimicrobial drugs.

If the child has severe dehydration, then he is carefully soldered. For this purpose use ordinary water, teas, decoctions of dried fruits, compotes and jelly. Well helps rice water, which is often given in small portions. In a hospital, intravenous administration of solutions - glucose and saline is indicated.

With severe pain in the abdomen, antispasmodics are prescribed. With signs of enzyme deficiency, mezim, festal or creon are prescribed. To quickly restore digestion, probiotics and vitamin complexes are prescribed.

How long a child needs to be in the hospital with dysentery, only the attending physician decides. But therapy is continued until all symptoms disappear and the test results are good.

Diet during the rehabilitation period

A diet for dysentery in children is prescribed immediately after the acute symptoms subside. Therapeutic starvation in children is not practiced now, food is given in small portions. If the baby is artificially fed, then it is temporarily transferred to fermented milk products.

For children older than a year, porridge is cooked from oatmeal, buckwheat and rice. You can give vegetable puree soups, as well as steamed meat products. Well normalizes digestion applesauce, which contains pectin.

After a child has had dysentery, he should not eat fried and smoked foods for about two months. As well as spicy food, which is flavored with a lot of spices.

How to prevent shigellosis

Preventive measures to prevent cases of the disease are simple and come down to compliance with hygiene rules:

• Hands must be washed after the street and going to the toilet.
• Vegetables, fruits and berries are thoroughly washed with running water, and then rinsed with boiling water.
• Do not eat foods of dubious quality.
• If a case of dysentery is registered in the children's group, then quarantine is introduced.
• The dishes for feeding the artificial child are well washed and doused with boiling water.

Any infectious disease is easier to prevent than to treat later. Therefore, parents should instill hygiene habits in their children from early childhood. If the child is still sick, then you should not self-medicate, you need to consult a doctor for advice and treatment.

Children are highly susceptible to various diseases. Among the common diseases among young patients is dysentery. This intestinal infectious disease is also called the disease of dirty hands, since the main reason for its occurrence is non-observance of personal hygiene rules. Children make up more than 70% of the total number of patients with this disease. Mostly these are preschoolers (from 2 to 7 years old), who often put various objects or their own pens into their mouths.

How dysentery is transmitted: ways of transmission, causes

The main cause of acute intestinal disease are various types of pathogens of the genus Gram-negative rod-shaped bacteria - Shiggel. To establish the exact cause of the disease and identify the source of infection, it is necessary to know the mechanism of infection.

In children, infection occurs in the following ways:

• water;
• food;
• contact-household.

The most common source of infection for children is food that has not been heat-treated (dairy products, salads, etc.) or poorly washed, expired, or stored incorrectly.

Water can also be a source of infection. Basically, infection occurs through the use of raw (that is, unboiled) liquid, especially from unreliable sources. For example, well or spring drinking is often contaminated with feces that penetrate from the soil into groundwater.

In case of contact-household infection, the infection of a child occurs through household items (dishes, door handles, linen, etc.) or toys. If the carrier of the infection did not wash his hands after the defecation process, then he transfers the infection to all objects that he touches, and the child, in turn, in contact with the same things, brings the “infection” into his body. That is why it is so important for people who surround the baby to carefully observe all the rules of personal hygiene. Indeed, in most cases, infection of children occurs from people who care for them.

How to determine that a child has dysentery: symptoms

The clinical manifestation of an acute intestinal ailment depends on many factors: the type of bacteria, the degree of infection, the age of the patient, the state of his immune system, the presence of concomitant pathological processes.

At the initial stage of development, the disease is manifested by general malaise, weakness, fever, nausea and vomiting. Later, the main symptoms are complicated by bowel disorders. In some children, an infectious disease immediately begins with intestinal disorders, which are manifested by painful sensations in the abdomen and diarrhea, while children's feces remain fecal in nature, but over time, mucous and bloody streaks appear in them. Soon the feces become greenish in color, and the frequency of urges can reach up to 20 times a day.

Features of the course of dysentery in young children

It is much more difficult to determine the signs of bacterial infection in children of the first year of life. Firstly, they still cannot tell their parents about their health problems on their own. Secondly, the clinical manifestation of an infectious disease has a slightly different character:

• gradual development of colitis syndrome;
• violation of the normal activity of the gastrointestinal tract;
• the fecal nature of the stool is preserved;
• green color of feces with mucus and lumps of undigested food, in rare cases, bloody streaks may appear;
• fetid stool;
• bloating;
• pain during defecation.

In severe cases, one-year-olds may experience frequent vomiting, profuse diarrhea, fever, and significant weight loss.

What to do if a child has dysentery

It is impossible to cure dysentery on your own without medical help. Therefore, the first thing parents should do when they find signs of infection is to show the child to the doctor and undergo the necessary examination. Treatment of an infectious disease is carried out on an outpatient or inpatient basis. This largely depends on the severity and clinical form of the disease.

Therapy of dysentery in children is carried out in a complex manner. Treatment includes taking medications, following a certain regimen, and dietary nutrition.

Antibiotics

Antibiotic therapy is prescribed for moderate and severe infection. The type of drug depends on the variety of pathogenic microorganisms, in our case bacteria of the genus Shigella. The most commonly used drugs are Ampicillin, Gentamicin, Polymyxin, Furazolidone, Nifuroxazide and others.

However, do not forget that it is forbidden and dangerous to treat a baby with antibiotics on its own. The duration of therapy and dosage should be determined exclusively by a specialist.

Treatment at home with folk remedies

Doctors approve of the use of traditional medicine in the treatment of dysentery in children. However, parents should take into account that Mother Nature's medicines bring results only if the therapy is carried out in a complex manner, so do not forget to discuss this issue with your doctor before using them.

It is very important for an infectious infection to give the child as much to drink as possible. And in this case, recipes for folk therapy come to the rescue. Small patients are recommended to give various decoctions, for example, rice, chamomile, apple. Also useful in the treatment of dysentery is rice porridge boiled in water without adding salt.

Diet

Nutrition during the treatment period is selected based on the age of the patient. Typically, the diet menu includes the following dishes:

• cereals (semolina, oatmeal, rice);
• steam products (cutlets);
• vegetable soups;
• grated apple;
• kissels, decoctions.

As a rule, the patient begins to feed after the vomiting stops. The first days the child should eat often and in small portions. If the baby is on artificial feeding, then give preference to fermented milk mixtures.

From the second week of treatment, if the doctor allows, the nutritional diet of a small patient can be gradually expanded. However, spicy, salty, fried and fatty foods should be avoided for about 2-3 months after recovery.

Where and how to treat the baby - only the doctor decides. The main task of dad and mom is the strict implementation of all medical recommendations. Home treatment implies compliance with all measures to prevent infection of others, and care for a sick child. The following recommendations will help speed up the recovery process and prevent infection of others:

• take care to eliminate the source of infection and disinfect the house;
• observe bed and sanitary and hygienic regimen;
• control the intake of medications prescribed by the doctor;
• Provide your child with a balanced diet.

Urgent care

If the patient has symptoms of an acute intestinal disease (diarrhea with blood, high fever), it is necessary to act immediately. What can you do:

• contact a doctor and call an ambulance;
• give the child as much to drink as possible, the best drink in this situation will be boiled water with the addition of sugar (2 tbsp) and salt (1 tbsp);
• do not give the baby any medication without the permission of the doctor - this can complicate the course of the disease and harm the little patient;
• isolate a sick child from the household and control that his feces are immediately flushed down the toilet.

Consequences and complications

With illiterate treatment and a complex course of an infectious disease in children, chronic pathologies can worsen, concomitant diseases occur and, in fact, the development of dysentery is complicated. With deep intestinal damage in a child, the following complications may occur:

• bleeding in the gastrointestinal tract;
• cicatricial strictures;
• intestinal perforation with subsequent inflammation;
• rectal prolapse;
• the occurrence of dysbacteriosis.

In addition, complications may occur, the mechanism of development of which in shigellosis has not yet been studied, namely:

• joint damage (arthritis);
• inflammation of the peripheral nerves (neuritis);
• inflammation in the iris of the eyeball (iritis);
• brain damage (encephalitis).

Especially for - Marina Amiran

Due to weak immunity and inaccuracies in personal hygiene, babies are highly susceptible to intestinal infections. A very common disease among preschool children is dysentery. In order not to confuse it with other similar pathologies and start treatment in a timely manner, it is important to know the specific symptoms of the disease.

Dysentery - the causes of the disease

There are several ways in which dysentery is transmitted - symptoms in children occur after contact with an infected person or a carrier of pathogens. Other ways of infection:

• consumption of contaminated foods;
• bathing in reservoirs, pools with bacteria and protozoa;
• drinking contaminated water;
• contact with contaminated household items.

What are the signs of a child with dysentery?

Symptoms of the described disease are individual for each baby. The characteristic signs of dysentery in a child depend on the following factors:

• type of pathogen;
• the state of the immune system;
• severity of the pathology;
• severity of manifestations;
• the extent of damage to the gastrointestinal tract;
• patient's age;
• the presence of concomitant digestive disorders.

Dysentery - incubation period in children

The duration of the latent progression of the disease corresponds to the number of microorganisms that have entered the baby's gastrointestinal tract. Shigellous dysentery manifests itself faster - the incubation period ranges from several hours to a week, more often it is 2-3 days. Amebiasis remains hidden longer, this form of pathology can develop latently for 2-3 months.

Acute dysentery is diagnosed earlier than other types of the disease - symptoms in children up to a year old are observed within a few hours after infection, especially if a lot of shigella got into the body of the crumbs at once. The chronic form of the disease is constantly accompanied by specific symptoms, but they are erased, so parents sometimes do not notice the progression of the pathology.

Early clinical manifestations of the disease represent a clear intoxication. Dysentery in children begins with fever, elevated body temperature ranges between 37.5 and 40 degrees. The baby is very sick, often there is 1-2 times vomiting. The child feels severe weakness and malaise, drowsiness, apathy, refuses active games.

With impaired immune functions and the presence of other infectious diseases, dysentery is more severe - symptoms in children include:

• lack of appetite;
• severe headache;
• stool disorders;
• intense (sharp, pulling);
• bloating.

temperature for dysentery

Fever is observed throughout the acute period of pathology. The body temperature of the baby is kept at 38.5-39 degrees for 3-5 days, after which it gradually returns to normal. Dysentery in children under one year is rarely accompanied by fever. Subfebrile fever (37-38.5 degrees) is observed for about 10-15 days, which makes babies more difficult to tolerate the disease.

Feces for dysentery in a child

Stool disorders are the most specific symptom of the pathology in question. How does dysentery manifest in children older than 12 months:

• frequent bowel movements (up to 25 times a day);
• copious loose stools;
• impurities of cloudy mucus, blood and green streaks in the feces;
• painful urge to empty the bowels;
• rumbling in the stomach;
• decrease in fecal volume after 2-3 days ("rectal spit");
• a strong unpleasant odor from the stool.

In babies, dysentery is more difficult to diagnose - symptoms in children under 1 year old:

• flatulence;
• standard consistency of feces;
• the presence of greenish impurities and mucus in the feces, rarely - a streak of blood.

The child has dysentery - what to do?

If parents suspect the described infectious disease, you should immediately consult a doctor and immediately isolate the baby. It is important to realize how serious dysentery is in children - it is desirable to detect and develop symptoms and treatment at an early stage of the pathology. Otherwise, the disease can lead to dangerous consequences and irreversible complications. Effective therapy requires a comprehensive approach, including:

• bed rest;
• drug treatment;
• diet compliance.

Diagnosis of this disease is carried out on the basis of the existing symptoms, epidemiological history and laboratory results. To prescribe the correct treatment of dysentery in children, it is necessary to identify the causative agent of the infection. To do this, a bacteriological analysis of feces and vomit is carried out with a parallel determination of the sensitivity of the detected microorganisms to antibiotics. Biological material is delivered urgently, without prior preparation.

Treatment of dysentery in children at home

Self-treatment of the infection in question is undesirable, even if the disease is mild. Only a specialist can decide how to treat dysentery in children. Several groups of medicines are prescribed as symptomatic therapy:

1. rehydration solutions. Provide prevention of dehydration and restore the fluid-salt balance - Hydrovit, Gastrolit and others. In severe situations, rehydration is carried out through infusions (droppers).
2. Antispasmodics. Help eliminate pain and relax the abdominal muscles - Drotaverine, Spasmalgon, Papaverine.
3. Enzymes. Necessary in violation of the activity of the pancreas -, Creon, Festal.
4. Pre- and probiotics. They are prescribed to restore the intestinal microflora and normalize the consistency of the stool - Bifiform, Laktofiltrum, Bifidumbacterin.
5. Sorbents. Recommended for the purpose of stopping the intoxication of the body - Atoxil, Smekta.

Antibiotic for dysentery in children

Antimicrobials and intestinal antiseptics are selected exclusively by a doctor. An effective medicine for dysentery for children is prescribed in accordance with the results of a study of feces and determining the sensitivity of the inoculated pathogens to antibacterial drugs. The most commonly used agents from the group of nitrofurans:

• Furazolidone;
• Furazidin;
• Nitrofurantoin;
• Nifuratel and others.

Severe dysentery is treated with more potent drugs - symptoms in children that progress quickly and flow into complications must be stopped with antibiotics with the widest possible spectrum of activity. Simultaneously with the use of a polyvalent bacteriophage, the following are prescribed:

• Monomycin;
• Polymyxin M;
• Gentamicin;
• Terramycin;
• Streptomycin;
• Erythromycin;
• Amoxicillin and analogues.

Phytotherapy in the described case is allowed only as a supportive measure to prevent dehydration. Alternative recipes do not stop dysentery in children - home treatment can end in failure, especially without the use of effective medications. There are no medicinal plants that can act identically to antibiotics and quickly eliminate bacterial colonies in the intestines.

What can you eat with dysentery in children?

It is necessary to feed the baby immediately after the cessation of vomiting. Babies continue to be fed with mother's milk, it is better for artificers to purchase a mixture with live lactic acid bacteria. The diet for dysentery in children provides for a more frequent meal, but in portions reduced by a third or half. This helps to reduce the load on the pancreas, liver and intestines, speed up the recovery of the body.

Nutrition for dysentery in children older than 12 months should include:

• vegetable purees and decoctions;
• semolina, rice, oatmeal;
• mucous soups;
• cottage cheese;
• lean meat in the form of minced meat products (cutlets, casseroles, meatballs);
• jelly;
• steamed food;
• wheat crackers;
• non-acid compotes, decoctions and fruit drinks;
• weak tea, including herbal tea.

Dysentery in children - consequences

With timely and adequate treatment, the considered pathology can be cured completely. Complicated dysentery is accompanied by negative consequences - severe symptoms in children occur against the background of a weakened immune system, late detection of the disease, and the presence of chronic disorders of the gastrointestinal tract. Sometimes exacerbation of the disease occurs due to a violation of the diet prescribed for a period of 2-3 months.

One of the leading places among acute intestinal infections in children aged 1 to 7 years is dysentery. Symptoms in children depend on the type of pathogen and the age of the child, the most typical of the signs is bloody stools.

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Causes of dysentery and ways of infection

The main cause of infection with dysentery is non-observance of personal hygiene rules. The source of infection is a sick child with an acute or chronic form of the disease or a healthy carrier of the bacterium. A feature of the pathology is a pronounced onset and a rapid course.

There are two routes of infection:

1. Fecal-oral: swimming in open water or pools, drinking raw water, expired or thermally unprocessed products (especially dairy).
2. Contact-household: dirty hands, toys, clothes, dishes and other everyday items.

Classification and symptoms of dysentery

ICD-10 disease code Shigellosis A03.

There are two types of dysentery: bacterial and amoebic.

Bacterial dysentery (shigellosis) differs in the types of pathogen:

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

The incubation period of shigellosis is from 6 hours to 7 days, while the disease can have two forms:

• typical (light, moderate, heavy);
• atypical (erased, toxic, hypertoxic).

The main symptoms of shigellosis:

• nausea and vomiting;
• belching, heartburn;
• tenesmus (false urge to defecate);
• diarrhea with a lot of mucus, greens and streaks of blood, more than 10 times a day;
• flatulence.

An additional symptom is an increase in body temperature up to 40 ° C, while the child has drowsiness, he is lethargic and apathetic. Sometimes there may be failures of the cardiovascular system.

Amoebic dysentery (amebiasis) in Russia is rare and its occurrence is associated with infection with bacteria during the rest period in hot countries. The incubation period is from 7 days to 3 months. The disease can have a different course, which is characterized by exacerbations and is divided into acute (lasting up to 2-3 months) and chronic (more than 3 months).

The main symptoms of amoebiasis:

• headache and discomfort in the lower abdomen on the left;
• bloody diarrhea or jelly-like, glassy mucus;
• dryness and wrinkling of the skin;
• emaciated appearance with dramatic weight loss;
• intestinal bleeding.

Intestine in dysentery

Features of the course of dysentery at an early age

In newborns, dysentery is not diagnosed. In babies under 1 year old, the disease is rare and occurs against the background of rickets, diathesis or anemia. Formula-fed children are more prone to infection. This is due to insufficient processing of bottles and nipples for feeding.

At the age of 3 years, shiggelosis has a number of its features:

• bloating (instead of the typical confluence);
• anxiety;
• crying during bowel movements;
• relaxation of the anus, gaping of the anus;
• malevolent plentiful stools, green stools, mucous-bloody discharge against the background of formed feces, undigested pieces of food, extremely rarely - streaks of blood.

Young children rarely develop toxic forms of the disease. With untimely treatment, secondary toxicosis can be diagnosed, which is characterized by a pronounced rise in temperature, a decrease in body weight, a violation of water and mineral metabolism. Dysentery in children 1-3 years old is often accompanied by staphylococcal infections or salmonellosis. The disease tends to become chronic.

Light form

The mild form is characteristic of Sonne's dysentery and most often begins with the onset of fever, which is of a short duration. The child may have an increased heart rate, heaviness in the abdomen, and discomfort is observed on palpation in the sigmoid colon.

Intoxication is mild, while:

• the course of the disease is erased, the general condition of the sick child is normal;
• body temperature does not rise or rises slightly (up to 38.5º);
• intestinal mucosa without necrotic changes;
• stool formed with an admixture of mucus up to 8 times a day.

Improvement occurs a few days after the first clinical manifestations.

Moderate form

Intoxication is expressed moderately, while the child becomes nervous and irritable. The act of defecation does not bring relief to the patient, and the urge to defecate most often turns out to be false.

The course of the disease is accompanied by:

• an increase in body temperature up to 39 ° (lasts 2-3 days);
• diarrhea or scanty stools with green mucus and streaks of blood (fixed about 10 times a day);
• cramping pains in the abdomen, strong rumbling;
• the appearance of a white dry coating on the tongue;
• retracted and painful along the large intestine belly.

Normalization of the condition occurs from 7 to 10 days of illness.

Severe form

With this form of dysentery, already in the early stages, changes in the cardiovascular system are observed: the child's blood pressure drops sharply. The liver and spleen increase in size and are well palpable on palpation.

Intoxication is very pronounced, while:

• body temperature rises to 40 °, with the help of medications it decreases to 37.5 °, but is kept for a long time;
• appetite decreases or disappears;
• emptying occurs more often than 15 times a day (diarrhea replaces rectal spitting);
• there is marked weakness;
• superficial necrosis develops in the intestine, ulcers form.

Normalization of the condition begins on the 7th day of the disease.

toxic form

A symptom characteristic of dysentery in children, namely a change in stool, may appear several hours after the onset of the disease.

In the first hours of the disease it is noted:

• increase in body temperature;
• severe retraction of the abdomen;
• the formation of rapidly scarring ulcers in the walls of the intestine;
• dystrophic changes in the internal organs;
• copious stools, which are quickly replaced by scanty secretions with a lot of mucus and blood.

Hypertoxic form

Characteristic signs:

• a sharp decrease in blood pressure;
• pallor and cyanosis of the skin;
• cold extremities;
• disorders of the cardiovascular system;
• loss of consciousness;
• convulsions.

Death can occur before the onset of diarrhea.

Chronic form

Any form of dysentery can become chronic, which lasts for years with periods of relapse and remission. Especially often chronization occurs with amoebiasis. Risk factors include children under 3 years of age, helminthic invasion and re-infection with dysenteric bacillus. The presence of concomitant or chronic diseases in babies, a decrease in immunity also contribute to chronicity. At the same time, intoxication is mild - the child feels normal, the general condition is satisfactory.

Main symptoms:

• loss of appetite;
• lethargy and fatigue;
• frequent pain in the lower abdomen;
• alternating diarrhea and constipation (with amoebic dysentery).

Regardless of how dysentery develops, symptoms in children can be permanent (continuous) or interspersed with periods of well-being (relapsing). In this case, enzymatic deficiency, anemia, hypovitaminosis, malnutrition (lack of body weight in relation to the height of the child) often occur.

The causes, development, syndromes and symptoms of the disease are described in the video “Three deadly bacteria. How to deal with them. Video taken from JitZdorovo channel.

Diagnosis of dysentery in children

The initial diagnosis of the disease includes a physical examination and a thorough history. The epidemiological situation and the fact of the patient's stay in countries with a hot tropical climate are important. To identify amoebic bacillus, multiple examination of feces is necessary. A sigmoidoscopy may be prescribed, which will show characteristic changes in the intestinal walls. If necessary, the attending physician can send a small patient for an abdominal ultrasound, CT scan, MRI or X-ray. A clinical blood test in this case is not informative.

Laboratory tests for dysentery include:

1. Bakposev feces and / or vomit. Sowing is carried out on selective media and, among other things, helps to determine the sensitivity of the pathogen to types of antibiotics. A positive result can be detected on the 5-7th day from the moment of material sampling.
2. Serological methods: determination of antibodies in the child's blood serum and antigen in feces. It is prescribed for a doubtfully negative result of bakposev.
3. Express methods: enzyme immunoassay and immunofluorescent antibody method.
4. Rectromanoscopy is prescribed for the erased course of the disease.
5. Coprogram. Applied in the presence of colitis, severe violations of the enzymatic and absorption functions of the intestine.

Differential Diagnosis

It is very important to differentiate shigellosis and amoebiasis from each other, as well as from:

• enterocolitis;
• salmonellosis;
• campylobacter;
• viral infections;
• acute appendicitis;
• intestinal intussusception;
• mesenteric lymphadenitis.

Symptoms of dysentery may be similar to ulcerative colitis, mushroom poisoning, or prolonged exposure to heavy metal salts.

Treatment of the disease

Dysentery can be cured in 2-3 weeks, but normalization of the gastrointestinal tract occurs after 2-3 months. After the illness, the supervision of an infectious disease specialist is necessary: ​​within a month with shigellosis and at least a year after amoebiasis.

Treatment of children under 1 year of age is symptomatic and is aimed primarily at preventing dehydration. At the same time, hospitalization is mandatory in order to avoid a sharp deterioration in the child's well-being, regardless of the form and severity of the disease. Children from 1 to 3 years old can be treated at home if the form of dysentery is mild. At the age of two, babies often experience straining of the rectum, which requires repositioning by specialists in a hospital setting. After three years, hospitalization is necessary only in severe cases. The main treatment includes bed rest (in the acute phase), diet and symptomatic therapy.

The nursing process plays an important role in hospitalization. The nurse must monitor the implementation of all medical instructions. First of all, this is the observance of bed rest, which can be strict (it is only allowed to lie down) and non-strict (it is allowed to sit in bed). Secondly, it is the control of the nutrition of a small patient, the provision of proper medical procedures and conditions in the ward. Regular airing of the room and wet cleaning with the use of disinfectants (at least 2 times a day) are important.

It is necessary to treat the disease with the following means:

Medicines should be taken in the dosage prescribed by the doctor.

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Features of nutrition during the treatment period

In the first day from the onset of clinical manifestations, food is prohibited. Further, the number of feedings must be reduced to 30-50% of the usual amount per day. Babies who are breastfed can be given expressed milk or kefir, on artificial - sour-milk mixtures. Children older than a year are removed from the diet of dairy and meat products. It is undesirable to give baking, fresh vegetables and black bread. It is necessary to gradually increase fluid intake. You can drink water, unsweetened weak tea, a decoction of raisins.

Can be eaten:

• liquid porridge - oatmeal, buckwheat or rice;
• vegetable soups;
• crackers, biscuits;
• potato and applesauce.

From day 5, with positive dynamics, a steam omelet, boiled chicken and fish, meatballs or steamed cutlets are added. After another 2 weeks, you can transfer the child to a diet, which must be followed for 2-3 months. Diet food provides for limited consumption of sweet and salty foods.

And also a complete rejection of:

• fatty;
• fried;
• acute;
• spices;
• smoked meats;
• cheeses.

Prevention of dysentery

To reduce the risk of getting sick with shigellosis or amoebiasis, you must follow the general rules:

• children under one year old should buy high-quality bottled water, over a year old - give only boiled water;
• always wash your hands with soap before eating, after going to the toilet and walking outside;
• disinfect children's toys at least once a week;
• comply with the deadlines for the sale and storage of products;
• in the autumn-summer period, thoroughly wash berries, fruits and vegetables, preferably pour boiling water over them.

There are additional measures to prevent outbreaks of morbidity: the identification and control of cases in preschool and school institutions and the implementation of sanitary and quarantine measures.

Consequences

Within a year after the disease, specific immunity is preserved, but both cure and exacerbation of the disease are possible when infected with another type of pathogen. Mortality of patients among children reaches 50%.

Complications after dysentery occur against the background of reduced immunity of the child, untimely (or incorrectly) selected treatment and depend on the pathogen.

So after shigellosis may occur:

• pneumonia;
• otitis;
• toxic megacolon;
• dysbacteriosis;
• intestinal paresis;
• encephalitis;
• neuritis;
• arthritis;
• gaping or compliance of the anus;
• rectal prolapse;
• peritonitis;
• heart or kidney failure;
• hemolytic-uremic syndrome;
• anemia;
• avitaminosis;
• acidosis;
• conjunctivitis;
• toxic shock.

After amoebiasis:

• appendicitis;
• single or multiple abscesses of internal organs;
• narrowing of the intestinal lumen;
• amoeba - a formation that leads to intestinal obstruction.

In general, the prognosis for the disease is favorable.