bubble_chart Overview

Bacterial dysentery (bacillary dysentery), commonly referred to as bacillary dysentery, is an acute intestinal infectious disease caused by dysentery bacilli. In China, dysentery caused by Flexner's bacillus is the most common (accounting for about 80%), followed by Sonne's bacillus. It occurs throughout the year but is more prevalent in summer and autumn.

bubble_chart Clinical Manifestations

1. Typical Bacillary Dysentery Onset is sudden, with fear of cold, fever, abdominal pain, diarrhea. Stools initially loose, then turn into mucus and purulent bloody stools. Often accompanied by tenesmus. Physical examination may reveal tenderness in the lower left abdomen. Severe cases involve frequent bowel movements, leading to dehydration and acidosis.
2. Atypical Bacillary Dysentery More common in infants and young children. Systemic and intestinal symptoms are mild, with stools being loose or mucous, and bowel movements not too frequent.
3. Toxic Bacillary Dysentery Mostly seen in children aged 2–7. Presents with severe systemic toxemia symptoms. Sudden onset, with abrupt high fever, repeated convulsions, drowsiness, unconsciousness, and rapid development of circulatory and respiratory failure symptoms. Intestinal symptoms may initially be absent, with purulent bloody stools appearing later. Toxic bacillary dysentery can manifest as shock type (presenting as septic shock), encephalic type (presenting with unconsciousness, convulsions, and severe cerebral symptoms), or mixed type (presenting with peripheral circulatory failure and respiratory failure).
4. Chronic Bacillary Dysentery Symptoms of bacillary dysentery recur or persist, lasting over 2 months. Often caused by incomplete treatment during the acute phase, bacterial resistance, malnutrition, or intestinal Chinese Taxillus Herb parasites.

bubble_chart Auxiliary Examination

1. Stool Examination The appearance is mucopurulent bloody stool, and microscopy reveals a large number of red and white blood cells, pus cells, and macrophages. When toxic bacillary dysentery is suspected, if there is no diarrhea, a stool examination can be performed after a saline enema.
2. Stool Culture It is advisable to culture fresh stool samples with mucus and blood before medication, as bedside inoculation yields a higher positive rate.
3. Immunological Tests Early diagnosis can be aided by immunostaining and fluorescent antibody tests.

bubble_chart Diagnosis

Epidemiological history, including the season of onset, prevalence, contact history, and unclean diet, aids in diagnosis.

bubble_chart Treatment Measures

﹝Treatment﹞

(I) Acute Bacillary Dysentery

1. General Treatment Gastrointestinal isolation should be maintained until symptoms disappear and stool cultures are negative twice consecutively. Bed rest is advised, with a liquid or semi-liquid diet. Symptomatic treatment is provided. Intravenous fluids may be administered if necessary to correct dehydration and acidosis.
2. Pathogenic Treatment (1) Compound formula sulfamethoxazole (SMZ + TMP): The dosage is calculated as SMZ 50mg/(kg·d), divided into two oral doses daily. (2) Pipemidic acid: The dose is 30–40mg/(kg·d), taken orally three times daily. If combined with TMP 5–10mg/(kg·d), the effect is enhanced. Use with caution in infants and young children, as it may affect cartilage development. (3) Berberine: Suitable for mild cases or older children, the dose is 15–20mg/(kg·d), divided into three oral doses daily. (4) Norfloxacin: The dose is 10–15mg/(kg·d), divided into three oral doses daily. (5) Antibiotics: Third-generation cephalosporins (e.g., ceftriaxone, cefoperazone, ceftazidime), ampicillin, gentamicin, or amikacin may be administered intramuscularly or intravenously. Caution is advised with the latter two due to potential eighth cranial nerve injury. (II) Toxic Bacillary Dysentery 1

. General Treatment In addition to gastrointestinal isolation, intensive monitoring is required to closely observe changes in the patient's condition. 2. Antibacterial Drugs (1) Chloramphenicol: 50mg/(kg·d), divided into 2–3 intravenous infusions. (2) Alternatively, ampicillin 100–200mg/(kg·d) may be used, divided into 3–4 intravenous injections. (3) Gentamicin 3–5mg/(kg·d), divided into two intramuscular injections. Switch to oral administration once the condition stabilizes. 3. Fever Reduction Therapy Reduce body temperature to below 39°C. Use metamizole intramuscularly or nasally for fever reduction. Simultaneously, administer chlorpromazine and promethazine, each at 1mg/kg intramuscularly or intravenously. Once the child falls asleep, cold saline enemas, alcohol sponge baths, cold compresses, ice packs on major blood vessels, or lukewarm baths (2–3°C below body temperature) may be applied. 4. Calming Fright 1) Anticonvulsant Drugs: Use 10% chloral hydrate at 50mg/kg per dose for enema; phenobarbital at 6–10mg/kg per dose, not exceeding 0.1g, or diazepam at 0.1–0.3mg/kg per dose intramuscularly; alternatively, paraldehyde at 0.15–0.2ml/kg per dose intramuscularly or amobarbital sodium at 5mg/kg per dose intravenously as a slow push. (2) Dehydrating Agents: Since convulsions may exacerbate cerebral edema, dehydrating agents should be used early. Options include 20% mannitol at 1.0–2.0g/kg per dose or 25% sorbitol at 1.0–2.0g/kg per dose, administered intravenously, repeated every 4–8 hours if necessary. Urea or furosemide may also be used. 5. Anti-Shock Treatment Same as for "Epidemic Cerebrospinal Meningitis." 6. Management of Respiratory Failure Refer to "Epidemic Encephalitis B." 7. Other Applications of Adrenocortical Hormones Refer to "Epidemic Encephalitis B." (III) Chronic Bacillary Dysentery

1. General Treatment The diet should be low-residue, easily digestible, and nutrient-rich, avoiding raw, cold, greasy, or irritating foods. Adequate rest is advised. Actively treat complications such as rickets, anemia, or Chinese Taxillus Herb infestation.
2. ?Pathogenic Treatment (1) Antibiotic Therapy: For those with repeated positive stool cultures, select 2-3 types of antibacterial drugs based on drug sensitivity tests for combined use, and the treatment course should be appropriately prolonged. (2) Enema: Use 1:1000 furacilin 30-60ml, with procaine 40-80mg and prednisone 5mg added, or use kanamycin (0.5%) or neomycin (1-2%) for retention enema, twice daily, with a course of 7-10 days. (3) Enhance Body Immunity: Oral multivitamins or intramuscular injection of gamma globulin can be administered. (4) Adjust Gastrointestinal Dysfunction and Flora Imbalance: Long-term use of antibiotics may lead to gastrointestinal dysfunction. If stool routine tests are repeatedly normal, pepsin and astringents (such as bismuth subcarbonate, activated charcoal, etc.) can be used. For flora imbalance, medications that support normal intestinal bacteria, such as yeast tablets, vitamin B6, folic acid, lactasin, etc., can be used.

bubble_chart Prevention

(1) Thoroughly treat patients to eliminate the source of pestilence. (2) Isolate patients and carriers. After 5-7 days of medication, stop treatment for 3 days and then conduct stool cultures. Isolation can only be lifted after three consecutive negative results. (3) Strengthen health education, improve environmental hygiene, food hygiene, and personal hygiene.

bubble_chart Differentiation

Acute bacillary dysentery should be differentiated from amoebic dysentery, Escherichia coli enteritis, typhoid enteritis, acute hemorrhagic necrotizing enteritis, intussusception, and appendicitis. Toxic bacillary dysentery must be distinguished from Japanese encephalitis and septicemia, while chronic bacillary dysentery should be differentiated from schistosomiasis.