Bacillarydysentery细菌性痢疾Shigellosis志贺菌病Infectiousdiarrhea传染性痢疾2024/8/19Shigellosis2Contents目录nGeneralcondition概述nEtiology病因nEpidemiology流行病学nPathogenesis发病机理nClinicalmanifestation临床表现nLaboratoryexamination实验室检查nDiagnosis诊断nTreatment治疗nPrevention预防2024/8/19Shigellosis31.Generalcondition概述nDefinition: 定义定义Shigellosis is also called bacillary dysentery, this is an acute bacterial disease characterized by fever, nausea, vomiting, cramps, diarrhea and feeling of tenesmus caused by Shigella species. In most cases, the stools contain blood and mucus. 志志贺氏菌病也称氏菌病也称为菌痢菌痢,这是一种是一种由志贺氏杆菌引起的由志贺氏杆菌引起的急性急性细菌性疾病菌性疾病,其特征是其特征是发热、恶心、呕吐、抽搐、腹泻及里急后重感心、呕吐、抽搐、腹泻及里急后重感 。在大多数情况下。在大多数情况下,粪便中粪便中包含血液和粘液。包含血液和粘液。2024/8/19Shigellosis42.Etiology病因nShigella:志贺氏杆菌：nGram - ,facultative anaerobic(with or without oxygen), rod bacteria 革兰阴性，兼性厌氧（有氧或无氧），杆菌nVery similar to E.coli 非常类似于大肠杆菌npH: survives in neutral pH, resistant to stomach acids pH:存活于中性pH，耐胃酸nTemperature: (depends on serotype.) 温度：（取决于血清型）nCan survive at 4C for 21 days in cheese, potato,salad and mayonnaise n可以在4下在奶酪，马铃薯，沙拉和蛋黄酱中存活21天nCan survive and grow at under 25 C for 50 days in flour, milk, eggs, shrimps, oyster 可以在25，在面粉，牛奶，鸡蛋，虾，牡蛎中存活50天2024/8/19Shigellosis52024/8/19Shigellosis6Shigella bacteria in a stool sample(Under high power microscope) 粪便样品中的志贺氏菌（在高倍显微镜）粪便样品中的志贺氏菌（在高倍显微镜）2024/8/19Shigellosis7Gram stain: Shigella革兰染色：志贺氏菌革兰染色：志贺氏菌2024/8/19Shigellosis8Several media have been designed to selectively grow enteric bacteria and allow differentiation of Salmonella and Shigella from E. coli. The primary plating media shown here are eosin methylene blue (EMB) agar, MacConkey agar, ENDO agar, Hektoen enteric (HE) agar and Salmonella-Shigella (SS) agar. 几个培养基制成可以选择性几个培养基制成可以选择性地生长肠细菌，从大肠杆菌地生长肠细菌，从大肠杆菌中分化沙门氏菌和志贺氏菌。中分化沙门氏菌和志贺氏菌。这里显示的平板为伊红美蓝这里显示的平板为伊红美蓝（EMB）培养基，麦康凯培）培养基，麦康凯培养基，远藤培养基，养基，远藤培养基，HE培养培养基和基和SS选择鉴别培养基。选择鉴别培养基。2024/8/19Shigellosis93.Epidemiology流行病学nWorldwide, major cause of diarrhea 在世界范围内，主要原因是腹泻在世界范围内，主要原因是腹泻n165 million cases/year (99% in developing c.) n165000000例例/年（年（99%在发展中在发展中C）nIs about 5-15% of all cases of diarrhea, mostly kids 1020109/Ln血液检查：白细胞1020109/LnStooltest:Bloodypurulentappearance.Leukocytescanbefound15/HPn粪便检查：血脓性外观。白细胞可以发现15/HPnBacteriaculture:(+),thedysenterybacillusofthecultureisagolden standardofdiseasediagnosis.n细菌培养：（+），培养的痢疾杆菌是疾病诊断的标准nEarly, frequently, freshly collectsample (inoculated culture)-canimproveculturepositiverate.n早期，频繁，新鲜采集的样品（接种培养）-可提高培养阳性率。nBloodculture:unnecessary!血培养：没有必要！2024/8/19Shigellosis237.Diagnosis诊断nEpidemicdata(exposedtopatients)n流行病学资料（接触病人）nClinicalfeature(typicaltype)n临床特征（典型类型）nLaboratoryfindingsn实验室检查结果nAimingtotoxicdysentery,checkingstoolsbydigital rectal examination(DRE)orcold salt liquid enemaisthemostimportantdiagnosismethod.n旨在中毒性痢疾，通过直肠指诊（DRE）或冷盐水灌肠液检查凳子是最重要的诊断方法。2024/8/19Shigellosis248.Treatment治疗Acutedysentery急性菌痢nAntibiotics medication is very important.抗生素药物是抗生素药物是非常重要的。非常重要的。nTo severe cases , treatment with antibiotics can shorten the duration of the illness.and can reduce the period of excretion of the organism. n严重的情况下，用抗生素治疗即可缩短疾病的持续时间。并能降低生物体的排泄时期nTo mild cases, treatment with antibiotics is unnecessary. n轻度情况下，用抗生素治疗是不必要的。2024/8/19Shigellosis25Selectionofantibiotics选择抗生素nThe first line medication should be quinolones,such as norfloxacin (0.4 tid for adult) or Ciprofloxacin(0.2 tid for adult) or Ofloxacin(0.2 tid for adult) .The duration is 35 days for typical cases.第一次用药应选用喹诺酮类药物，如诺氟沙星（第一次用药应选用喹诺酮类药物，如诺氟沙星（0.4 TID成人）或环丙沙星（成人）或环丙沙星（0.2 TID成人）或氧氟沙星（成人）或氧氟沙星（0.2 TID成成人）。该典型病例持续时间为人）。该典型病例持续时间为35天。天。nFor severe cases, Quinolone or 3rd cephalosporin,such as Ceftriaxone or cefotaxime were chosen with vein route.对于严重对于严重的情况下，静脉注射喹诺酮类或第三头孢菌素，如头孢曲松或头的情况下，静脉注射喹诺酮类或第三头孢菌素，如头孢曲松或头孢噻肟孢噻肟nBecause of high drug-resistance and unsafety , sulphonamides or chloramphenicol were not recommended 由于高耐药性和不安全由于高耐药性和不安全的，不推荐磺胺类或氯霉素的，不推荐磺胺类或氯霉素2024/8/19Shigellosis26RehydrationTreatment补液处理nAlthough dehydration is not a common feature of shigellosis infection, but if it occurs or the stools are watery, patients should be given the oral rehydration salt (ORS) recommended by WHO /UNICEF(United Nations International Childrens Emergency Fund) n虽然脱水不是志贺氏菌感染的共同特征，但如果发生水样便，应给虽然脱水不是志贺氏菌感染的共同特征，但如果发生水样便，应给予患者由予患者由WHO / UNICEF（联合国国际儿童紧急基金会）推荐的口（联合国国际儿童紧急基金会）推荐的口服补液盐（服补液盐（ORS）nIn severe dehydration, intravenous fluids is recommendedn在严重脱水时，推荐静脉输液在严重脱水时，推荐静脉输液nHowever, clinical experience indicates that ORS is beneficial in all cases of shigellosis if given as routine fluid intake. n然而，临床经验表明，口服补液盐如果给作为常规液体摄入所有情况下对然而，临床经验表明，口服补液盐如果给作为常规液体摄入所有情况下对志贺氏菌是有益的，。志贺氏菌是有益的，。2024/8/19Shigellosis27Nurses is encouraging patient to drink an ORS(Oral Rehydration Solution) to improve dehydration护士在给病人喝护士在给病人喝ORS（口服补液（口服补液盐），以改善脱水盐），以改善脱水2024/8/19Shigellosis28Symptomatictreatment对症治疗nAbdomenpain:atropine0.5mg,Imn腹痛：阿托品0.5mg，nHighfeverortoxemia:dexamethasone(DXM)n高热或毒血症：地塞米松（DXM）nShock:休克：nHigh effect and broad spectrum antibiotics 高效果和广高效果和广谱抗抗生素生素nSupply enough fluid intravenously供供应足足够的静脉注射液的静脉注射液nDrugs that constrict the blood vessels may be given to boost blood flow to the brain or heart(dopamine, 1020 g/kg/min)收收缩血管的血管的药物，可物，可给予刺激血液流向大予刺激血液流向大脑或心或心脏（多巴胺，（多巴胺，1020微克微克/千克千克/分分钟）nGlucocorticoid (such as DXM to reduce symptom of toxemia)糖皮糖皮质激素（如地塞米松，以减少毒血症症状）激素（如地塞米松，以减少毒血症症状）2024/8/19Shigellosis29Toxicbacillarydysentery中毒性痢疾nAntibioticsadministerintravascularlyn血管内服用抗生素nAnti-shock抗休克nPreventandcurehydrocephalusn预防和治疗脑积水nDehydrationwith20%mannitol125ml-250ml,q412h用20甘露醇125毫升-250毫升，脱水412小时nInhaleoxygen吸氧nKeeprespiratoryfunctionnormal.保持呼吸功能正常。2024/8/19Shigellosis3010.Shigellosis:Prevention10.志贺氏菌病：预防n1.Controlthesourceofinfection.1.控制感染源。Individualsexcretingshigellaeshouldbeisolatedearlyuntilnegativecultureshavebeenobtainedfromthestoolspecimens.(Carriers! ignore )产生志贺氏菌的患者，应及早产生志贺氏菌的患者，应及早隔离，直到粪便标本的细菌培养中阴性。隔离，直到粪便标本的细菌培养中阴性。 （携带者（携带者!忽略）忽略）n2.Cuttingouttheroutoftransmission.切断传播途径nAll individuals exposed to patients of shigellosis should wash hand with soap and water.接触过细菌性痢疾患者的所有人都应接触过细菌性痢疾患者的所有人都应该用肥皂和水洗手。该用肥皂和水洗手。 nEspecially food handlers尤其是食品从业人员尤其是食品从业人员n3.Vaccination?疫苗？nNO vaccine available in clinic up to now.在临床上到现在还没有在临床上到现在还没有疫苗疫苗2024/8/19Shigellosis31nPatient xxx ,female,25-year-old,mess steward, Suddenly onset 2 days ago with general malaise, chill ,fever ,fatigue ,headache and cramping abdominal pain ,especially in left inferior abdomen ,then followed diarrhea with water stool initially, and then bloody purulent stools, 1020 times per day ,accompanied with burning sensation at Anus- tenesmus.Five days ago this woman had nursed a diarrhea patient.nPE：T 39.5，R 30/m，P 110/m，BP 110/80mmHg。Press-pain on the left inferior abdomenReview the Case report 查看病例看病例报告告2024/8/19Shigellosis32nBlood test: WBC 12.5109/L; neutrophilic leukocyte 85% Stool test:WBC 5060/HP，RBC2030/HP。Questionsn1.Whatdiseaseisthepatientsufferedfrom?n2.Whatistheprincipleoftreatmentforthispatient?(Antibioticsandsymptomatic,supportivetreatment)n3.Howtopreventthisdisease?(isolatethepatientandwashinghands)2024/8/19Shigellosis33Amoebicdysentery阿米巴痢疾AmebiasisiscausedbytheprotozoanparasiteEntamoebahistolytica.Cystsshedinhumanfecesmaycontaminatefoodordrinkingwaterorbetransferredsexually,onhands,orfomites.cystsarerelativelychlorine-resistant.Incubationperiodis1-4weeks.Whileintestinaldiseaseisoftenasymptomatic,symptomsmayrangefromacuteabdominalpain,fever,chills,andbloodydiarrheatomildabdominaldiscomfortwithdiarrheaalternatingwithconstipation.Extraintestinalinfectionoccurswhenorganismsbecomebloodborne,leadingtoamebicabscessesintheliver,lungsorbrain.Complicationsincludecolonicperforation.2024/8/19Shigellosis34nThemostcommonlyorderedparasitetest(microscopyofstoolforovaandparasites)cannotdistinguishE.histolyticafromE.dispar,anon-pathogenicamebicspecies.ThereisanavailableEIAtest,however,thatcandistinguishbetweenthetwo.最常用有序寄生虫试验（粪便为卵和寄生虫的显微镜）不能从大肠杆菌毒蛾，一个非致病阿米巴物种区别溶组织内阿米巴。可用EIA试验，在两者之间进行区分。nThereisnovaccine.没有疫苗。2024/8/19Shigellosis35amebic dysenteryShigellosis General conditionmild，lower fever, toxemia unusually severe, high fever, toxemia usually Stool frequencyless, 210 times/daymore,1030 times/dayStool volumeMore/each time Less/each time Tenesmusmild or withoutObviously Site of press-pain right inferior abdomenleft inferior abdomenStool appearancemore fecal and less watery,contain mucus ,like fruit paste with uncomfortable odors less fecal, contain purulent and blood,without special odorsStool under microscopeFewer WBC,More RBC,Special crystal More WBC, Fewer RBCStool cultureWithoutShigellaShigellatreatmentmetronidazoleFluoroquinolones or 3rd cephalosporin (cefotaxime)2024/8/19Shigellosis36Term explanation：Tenesmusistheconstantfeelingoftheneedtopassstool,accompaniedbypain,crampingbecauseofinflammatoryofthebowel,butlittlestoolispassed.名词解释：里急后重是一种有急于排泄粪便的迫切,伴有疼痛感觉，肠道炎症的痉挛，但很少大便排出的持续的感觉。2024/8/19Shigellosis37