Symptoms of shigellosis (bacterial dysentery)

Dysentery has an incubation period, which in most cases is limited to 2-5 days, after which symptoms of dysentery appear. The duration of the disease is from several days to 3 months, shigellosis lasting more than 3 months is considered chronic.

The currently accepted classification of shigellosis takes into account the severity of the main syndromes, the nature of the course of the disease, and the type of pathogen.

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Symptoms of dysentery with colitic variant

This variant of the disease course is diagnosed most often in clinical practice. It reveals characteristic signs of shigellosis, especially in severe and moderate cases. Dysentery usually begins acutely, in some patients it is possible to establish a short-term prodromal period, manifested by a short-term feeling of discomfort in the abdomen, mild chills, headache, weakness. After the prodromal period (and more often against the background of complete health), characteristic symptoms of the disease appear. First of all, the following symptoms of dysentery appear: cramping pains in the lower abdomen, mainly in the left iliac region; sometimes the pain is diffuse, atypically localized (epigastric, umbilical, right iliac region). A feature of the pain syndrome is its reduction or short-term disappearance after defecation. The urge to defecate appears simultaneously with the pain or a little later. The stool is initially fecal, gradually the volume of feces decreases, an admixture of mucus and blood appears, the frequency of bowel movements increases. At the height of the disease, the feces may lose their fecal character and have the appearance of so-called rectal spit, i.e. consist only of a scanty amount of mucus and blood. Defecation may be accompanied by tenesmus (pulling cramping pains in the anus), false urges often occur. The admixture of blood is most often insignificant (in the form of blood spots or streaks). When palpating the abdomen, spasms are noted, less often - soreness of the sigmoid colon, sometimes - flatulence. From the first day of the disease, signs of intoxication appear: fever, malaise, headache, dizziness. Cardiovascular disorders closely associated with intoxication syndrome are possible (extrasystole, systolic murmur at the apex, muffled heart sounds, blood pressure fluctuations, changes in the electrocardiogram indicating diffuse changes in the myocardium of the left ventricle, overload of the right heart chambers).

The duration of clinical symptoms in uncomplicated acute shigellosis is 5-10 days. In most patients, the temperature first normalizes and other signs of intoxication disappear, and then the stool normalizes. Abdominal pain persists for a longer time. The severity criterion for patients with shigellosis is the severity of intoxication, gastrointestinal tract damage, as well as the state of the cardiovascular, central nervous system and the nature of the damage to the distal colon.

Symptoms of dysentery with gastroenterocolitic variant

The symptoms of dysentery of this variant are that the onset of the disease resembles food poisoning, and at the height of the disease, symptoms of colitis appear and come to the fore. The gastroenteric variant of acute shigellosis in its course corresponds to the initial period of the gastroenterocolitic variant. The difference is that at later stages, the symptoms of enterocolitis do not dominate and clinically this variant of the course is more similar to food poisoning. Less pronounced changes are usually observed during rectoscopy.

Symptoms of dysentery with latent course

This form of the disease has short-term and unexpressed symptoms of dysentery (1-2-fold bowel disorder, short-term abdominal pain), with no symptoms of intoxication. Such cases of the disease are diagnosed when rectoscope changes (usually catarrhal) are detected and shigella is isolated from feces. A protracted course of acute shigellosis is said to occur when the main clinical symptoms do not disappear or recur after a short-term remission for 3 weeks to 3 months.

Carriage of dysentery bacteria

This form of the infectious process includes cases when there are no clinical symptoms of dysentery at the time of examination and in the preceding 3 months, and no changes in the mucous membrane of the large intestine are detected during rectoscopy and isolation of shigella from feces. Bacterial carriage can be convalescent (immediately after acute shigellosis) and subclinical, if shigella are isolated from bacteria that do not have clinical manifestations and changes in the mucous membrane of the distal colon.

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Symptoms of chronic dysentery

A chronic disease is registered in cases where the pathological process continues for more than 3 months. Chronic shigellosis is divided into two forms according to the clinical course - recurrent and continuous. In the recurrent form, periods of exacerbation are replaced by remission. Exacerbations are characterized by clinical symptoms typical of the colitic or gastroenterocolitic variant of acute shigellosis, but with a weak expression of intoxication. In the continuous course, the colitic syndrome does not subside, hepatomegaly is noted. In chronic shigellosis, moderate inflammatory and atrophic changes are also detected during rectoscopy.

Features of Grigoriev-Shiga shigellosis

Symptoms of this form of dysentery are generally severe, characterized by an acute onset, intense cramping abdominal pain, chills, and an increase in body temperature to 40 °C. During the first day, the stool resembles meat slops in appearance, then the volume of feces decreases, and an admixture of blood and pus appears. Tenesmus is noted. In some cases, infectious toxic shock, sepsis with the pathogen being seeded from the blood are observed, and hemolytic uremic syndrome may develop. Hypovolemic shock occurs with abundant stool and early vomiting.

Complications of dysentery

ITS, serous (intestinal wall perspiration) or perforative (with circular necrosis or deep ulcerative defects) peritonitis, acute pancreatitis. Motility disorders can lead to the development of intestinal intussusception. Intestinal and gastric bleeding, myocarditis, polyarthritis, nephritis, iridocyclitis, polyneuritis, toxic hepatitis have been described. In patients with an unfavorable premorbid background and severe shigellosis, pneumonia and acute cardiovascular failure develop, which are one of the main causes of death.

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Mortality

The mortality rate in Russia in the 70-80s of the last century did not exceed 0.2%, in the 90s due to the prevalence of the highly pathogenic pathogen Shigella flexneri 2A, the mortality rate increased fivefold, and during individual outbreaks reached 6%. Since the end of the 90s, a decrease in mortality has been noted.