Dizenteria (b miinilor murdare) Pseudotuberculoza Yersinioza

Gen Shigella Yersinia pseidotuberculosis Yersinia enterocolitica

Familia
ET Bacilli Gr-,imobli, lactozo-
a-dysenteriae/b-flexneri/c-boydii/d-sonnei
sensibil la caldura, AB, Chimie
Sursa Bolnavi ac/cr, purtatori
Vector Pasiv-musti
Cai f-o, apa, alim, cont habit
PAT Mec invaziv local-la niv IG(distal)-colita infl
Fagocitat-multiplicarea-in citoplasma
“propulsat” in cel vecine-focare de infectie-
moartea celulara-ulceratii
Dysenteria tip I-neurotoxina-moartea cel
Alte-enterotoxine
Colon-colita inf usoara-necroza hemoragica
ulcerativasevera
Enterobacteriacea
Bacil rotund,Gr -,nu foarmeaza spori, mobil,
tem favorabila pt crestere -22-28,serovarI-90%
Contin-endotoxine
EPIDEMIOLOGIE
Rozatoare,soricide,carnivore,pasari,maimute
Alimente, legume
Contact direct, digestiv
Mec-F-O (iarna-primavara)
Cale bucala-muc buca faringiana si GL
periferici-stomac,int subt-GL perif ileocecali-
singe-ficat, plamini, splina-bacteriemia
Mobil(37),nu formeaza
spori/capsule,aerobi facultative.
Elimina enterotoxini
Animale bolnave(vaci,porci),ciini ,pisici
Alimente,carne legume,fructe,lapte
Alimentara/hidrica
Hrana-TGI-af intest ac cu lez int
subtire/gros
GL periferici-limfadenita mezenterica
Toxicoza, alegie

INCUBATIA 1-7z
Debut Dupa 24-48 de ore dupa ingestia -t↑, dur abd
difuze-jum inf,diaree apoasa(int subt)
Stare Diaree muco-sanguinolenta,muco-
piosanguinolenta,afecaloida,colici abd,
tenesme,s de dishidratare(int gros)
NEURO(convulsii autolimitate,,confuzie, cef)
Prolapse rectal.
Scaune frecvente
+striuri sangv, tenesme(dur anala ,
pereanala) scuipat rectal
CLINICA
2-6/19-22 zile
Astenie,cefalee, frisoane, mialgii, artralgii
Greata, senzatii neplacute
2-6z/ frisoane t-38-39-ondulanta(1-48 de zile)
Eruptii la a 1-4 zi(rozeolice,eritematoase,
papuloasa) Polimorfe(rozeolo-papuloase,
maculo-papuloase, hemoragice)- lat a toralelui,
part inf a abd, supraf mediana a minilor,,
coapse , gambe. Af art mari. PRURIT.Edem-
manusi /sosete, capiusonnMialgii
CV-brad,puls labil, dil lim cord,Zg systolic ,extr
Resp-tuse,junghi thoracic
GI-scaun pastos/lichid-4-8 pe nictemer,limba
zmeurie, SplM /Hep
Rinichi-Paster+,leu,alb,hematuria,cilindrurie
SN-inh psihica,cef,adinamie,hiperestezie tactila
1-2—6zile
Violent,dur abd-paroxistica,t-37.5-
39,cefalee,vertij,greata,cianoza muc.
Dupa 8-14h-voma,diaree.Scaun-lichid
,abundant,brun verzui, spumos cu
miros respingator(singe).
A3-7 zi –eruptii pe palme reg plantara.
GL-mezenter mariti. Ficat marit in 2-
5%.
GENERAL-Dureri articulare, semen de
intoxicatie,eruptii-rubeolice, rujeolice,
hyperemia palmelor,
picioarelor,miocardita, septicemie
Diarea seroasa

Ex Palp int sigmoidian –cilindru dureros,
spasmat, comprimat, infiltrat
NESP -ex microscopic direct
-AGS(leucocitoza, neutrofilia, leuc nesg, VSH)
SPECIF Ionograma, echilibru AB
MF-lichid saracacios, mucus si striuri de singe
uniori cu puroi( scuipat rectal), chemari false
-izolarea germenului
-t.Sereny/ latex aglutinare
Rectomanoscopie
PCR
Bacteriologic- MF, mase vom, spal gastr 3zile.
Imunofluorescent-Ag pat
Serologic- RA (1/200)/ RHAI (5-6zi) 1/160
Coprologic-mucus , leucocite
Ext-3z de la disp semnelor
Flurochinolone
Levofloxacina-500mg/zi/Cotrimaxozol
Ciprofloxacina-500mg-2ori/zi
Norfloxacin-400mg -2 ori /zi
Enterofuril
Ceftriaxon
Desensibilizare/dezintoxicante/Antidiareice,antiperistaltice, antispastice
Sol ionice( Hartman, NaCl , disol, trisol)
DIAGNOSTIC
Forme –abd, scarlatiniforma, icterica, catarala, Forme GI, Gastr-enteritica,
artralgica, mistral, septicemica(gener). enterocolica, gastroenterocolica,
Intoxicatie si alergie. apendiculara, de adenita mesenteriala,
eleita terminal , septicemica.
Intoxicatie si alergie
Leucocitoza cu deviere in stinga,, monocitoza, leucopenie rel, eozinofilie , VSH
Urina(proteinuria, albuminuria, microhematuria,cilinduria)
Bichimic(hyperbilirubinemia, ALAT ASAT creste)
1)Serologic –RA(1/100,incep sapt a 2 de boala, creste pe parcurs)/RHAI(1/200 din a 3-5 zi
mal) –AC in singe bolnavilor se recol 1-3 si 7-10zile de boala
2)Bacteriologica( MF, singe , urina, spalaturi faringiene, LCR, bila)-bio/serovarianta 16-
17z dupa insemintare
-Imunofluorescenta-Ac fluorescebti
RHAP/r de aglutinare Imunobloting si r. de polimerizare in
lant
RHAP-AC specifici
TRATAMENT-reg igieno-dietetic
Streptomicina Gentamicina
Levomecitina Amicacina-7 -15z
Tetraciclina
K Glucoza 4%, vit C