Acute intestinal infections, dysentery and salmonellosis, emergency care, measures in the foci of dysentery and salmonellosis.

Acute intestinal infections is a group of diseases caused by microorganisms and accompanied by damage to the gastrointestinal tract and intoxication. The source of infection is a patient or a carrier (human or animal). It releases the pathogen into the environment with feces, vomit. Most often, acute intestinal infections are associated with a violation of personal hygiene, the use of poor-quality food and water. 

Acute intestinal infections, dysentery and salmonellosis, emergency care, measures in the foci of dysentery and salmonellosis.

Dysentery.

Dysentery is an infectious inflammatory lesion of the colon. The causative agent of the disease are intestinal Shigella and amoeba. The most common dysentery caused by Shigella Flexner, Sonne. They enter the environment with feces of the patient, spread through contaminated hands, as well as flies.

facilities. Can be used to reduce body temperature with an ice bubble. With very frequent stools, astringents are prescribed. Patients with dysentery need antibacterial treatment. They are prescribed tetracycline drugs, phenol chloram, sulfonamides, nitrofurans according to the scheme. With amoebic dysentery, metronidazole is more effective.

Depending on the condition of the patient, symptomatic therapy is carried out, intravenous infusion of medicinal solutions during dehydration and intestinal bleeding. In case of severe intoxication and impaired activity of the cardiovascular system, drugs are used that normalize the work of the heart and blood pressure. To improve digestion, pancreatic enzymes are prescribed, vitamins are also used..

Activities in the focus of dysentery.

Patients with dysentery must be hospitalized in an infectious diseases hospital. In some cases, it is acceptable to treat the disease in a mild form at home. All patient care items and their excretions (vomit, feces) are disinfected. Patients are discharged from the hospital no earlier than 3 days after the disappearance of signs of the disease and one bacteriological examination of feces with a negative result. Fecal bacanalysis is carried out no earlier than 2 days after the end of antibiotic treatment.

After discharge of the patient, the ward is disinfected. For patients working in the food industry, a double bacteriological examination is carried out with an interval of 1-2 days. Persons who have undergone dysentery for 3–6 months are registered in the dispensary and are subject to monitoring. All who have been in contact with a patient with dysentery undergo medical observation for 7 days (monitor the frequency and nature of the stool, body temperature). If a patient is found in an organized team, all contact persons undergo bacteriological examination.

Salmonellosis.

Salmonellosis refers to acute infectious intestinal diseases. It can occur in various forms, including asymptomatic and septic. More often salmonellosis according to clinical manifestations corresponds to gastroenterocolitis, colitis. The disease is caused by salmonella. There are many types of salmonella. Their source is often sick or carriers (humans, birds, pets). Intestinal infections, as a rule, occur when eating foods containing large amounts of Salmonella (with insufficient heat treatment of milk, meat), or using contaminated household items.

Often the disease is detected among children. The latent period of salmonellosis is from 6 hours to 3 days (an average of 12-24 hours). Salmonellosis may vary in severity. The most common salmonellosis in the form of gastroenteritis. It begins acutely, with rises in body temperature to 38–39 degrees and above. The patient complains of severe weakness, chills, headache. Pain in the epigastric region and around the navel, nausea and vomiting are noted. The stool becomes frequent and runny. Signs of intoxication of the body are most pronounced on the 2nd – 3rd days of the disease.

If the disease proceeds in a mild form, then the body temperature does not exceed 38 degrees, vomiting occurs 1-2 times, stool is noted no more than 5 times a day. After 1-3 days, the stool consistency returns to normal. Total body fluid loss is not more than 3% of body weight. Salmonellosis of moderate severity is accompanied by an increase in body temperature up to 39 degrees. Fever with this form of the disease is longer – up to 4 days. Vomiting is repeated several times, stool – up to 10 times a day. The patient noted an increase in heart rate, a decrease in blood pressure. Fluid deficiency in the body is up to 6% of body weight.

In severe salmonellosis, body temperature up to 5 days or more is held at 39 degrees or higher. Intoxication of the body is expressed significantly. Over the course of several days, repeated vomiting is noted, the stool is often 10 times a day (watery, with mucus, fetid). There may be yellowness of the sclera and skin, enlarged liver and spleen. The skin of the patient is cyanotic. The pulse is rapid, low blood pressure. With such salmonellosis, acute renal failure, convulsions can develop. Fluid deficiency in the body is 7-10% of body weight.

With a typhoid-like course, salmonellosis develops in a short time. First, gastrointestinal upsets appear, then fever and signs of general intoxication of the body. After 1-2 days, vomiting stops, stool normalizes, but high body temperature remains (1-3 weeks), and signs of intoxication intensify. Patients become inhibited, indifferent to the environment. Their skin is pale; herpetic vesicles or a pale pink rash on the abdomen may appear on it. The pulse is rare, heart sounds are muffled, low blood pressure. The liver and spleen are enlarged, the stomach is swollen.

The most severe form of salmonellosis is septic. It begins as typhoid-like salmonellosis. Then the patient’s condition worsens significantly, and body temperature fluctuates on a large scale during the day. Fever is accompanied by severe chills, torrential sweat. Against the background of antibacterial treatment, the patient’s condition changes little. Secondary foci of infection develop in the body (osteomyelitis, arthritis, lymphadenitis, etc.). The disease is long lasting and can be fatal..

First aid for salmonellosis.

If nausea and vomiting occurs, it is necessary to provide the patient with appropriate assistance – substitute a container for collecting vomit, hold his head in case of severe vomiting, give water to rinse the mouth. It is advisable to rinse the stomach with a 2% solution of baking soda or cool water (2-3 l) until clean rinsing water. In the early days, nutrition is significantly limited. Only boiled mashed food in a small amount is permissible. Heavy drinking is recommended – glucose-salt solutions (for intoxication – 30–40 ml / kg body weight per day, and for severe dehydration – 40–70 ml / kg body weight per day).

In moderate and severe salmonellosis, medicinal solutions are administered intravenously for 2-3 days. Antibacterial treatment is mandatory, taking into account the sensitivity of microflora to antibacterial drugs. Salmonella are resistant to certain antibiotics. Prior to bacteriological analysis of feces, ampicillin or chloramphenicol is usually used..

To improve digestion, pancreatic enzymes are prescribed, and to restore normal microflora in the intestine, drugs with live bifido and lactobacilli are prescribed. Used in the treatment of phages (drugs containing viruses that have a detrimental effect on salmonella). At high temperatures, antipyretics are prescribed (acetylsalicylic acid, paracetamol), an ice bladder is used. In severe cases, cardiovascular drugs are used..

Activities in the focus of salmonellosis.

A patient with salmonellosis needs isolation and inpatient treatment. The product, which was suspected to be the cause of the infection, is sent for research to a bacteriological laboratory. If a source of infection is detected, for example, a catering company where there was a case of infection with salmonellosis, then the culinary unit in it is subjected to disinfection. All employees of the catering department undergo bacteriological examination. Persons in contact with the patient are subject to medical observation for 7 days (they monitor the body temperature, frequency and nature of the stool) and a single bacteriological examination. Disinfection is carried out in the outbreak.

All patient care items are sanitized. After discharge of the patient from the hospital, a final disinfection is carried out in the ward. If the patient works at an enterprise in the food industry, then after recovery he undergoes a three-fold bacteriological examination within 15 days. Within 3 months, he is registered in the dispensary and undergoes a bacteriological examination once a month. Children attending kindergartens and schools are allowed into the team only after a three-time bacteriological examination with negative results. Then another 1 month is observed by the doctor. During this period they are not allowed to be on duty in the dining room, buffet, etc..

Based on Quick Help in Emergencies.
Kashin S.P..

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