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Bacillary Dysentery


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Bacillary Dysentery

  1. 1. Bacillary Dysentery Shigellosis Prepared by: Ma. Danica C. Consuelo BSN III-B Mr. Richard Bartolata professor
  2. 2. Definition <ul><ul><li>The term “dysentery” is used in connection with various intestinal disturbances. The modifying word “bacillary” is employed to denote that form of dysentery caused by specific bacilli of the dysentery group. </li></ul></ul>
  3. 3. <ul><ul><li>Bacillary Dysentery is an acute bacterial infection of the intestine. </li></ul></ul><ul><ul><li>It is a contagious infection, occurs in epidemics and  occurs more frequently in the summer and fall. </li></ul></ul>
  4. 4. <ul><ul><li>Epidemics are most frequent in overcrowded populations with inadequate sanitation. </li></ul></ul><ul><ul><li>Patients with mild undiagnosed infections have only transient diarrhea or no intestinal symptoms. Severe infections are frequent in infants and in elderly debilitated person </li></ul></ul>
  5. 5. E t I o l o g I c A g e n t <ul><li>The causative agent is a bacteria of the Shigella ( Kiyoshi Shiga ) group, a short, non-motile, gram negative organism </li></ul><ul><li>There are four serologic groups: </li></ul><ul><li>1. Shigella dysenteriae (Group A) </li></ul><ul><ul><li>considered as the most infectious </li></ul></ul><ul><ul><li>their habitat is almost exclusively the GIT of man </li></ul></ul><ul><ul><li>they rarely invade the blood stream, and are cultured from the stools </li></ul></ul>
  6. 6. <ul><li>-------Scanning Electron Micrograph of Shigella dysenteriae - Gram - negative, enteric, facultatively anaerobic, rod prokaryote; causes bacterial dysentery . This species is most often found in water contaminated with human feces . </li></ul>
  7. 7. <ul><ul><li>like other gram negative bacilli, they develop resistance against antibiotics </li></ul></ul><ul><li>2. Shigella flexneri (Group B) </li></ul><ul><ul><li>predominant in developing countries </li></ul></ul><ul><ul><li>common in the Philippines </li></ul></ul><ul><li>3. Shigella boydii (Group C) </li></ul>
  8. 8. <ul><li>4. Shigella sonnei - the commonest but also the mildest form . Many milder cases are probably never diagnosed and so never reported, so the true incidence may be substantially higher . </li></ul>
  9. 9. <ul><li>-----Scanning Electron Micrograph of Shigella sonnei - Gram - negative, facultatively anaerobic, rod prokaryote; causes shigellosis ( bacterial dysentery ). This species is most often linked to infection from food . </li></ul>
  10. 10. I n c u b a t I o n P e r I o d <ul><li>Seven hours to seven days with an average of three to five days. </li></ul>
  11. 11. Period of Communicability <ul><li>The disease is communicable during the acute phase and until the microorganism is absent from the bowel discharges, usually within a few weeks even without specified therapy. A few individuals became carriers for a year or two. </li></ul>
  12. 12. Mode of Transmission <ul><li>The organism is transmitted through ingestion of contaminated food or drinking contaminated water or milk. </li></ul><ul><li>It is transmitted by flies or through other objects contaminated by feces of the patient. </li></ul>
  13. 13. <ul><li>Fecal-oral transmission is possible. </li></ul><ul><li>Hand-to mouth transfer of contaminated material </li></ul><ul><li>Swimming in infected waters. </li></ul><ul><li>Eating contaminated food with human sewage (either directly or via contaminated water) especially with cold uncooked foods such as salads. </li></ul>
  14. 14. <ul><ul><li>In developing countries, Shigella is a common infection because of inadequate sewage disposal and lack of effectively treated water supplies . It is a cause of severe, potentially fatal, infection in children . Shigella is of major importance in refugee camps or following natural disasters, when once again disposal of sewage and the provision of clean water may be extremely difficult . It has been suggested that in developing countries flies may spread the infection from person to person, as the disease is commonest at the time of year when the fly population is highest. </li></ul></ul>
  15. 15. P a t h o l o g y <ul><li>After the incubation period, the organism invades the intestinal mucosa and causes inflammation. The organism invades the cells lining the large bowel and multiplies there, killing the cell; this is the cause of the symptoms produced . However, it occasionally invades the bowel beyond the surface lining . </li></ul>
  16. 16. <ul><li>Dirty, fibrinous sloughing areas or ulcers are formed </li></ul><ul><li>Within the few days, the stool may contain pus, mucus and blood. </li></ul>
  17. 17. Clinical Manifestations <ul><li>Fever especially in children </li></ul><ul><li>Tenesmus, nausea, vomiting, and headache </li></ul><ul><li>Colicky or cramping abdominal pain (days to weeks) associated with anorexia and body weakness. </li></ul><ul><li>Diarrhea with bloody-mucoid stool that is watery at first </li></ul><ul><li>Rapid dehydration and loss of weight </li></ul>
  18. 18. C o m p l I c a t I o n s <ul><li>Rectal prolapse particularly in undernourished children. </li></ul><ul><li>Non-suppurative arthritis with one or several joints involved (accompanied with fever and a serous effusion into the joint, which has sometimes been found to contain Shiga’s bacillus). </li></ul><ul><li>Anemia </li></ul>
  19. 19. <ul><li>Parotitis (due to secondary infection from mouth organism) </li></ul><ul><li>Bacteraemia occurs primarily in malnourished children </li></ul><ul><li>Hemolysis (destruction of RBC) </li></ul><ul><li>Ulceration in the intestine can lead to severe blood loss </li></ul><ul><li>In rare cases, the bacteria may enter the bloodstream from the digestive tract and infect other body organs, such as kidneys, gallbladder, liver or heart and joints. This may cause shock and death. </li></ul><ul><li>Shock -marked by a weak pulse, coldness, sweating, and irregular breathing, and resulting from a situation such as blood loss </li></ul>
  20. 20. Diagnostic Procedures <ul><li>Fecalysis or microscopic examination of the stool. </li></ul><ul><li>Rectal swab - a laboratory test to isolate and identify organisms in the rectum that can cause gastrointestinal symptoms and disease. Normally, many organisms are present in the lower gastrointestinal (GI) tract, but some can act as pathogens (disease-causing organisms) in the bowel. </li></ul><ul><li>Peripheral blood examination. </li></ul>
  21. 21. <ul><li>Blood tests </li></ul><ul><li>>Full blood count and ESR looking for anemia, infection or inflammation </li></ul><ul><li>>Electrolytes to assess loss e.g. low potassium, magnesium and calcium </li></ul><ul><li>>Iron studies looking for iron deficiency due to blood loss or malabsorption </li></ul><ul><li>>Vitamin B12 to assess malabsorption </li></ul>
  22. 22. <ul><li>Nursing </li></ul><ul><li>Process </li></ul>
  23. 23. <ul><li>A S S E S S M E N T </li></ul><ul><li>Lower abdominal tenderness </li></ul><ul><li>Normal or increased bowel sounds </li></ul><ul><li>Hydration Status </li></ul><ul><li>evaluation for thirst, oral mucous membrane dryness, sunken eyes, a weakened pulse, and loss of skin turgor </li></ul><ul><li>liquid stool should be measured and recorded along with a record of the frequency of stools. </li></ul><ul><li>(note the consistency and appearance and the presence of mucous or blood) </li></ul>
  24. 24. <ul><li>Health History </li></ul><ul><li>determine whether the patient has been in contact with anyone who has recently had diarrheal disease </li></ul><ul><li>what the patient has recently eaten (meal preceding the illness and about all food intake in the previous 3 to 4 days). </li></ul><ul><li>If the patient is employed in a food preparation service. </li></ul>
  25. 25. <ul><li>D I A G N O S I S </li></ul><ul><li>(nursing diagnoses) </li></ul><ul><li>Deficient fluid volume related to fluid loss through diarrhea and vomiting. </li></ul><ul><li>Deficient knowledge about the infection and the risk of transmission to others </li></ul>
  26. 26. <ul><li>P L A N N I N G A N D G O A L S </li></ul><ul><ul><li>To maintain fluid and electrolyte balance. </li></ul></ul><ul><ul><li>To increase knowledge about the disease and risk of transmission. </li></ul></ul>
  27. 27. <ul><li>I N T E R V E N T I O N </li></ul><ul><li>* Correcting Dehydration Associated with Diarrhea </li></ul><ul><li>Assess the degree of dehydration </li></ul><ul><li>Mild dehydration (patient exhibits dry mucous membranes of the mouth and increased thirst) </li></ul><ul><li>Rehydration goal  deliver about 50mL of oral rehydration solution (ORS) per 1 kg of weight over a 4-hour interval. </li></ul>
  28. 28. <ul><li>Moderate dehydration (sunken eyes, loss of skin turgor, and dry oral mucous membranes. Infants may have sunken fontanel) </li></ul><ul><li>Rehydration goal  about 100mL /kg over 4 hours. </li></ul>
  29. 29. <ul><li>Severe Dehydration (signs of shock ie. Rapid thready pulse, cyanosis, cold extremities rapid breathing, or coma) </li></ul><ul><li>Rehydration goal  intravenous replacement as ordered until hemodynamic and mental status return to normal. </li></ul><ul><li> When improvement is evident, the patient can be treated with ORS. </li></ul><ul><li>*Restrict foods until nausea and vomiting subsides. </li></ul>
  30. 30. <ul><li>Increasing Knowledge and Preventing Spread of Infection </li></ul><ul><li>* Emphasize principles of safe food preparation, with special attention to meat preparation and cooking </li></ul><ul><li>>adequate provision for storage and reheating to meat temperature thresholds is important. </li></ul><ul><li>>it is important to use different surfaces, knives, and other equipment for meat and nonmeat items. </li></ul>
  31. 31. <ul><li> > Excreta must be properly disposed. </li></ul><ul><li> >Concurrent and terminal disinfection should be employed. </li></ul><ul><li>*Diarrheal diseases should be reported to local health departments </li></ul><ul><li>*The need for rehydration and refeeding should be taught to parents. </li></ul><ul><li>*Good hygiene in the health care delivery and home settings must be a focus. </li></ul><ul><li>>the principles of handwashing and glove use that are emphasized with Standard Precautions </li></ul>
  32. 32. M o d a l I t I e s o f T r e a t m e n t <ul><li>Antibiotics such as Ampicillin, Tetracycline or Cotrimoxazole is useful in severe cases or when the spread of infection to other people is likely and when the patient is very young </li></ul><ul><li>IV might be infused with normal saline (with electrolyte) to prevent dehydration. </li></ul><ul><li>Anti diarrheal drugs are contraindicated because they delay fecal excretion that can lead to prolong fever. </li></ul>
  33. 33. <ul><ul><ul><li>Diet: Liquid or soft diet until diarrhea stops, then return to normal diet . </li></ul></ul></ul>
  34. 34. <ul><li>E V A L U A T I O N </li></ul><ul><li>*Expected Patient Outcomes </li></ul><ul><li>Attains fluid balance </li></ul><ul><li>a. Output approximates intake </li></ul><ul><li>b. Mucous membranes appear moist </li></ul><ul><li>c. Normal skin turgor </li></ul><ul><li>Acquires knowledge and understanding about infectious diarrhea and transmission potential </li></ul><ul><li>a. Takes proper precautions to prevent spread of infection </li></ul><ul><li>b. Describes principles and techniques of safe food storage, preparation and cooking </li></ul>
  35. 35. Methods of Prevention and Control <ul><li>Sanitary disposal of human feces. </li></ul><ul><li>Sanitary supervision of processing, preparation and serving of food particularly those eaten raw. </li></ul><ul><li>Adequate provision and protection for safe water supplies. </li></ul><ul><li>Fly control and screening to protect foods against fly contamination. </li></ul><ul><li>Construction of safe privy. </li></ul><ul><li>Emphasizing good personal hygiene. </li></ul><ul><li>Provision of adequate hand washing facilities. </li></ul>
  36. 36. <ul><li>Control of infected individual contacts and environment. </li></ul><ul><li>Reporting to Local Health Officer. </li></ul><ul><li>Rigid personal precautions by attendants. </li></ul><ul><li>Isolation of patient during acute illness. </li></ul>
  37. 37. <ul><li>The following need advice from Environmental Health officers or a Consultant in Communicable Disease Control ( CCDC ): </li></ul><ul><li>Food handlers who touch unwrapped food to be consumed raw or without further cooking. </li></ul><ul><li>Health-care, nursery or other staff who have direct contact with people who are susceptible to infection .This includes simply serving food to them. </li></ul>
  38. 38. <ul><li>Children under 5 years attending nurseries, play groups, nursery schools etc. </li></ul><ul><li>Older children or adults with poor standards of personal hygiene like the mentally ill, handicapped or the elderly infirm. </li></ul>
  39. 39. <ul><li>Thank You </li></ul>
  40. 40. Sources : <ul><li> Bower, Albert G., Craft, Nina, and Pilant, Edith. Communicable Diseases: A Textbook for Nurses, Merriam and Webster, Inc. Manila, Philippines, Eighth Edition. </li></ul><ul><li> Mondejar, Dionesia and Navalez. Handbook of Common Communicable and Infectious Diseases, C & E Publishing, Inc. 1622 Quezon Avenue, South Triangle, Quezon City, 2006 </li></ul>
  41. 41. <ul><li>,BACILLARY%20(Shigellosis).htm </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>,BACILLARY%20(Shigellosis).htm </li></ul>
  42. 42. <ul><li> </li></ul><ul><li>*** </li></ul>