1. Symptoms of infantile dysentery

When infants and young children suffer from bacillary dysentery, as their body temperature rises, they may suffer from listlessness, lethargy, irritability and even convulsions. They may cry due to abdominal pain before defecation. Uneasy. Symptoms of dysentery are often atypical, manifesting as intestinal dysfunction, dyspeptic stools, straining during defecation or facial swelling indicating tenesmus.

2. Causes of Infantile Dysentery

1. Bacillary dysentery in infants and young children has been on the rise in recent years. This is because infants and young children’s diets tend to be diversified, and some infant complementary foods are added too early , the variety increases too much.

For example, for babies who are just one month old, parents begin to feed their children watermelon water, apple puree, etc. Some parents feed their children fish, shrimp, meat floss, etc. prematurely. These foods are easily contaminated by germs during storage and feeding, thus increasing the chance of infection.

2. The onset season is no longer limited to summer and autumn. At present, bacillary dysentery can be seen almost all year round, and even infant bacillary dysentery is not uncommon in winter, because in recent years, fruits, fish, shrimp and other foods can be eaten all year round. Infants and young children infected with bacillary dysentery after eating watermelon in winter have already Commonly seen.

3. Bacillary dysentery in children is easily confused with ordinary diarrhea. The younger the patient is, the more atypical the clinical symptoms are.

Most of the stools are watery at first, often accompanied by vomiting. Later, the frequency of stools increases, but the stool volume decreases, becomes sticky, and mucus stools appear. Children with recurring episodes may also experience prolapse. , it is easy to miss or misdiagnose without a stool test. Therefore, it is best for parents to save a little stool before seeing a doctor and take it to the hospital for examination within 2 hours.

4. It is easy to evolve into chronic bacillary dysentery. Generally, if the duration of bacillary dysentery exceeds two months, it can be diagnosed as chronic bacillary dysentery. Chronic bacillary dysentery will inevitably affect the digestion and absorption of food nutrients due to long-term diarrhea, leading to growth and development disorders in children.

5. Water and electrolyte disorders and poisoning symptoms are prone to occur.

The intestinal wall of children is thinner than that of adults but rich in blood vessels. Once intestinal infection occurs, it is more likely to lead to dehydration and toxin absorption, resulting in high fever, convulsions, mental disorders, and even life-threatening toxic bacillary dysentery. Therefore, early treatment of bacillary dysentery in children must not be taken lightly.

6. Children have difficulty taking medication and often cannot adhere to a sufficient course of treatment. Many drugs that are effective in adults, such as sulfonamides (trimoxazole), quinolones (such as norfloxacin), and aminoglycosides (gentamicin, kanamycin), are not suitable for children.

The third-generation cephalosporins (such as Bacteria Bide) have good intravenous effects, but are often rejected by children and parents because of the fear caused by intravenous infusion.

3. What to do if a child suffers from dysentery

1. Isolate the child and conduct treatment under the guidance of a doctor. 2. The air in the ward should be fresh, and the children's clothes should be washed and dried immediately. 3. Rest in bed, insist on taking medicine according to the doctor's instructions, and the treatment must be thorough. After the symptoms disappear, do not stop taking the medicine without the doctor's instructions to avoid recurrence of dysentery or turning into chronic dysentery. 4. When children have high fever, they should take antipyretics under the guidance of a doctor. When the fever exceeds 39.5°C, physical cooling should be used. 5. Pay close attention to the changes in the child's condition. If the child is found to be listless, pale, and has cold limbs, it may be toxic dysentery, and you should seek medical treatment immediately. 6. Let the child drink more water, preferably some sugary salt water, and eat easy-to-digest food.

IV. How to prevent dysentery in children

1. Dysentery is a common intestinal disease caused by eating food or drinks contaminated with feces containing Shigella dysenteriae.

Therefore, in order to prevent the occurrence of bacterial dysentery, we must pay attention to dietary hygiene. Note that food must be fresh and do not eat spoiled, rotten or overnight food. Cooked and raw food cannot be stored in the refrigerator for too long. Cooked food should be reheated.

2. Raw foods and fruits should be washed, preferably washed and scalded in boiling water.

It is particularly important to note that cold drinks play an important role in the spread of dysentery.

It is impossible not to let children eat cold drinks in summer. The key is to pay attention to buying products of good brands and not drinking drinks from stalls. It is extremely unhygienic to eat popsicles and ice cream on the road, especially when the wind is strong. The dust falling on the popsicles often contains germs.

5. What causes poisonous dysentery in children

1. Microcirculatory ischemic period

The sympathetic nerves are excited in the early stage of the disease, and the secretion of catecholamines increases at this time , alpha receptors are excited, causing cutaneous visceral arterioles, arterioles, precapillaries and muscular venules to spasm, causing peripheral vascular resistance to add up, reducing the volume within microvessels, reducing tissue blood perfusion, and causing brain tissue ischemia and deficiency. oxygen. Clinical manifestations include gray complexion, lethargy, coma, and convulsions.

2. Microcirculation congestion period

Ischemia and hypoxia stimulate mast cells on the walls of microvessels to release histamine, which has the effect of relaxing blood vessels. At the same time, metabolic acidosis occurs during the ischemic period, and acidosis also has the effect of vasodilation. These factors cause the anterior resistance vessels such as arterioles and precapillaries to relax, while the muscular venules are insensitive to the effects of histamine and acidosis and remain in a state of contraction.

After the anterior resistance is reduced, the resistance is still high, causing more perfusion and less flow in the microcirculation, causing congestion and hypoxia in the microcirculation. The hydrostatic pressure in the capillaries increases, the permeability increases, and intravascular fluid leaks out, forming brain tissue edema. Clinical manifestations include increased intracranial pressure, worsening coma in sick children, frequent convulsions, cerebral edema and increased intracranial pressure that compress cranial nerves, induce brain herniation, make one side of the pupil large and one side small, and in severe cases, respiratory failure and death may occur.

3. Shock period

In some children, due to microcirculation disorders in the skin and internal organs, a large amount of blood accumulates in the chest and abdominal viscera, the amount of blood returned to the heart is reduced, and the effective circulation is insufficient. In addition, skeletal muscles The blood vessels of the skeletal muscle are mainly controlled by M receptors and β2 receptors. During shock, these two receptors are activated, causing the blood vessels in the skeletal muscles to dilate, resulting in excessive blood perfusion in the skeletal muscles. This part of blood accounts for about 1/3 of the cardiac output, so the skeleton Intramuscular congestion is also one of the important reasons for the reduction of effective circulating volume. During the shock stage, clinical manifestations include decreased cardiac output, decreased blood pressure, rapid pulse, cold limbs, discolored skin, cyanosis on the extremities, and apathetic expression. In severe cases, circulatory failure and death may occur.

4. Disseminated intravascular coagulation (DIC) stage

After the microcirculatory disorder enters the congestion stage, due to the extravasation of fluid in the capillaries, the blood is concentrated, the blood viscosity increases, and the acidity Metabolites accumulate, platelet aggregation is destroyed, thromboplastin is released, and severe lactic acidemia inactivates heparin. At the same time, vascular endothelial cells are damaged, collagen fibers are exposed, and factor XII is activated.

The above factors cause blood to be in a hypercoagulable state and contribute to DIC. At this time, extensive microthrombi block the capillaries, further worsening the microcirculation disorder. During the coagulation process, a large amount of coagulation factors are consumed, platelets are reduced, and the body develops secondary fibrinolysis to fight against DIC. Therefore, the blood coagulability is reduced in the later stage, inducing bleeding tendencies.

6. How to prevent poisonous dysentery in children

Poisonous dysentery is a serious type of bacterial dysentery, and children aged 2 to 7 years old are most susceptible to this disease. The onset of this disease is sudden, and the course of the disease is extremely dangerous. If not treated in time, the sick child may quickly suffer from respiratory or circulatory failure and die.

1. Pay attention to environmental hygiene, especially food hygiene. At home, we must actively eliminate flies, mosquitoes, and rats, eliminate mosquito and fly breeding places, and keep indoors and outdoors clean and hygienic.

2. Cultivate children to wash their hands before meals and after going to the toilet, not to drink raw water, not to eat raw or cold vegetables and fruits, not to spit, and not to urinate anywhere, so as to reduce and control the intestinal tract The occurrence of infectious diseases.

3. Do not buy fake and expired food. Educate children not to be greedy for cold drinks and cold foods. When purchasing, pay attention to the manufacturer's trademark, date of manufacture, expiration date, and whether they have gone bad, etc. to avoid gastrointestinal problems caused by eating the wrong things.

7. Symptoms of bacillary dysentery in children

1. The incubation period ranges from several hours to 8 days, most of which are 1 to 3 days.

2. Bacillary dysentery can be divided into acute bacillary dysentery, chronic bacillary dysentery and toxic dysentery according to the course and condition of the disease.

(1) Acute bacillary dysentery

Typical dysentery

Typical cases have an acute onset of fever, low or high body temperature, and diarrhea and defecation 10 to 10 times a day. 30 times, the stool contained mucus, pus and blood. There is nausea, vomiting, and paroxysmal abdominal pain. There is mild tenderness in the abdomen. Sometimes the spasmodic sigmoid bowel can be palpated in the left lower abdomen. Hyperactive bowel sounds.

Having tenesmus and a sinking feeling after defecation. The child suffered from general weakness and loss of appetite. Infants and young children may sometimes have febrile convulsions. Most children with acute dysentery can gradually reduce and recover within a few days with reasonable treatment, and the prognosis is good. Older children's stools form quickly, while infants and young children have loose stools that can last for several days. This is related to the slow recovery of intestinal function in infants and young children.

Chronic bacillary dysentery

A disease lasting more than 2 weeks is called persistent dysentery, and a disease lasting more than 2 months is called chronic dysentery. The main causes of its occurrence are thin body, malnutrition, rickets or anemia and other comorbidities. Or it may be caused by children with such diseases not receiving reasonable treatment.

Due to the course of the disease, weight loss gradually occurs, and the stool contains a large amount of mucus, not necessarily pus and blood, or mucus and pus and blood appear alternately. Shigella dysenteriae can still be cultured from stool, but the positive rate is significantly lower than that of acute dysentery.

Children with chronic dysentery are often prone to crises if they are combined with severe malnutrition. Sick children may die unexpectedly due to electrolyte imbalance (low sodium, low potassium, low calcium) and severe myocardial damage.

8. Complications caused by bacillary dysentery in children

1. Children with acute bacillary dysentery may suffer from water and electrolyte disorders (dehydration, acidosis, hypoxia) if vomiting and diarrhea are severe. potassium, low sodium, low calcium, etc.).

2. Chronic bacillary dysentery has many complications, mainly caused by malnutrition and low immune function. The most common ones are malnutrition and dystrophic edema, as well as multivitamin and trace element deficiencies, manifested as xerophthalmia, dystrophic anemia, and rickets. In severe cases, beriberi and scurvy may occur.

9. What diseases are easily confused with bacillary dysentery in children?

Bacillary dysentery is characterized by pus and blood in the stool. However, when diagnosing bacillary dysentery based only on pus and blood, the misdiagnosis rate can reach about 30%. It is most easily confused with the following enteritis:

1. Invasive Escherichia coli (EIEC) enteritis. The onset season and symptoms of this disease are very similar to bacillary dysentery. It also manifests as fever, diarrhea, purulent and bloody stools, and is also found in It has symptoms similar to poisonous dysentery.

2. Campylobacter jejuni enteritis. The onset season and clinical course of this disease are also similar to bacillary dysentery. More common in children over 3 years old. Symptoms include fever and diarrhea, first with loose stools, and later with pus and blood, similar to dysentery.

3. Salmonella enteritis: It is more common in young infants and is characterized by diverse feces. It starts out as loose stools and can later appear as mucus, pus and bloody stools. It is easily misdiagnosed as bacillary dysentery.

10. What examinations should be done for bacillary dysentery in children

1. Routine blood examination: In acute cases, the total number of white blood cells and neutrophils increases, and in chronic cases, there is often mild anemia.

2. Stool routine: The appearance of stool is mucus and pus and blood. Under the microscope, more red and white blood cells and phagocytes are seen.

3. Fecal culture: about 70% or more can culture pathogenic bacteria. The pus and blood portion of the feces should be cultured before antibiotic administration. Specimens should be fresh. Those who are positive undergo drug sensitivity testing.

4. Fecal bacterial antigen detection: using fluorescent antibody staining method, immunofluorescent epibacterial method, latex agglutination test, collaborative agglutination test, PCR direct detection method, etc., it is a fast, sensitive and simple diagnosis method.

11. Diet for children with bacillary dysentery

The purpose of dietary treatment is to reduce intestinal irritation, relieve the patient's diarrhea symptoms, and prevent and correct water and electrolyte balance. When fever, abdominal pain, and diarrhea are obvious, you should fast. When the symptoms are slightly relieved, you can eat a light, nutritious, easy-to-digest, and low-fat liquid diet.

For example, lotus root starch, rice soup, fruit juice, vegetable juice, milk, soy milk and gas-producing foods are prohibited to ensure adequate rest for the intestines and to replenish water and electrolytes. 6 meals a day, 200ml to 250ml per meal.

After fever and diarrhea symptoms improve, you can eat a low-residue, non-irritating diet, such as porridge, noodles, noodles, steamed egg custard, small meatballs, vegetable purees, etc. You can eat 3 or 5 meals a day. Meals should not be too large. You should drink more water to improve dehydration and toxemia and facilitate the excretion of toxins.

12. How to care for children with dysentery

We all know that dysentery often occurs in children. When a child suffers from dysentery, our parents will be very worried. I am anxious, for fear that my child will be infected with other diseases due to dysentery. Therefore, when you find that your child has symptoms of dysentery, you must send your child to the hospital as soon as possible.

1. Antibiotics

Drugs should be selected based on the local, current and patient conditions. Antibiotics that Shigella dysenteriae are sensitive to should be selected. Toxic bacillary dysentery should be treated with a combination of 2-3 antibiotics. , and uses intravenous administration to make the antibiotics in the blood reach impact concentrations in a short period of time. Generally, bacillary dysentery can be treated orally. If oral administration is not possible, intravenous or intramuscular injection can also be used. Commonly used antibiotics include cephalosporins, ampicillin, etc., and the course of treatment is 7-10 days. Stop until stool culture is negative.

2. Correct water and electrolyte disorders and acidosis

Children with diarrhea lose a lot of fluid and electrolytes. Oral rehydration solution is suitable for children with mild to moderate dehydration. The dosage should be adjusted according to the condition of diarrhea and the correction of dehydration. Parents should follow the doctor's instructions to give their children water to drink until the dehydration is corrected. Severe dehydration or vomiting cannot be taken orally, and intravenous rehydration is required to correct it.

3. Treatment of toxic bacillary dysentery

The principle is to rapidly cool down, relieve arteriolar spasm, and improve microcirculation. Often high fever cannot be lowered by using antipyretics alone. It should be combined with physical cooling, such as ice caps, alcohol baths, etc., and at the same time, use 1 warm salt water enema. If it is ineffective, hibernation therapy can be used to try to lower the body temperature to 36-36 in a short time. 37 degrees, hibernation time does not exceed 12-24 hours, and active rescue of circulatory and respiratory failure is required.

4. Rest and diet

Children with bacillary dysentery should rest in bed, isolate according to intestinal infectious diseases, and disinfect and dispose of feces. Generally, fasting is not required if there is no vomiting or severe bacillary dysentery, but the diet should be adjusted according to the condition. First stop eating foods that are not easy to digest to reduce the burden on the gastrointestinal tract. Breastfed children can continue to breastfeed, the number of feedings can be appropriately reduced, the interval between feedings can be appropriately extended, the time of each feeding can be shortened, and the addition of complementary foods can be suspended.

5. Keep the buttocks clean

Children with frequent diarrhea are prone to diaper dermatitis. Therefore, children should wash their buttocks with warm water and dry them after each defecation. Diapers should be made of highly absorbent, soft cloth, and avoid using plastic cloth on the child's buttocks or wrapping it too tightly. After diaper dermatitis occurs, you can apply petroleum jelly, zinc oxide oil, etc. on the buttocks 2-3 times a day. In mild cases, it can be cured in 2-3 days, and in severe cases, it can be cured in 5-7 days.

Children should pay attention to three points to use medicine safely

1. Parents should understand the mechanism of action of the medicine, master the indications, dosage, precautions and possible risks of the medicine. Be aware of adverse reactions. In order to achieve the best therapeutic effect. 2. When selecting drugs and dosage, consider the child's age, physical strength, severity of illness, liver function, previous medications, and any history of allergies, etc., and inform the doctor of the relevant information so that he or she can take appropriate measures. Ensure that medication is safe, effective, reasonable and economical. 3. Children should not take too many types of medicines. If you need to take several drugs at the same time, care should be taken to avoid toxic side effects caused by interactions between drugs in the body. Therefore, several drugs should be taken at a certain interval.