Clinical Manifestations and Diagnosis of Toxic Bacillary Dysentery in Children
May 09, 2023
Source: Cainiu Health
Dr. Yang Shuwen
Introduction
Pediatric toxic bacillary dysentery is an intestinal infectious disease caused by Shigella species and represents the severe fulminant form of acute bacterial dysentery. Due to varying degrees of microcirculatory dysfunction in multiple organs, clinical manifestations may include hypoxia, ischemia, abdominal pain, diarrhea, and septic shock. Diagnosis can be made based on clinical presentation, as well as through routine stool examination, immunological testing, and other methods.
In general, pediatric toxic bacillary dysentery refers to an intestinal infectious disease caused by Shigella species. It is the severe form of acute bacterial dysentery and develops abruptly. Due to varying degrees of microcirculatory disturbances in multiple organs, clinical manifestations may include hypoxia, ischemia, abdominal pain, diarrhea, and septic shock. Diagnosis can be made based on clinical presentation, stool routine examination, immunological testing, and other methods. The details are as follows:
I. Clinical Manifestations
1. Hypoxia and Ischemia
This occurs when polypeptide toxins invade colonic epithelial cells and multiply within them. After bacterial lysis, large amounts of endotoxins are released, causing spasm of microvessels, leading to hypoxia and ischemia, which triggers toxic bacillary dysentery in children.
2. Abdominal Pain and Diarrhea
This is an acute gastrointestinal infectious disease caused by Shigella bacteria. The pathogens induce contraction and spasm of gastrointestinal smooth muscles, resulting in abdominal pain and diarrhea.
3. Septic Shock
Mainly due to Shigella bacteria multiplying in the intestine and releasing large quantities of endotoxins. Some children are particularly sensitive to these toxins, leading to severe septic shock. Early symptoms include pallor, cyanosis around the lips, pale fingers and toes, weak and rapid pulse, and increased heart rate. Later stages present with cyanosis, decreased blood pressure, reduced urine output; in severe cases, profound cyanosis and bradycardia may occur.
Besides the above symptoms, other manifestations such as lethargy, somnolence, and coma may also appear.
II. Diagnostic Methods
1. Clinical Presentation
Diagnosis can be based on clinical features. For instance, if a child presents with high fever, pallor, cold extremities, and convulsions, toxic bacillary dysentery should be considered.
2. Stool Routine Examination
Stool analysis typically reveals mucus, pus, and blood. Microscopic examination showing numerous pus cells, red blood cells, and macrophages suggests possible toxic bacillary dysentery.
3. Immunological Testing
Currently, fluorescent-labeled antibodies specific for Shigella are available for immunological detection of pathogenic bacteria in stool samples to identify the causative agent of bacterial dysentery.
In addition to the above diagnostic methods, this condition can also be diagnosed through tests including procalcitonin, complete blood count, and blood biochemistry.
