BacillaryDysentery

Shige llos is

Prepared by:Ma. Danica C. Consuelo

BSN III-B

Mr. Richard Bartolataprofessor

Definition

Th e t e rm “ d y s e n t e r y ” is u s e d

in c o n n e c t io n w it h v a r io u s in t e s t in a l

. d is t u r b a n c e s Th e m o d if y in g w o r d

“ b a c il la r y ” is e m p lo y e d t o d e n o t e

t h a t f o rm o f d y s e n t e r y c a u s e d b y

s p e c if ic b a c il l i o f t h e .d y s e n t e r y g r o u p

Bacillary Dysentery is a n a c u t e

b a c t e r ia l in f e c t io n o f t h e

.in t e s t in e

It is a c o n t a g io u s

, in f e c t io n o c c u r s in

e p id e m ic s a n d   o c c u r s

m o r e f r e q u e n t ly in

t h e s u m m e r .a n d f a ll

E p id e m ic s a r e m o s t f r e q u e n t in

o v e r c r o w d e d p o p u la t io n s w it h in a d e q u a t e

. s a n it a t io n P a t ie n t s w it h

m ild u n d ia g n o s e d

in f e c t io n s h a v e o n ly t r a n s ie n t

d ia r r h e a o r n o in t e s t in a l. s y m p t o m s

S e v e r e in f e c t io n s a r e

f r e q u e n t in in f a n t s a n d in e ld e r ly

d e b ilit a t e dp e r s o n

E t I o l o g I c A g e n t

Th e c a u s a t iv e a g e n t is a b a c t e r ia o f t h e Shige lla

(Kiyoshi Shiga ) , g r o u p a, - , s h o r t n o n m o t ile g r a m

n e g a t iv e o r g a n is m

Th e r e a r e f o u r s e r o lo g ic:g r o u p s

1. Shige lla dysenteriae ( )G r o u p A c o n s id e r e d a s t h e m o s t

in f e c t io u s t h e ir h a b it a t is a lm o s t

e x c lu s iv e ly t h e G IT o f m a n

t h e y r a r e ly in v a d e t h e , b lo o d s t r e a m a n d a r e

c u lt u r e d f r o m t h es t o o ls

------- S c a n n in g

E le c t r o n M ic r o g r a p h

o f S h ig e l la d y s e n t e r ia e

- G r a m -, n e g a t iv e

, e n t e r ic f a c u lt a t iv e ly

, a n a e r o b ic r o d

; p r o k a r y o t e c a u s e s

b a c t e r ia ld y s e n t e r y .

Th is s p e c ie s is m o s t

o f t e n f o u n d in w a t e r

c o n t a m in a t e d w it h

h u m a nf e c e s .

l ik e o t h e r g r a m , n e g a t iv e b a c il l i t h e y

d e v e lo p r e s is t a n c e a g a in s t a n t ib io t ic s

2. Shige lla flexneri ( G r o u p) B

p r e d o m in a n t in d e v e lo p in g

c o u n t r ie s c o m m o n in t h e

P h ilip p in e s

3. Shige lla boydii ( G r o u p)C

4 . S h ig e l la s o n n e i- t h e c o m m o n e s t b u t a ls o

t h e m ild e s t f o rm . M a n y m ild e r c a s e s

a r e p r o b a b ly n e v e r d ia g n o s e d a n d s o

, n e v e r r e p o r t e d s o t h e t r u e in c id e n c e m a y b e s u b s t a n t ia lly

h ig h e r .

----- S c a n n in g E le c t r o n M ic r o g r a p h o f S h ig e l la

s o n n e i - G r a m - , n e g a t iv e , f a c u lt a t iv e ly a n a e r o b ic

; r o d p r o k a r y o t e c a u s e s s h ig e llo s is ( b a c t e r ia l

d y s e n t e r y ). Th is s p e c ie s is m o s t o f t e n lin k e d t o

in f e c t io n f r o m f o o d .

I n c u b a t I o n P e r I o d S e v e n h o u r s t o

s e v e n d a y s w it h a n a v e r a g e o f

t h r e e t o f iv e.d a y s

P e r io d o fC o m m u n ic ab il it y Th e d is e a s e is

c o m m u n ic a b le d u r in g t h e a c u t e p h a s e a n d

u n t il t h e m ic r o o r g a n is m is

a b s e n t f r o m t h e , b o w e l d is c h a r g e s u s u a lly w it h in a f e w

w e e k s e v e n w it h o u t . s p e c if ie d t h e r a p y A f e w in d iv id u a ls

b e c a m e c a r r ie r s f o r .a y e a r o r t w o

M o d e o fTr a n s m is s ion The organism is transmitted through

ingestion of contaminated food or drinking contaminated water or milk.

It is transmitted by flies or through other objects contaminated by feces of the patient.

- F e c a l o r a l t r a n s m is s io n is

.p o s s ib le - H a n d t o m o u t h

t r a n s f e r o f c o n t a m in a t e d

m a t e r ia l S w im m in g in in f e c t e d

.w a t e r s E a t in g c o n t a m in a t e d

f o o d w it h h u m a n ( s e w a g e e it h e r d ir e c t ly o r v ia

) c o n t a m in a t e d w a t e r e s p e c ia lly w it h c o ld u n c o o k e d f o o d s s u c h

. a s s a la d s

, In d e v e lo p in g c o u n t r ie s S h ig e lla is a c o m m o n in f e c t io n b e c a u s e o f

in a d e q u a t e s e w a g e d is p o s a l a n d la c k o f

e f f e c t iv e ly t r e a t e d w a t e rs u p p lie s . It is a c a u s e o f

, , s e v e r e p o t e n t ia l ly f a t a l in f e c t io n in c h ild r e n .

S h ig e lla is o f m a jo r im p o r t a n c e in r e f u g e e

c a m p s o r f o llo w in g , n a t u r a l d is a s t e r s w h e n

o n c e a g a in d is p o s a l o f s e w a g e a n d t h e p r o v is io n

o f c le a n w a t e r m a y b e e x t r e m e ly d if f ic u lt . It h a s

b e e n s u g g e s t e d t h a t in d e v e lo p in g c o u n t r ie s f l ie s

m a y s p r e a d t h e in f e c t io n , f r o m p e r s o n t o p e r s o n a s

t h e d is e a s e is c o m m o n e s t a t t h e t im e o f y e a r w h e n

t h e f ly p o p u la t io n is. h ig h e s t

P a t h o l o g y

A f t e r t h e in c u b a t io n, p e r io d t h e o r g a n is m

in v a d e s t h e in t e s t in a l m u c o s a a n d c a u s e s

. in f la m m a t io n Th e o r g a n is m in v a d e s t h e

c e lls l in in g t h e la r g e b o w e l a n d m u lt ip lie s

, ; t h e r e k il l in g t h e c e ll t h is is t h e c a u s e o f t h e s y m p t o m s

p r o d u c e d . , H o w e v e r i t o c c a s io n a lly

in v a d e s t h e b o w e l b e y o n d t h e s u r f a c e

lin in g .

, D ir t y f ib r in o u s s lo u g h in g

a r e a s o r u lc e r s

a r ef o rm e d

Wit h in t h e f e w

, d a y s t h e s t o o l m a y

c o n t a in, p u s

m u c u s a n d

.b lo o d

C lin ic a lM a n if e s t a t ion s F e v e r e s p e c ia l ly in

c h ild r e n , , Te n e s m u s n a u s e a

, v o m it in g a n dh e a d a c h e

C o lic k y o r c r a m p in g ( a b d o m in a l p a in d a y s

) t o w e e k s a s s o c ia t e d w it h a n o r e x ia a n d b o d y

.w e a k n e s s -D ia r r h e a w it h b lo o d y

m u c o id s t o o l t h a t is w a t e r y a t f ir s t

R a p id d e h y d r a t io n a n d lo s s o f w e ig h t

C o m p l I c a t I o n s R e c t a l p r o la p s e

p a r t ic u la r ly in u n d e r n o u r is h e d

.c h ild r e n - N o n s u p p u r a t iv e

a r t h r it is w it h o n e o r s e v e r a l jo in t s in v o lv e d

( a c c o m p a n ie d w it h f e v e r a n d a s e r o u s

e f f u s io n in t o t h e, jo in t w h ic h h a s

s o m e t im e s b e e n f o u n d t o c o n t a in’ ).S h ig a s b a c il lu s

An e m ia

( P a r o t it is d u e t o s e c o n d a r y ) in f e c t io n f r o m m o u t h o r g a n is m

B a c t e r a e m ia o c c u r s p r im a r ily in m a ln o u r is h e d c h ild r e n

( )H e m o ly s is d e s t r u c t io n o f R B C U lc e r a t io n in t h e in t e s t in e c a n

le a d t o s e v e r e b lo o d lo s s , In r a r e c a s e s t h e b a c t e r ia

m a y e n t e r t h e b lo o d s t r e a m f r o m t h e d ig e s t iv e t r a c t a n d

, in f e c t o t h e r b o d y o r g a n s s u c h , , a s k id n e y s g a llb la d d e r liv e r . o r h e a r t a n d jo in t s Th is m a y

. c a u s e s h o c k a n d d e a t h - S h o c k m a r k e d b y a w e a k

, , , p u ls e c o ld n e s s s w e a t in g a n d , ir r e g u la r b r e a t h in g a n d r e s u lt in g f r o m a s it u a t io n s u c h

a s b lo o d lo s s

D ia g n o s t icP r o c e d u r e s F e c a ly s is o r

m ic r o s c o p ic e x a m in a t io n o f t h e

.s t o o l - R e c t a l s w a b a

la b o r a t o r y t e s t t o is o la t e a n d id e n t if y

o r g a n is m s in t h e r e c t u m t h a t c a n

c a u s e g a s t r o in t e s t in a l

s y m p t o m s a n d. , d is e a s e N o rm a lly

m a n y o r g a n is m s a r e p r e s e n t in t h e lo w e r

( ) g a s t r o in t e s t in a l G I, t r a c t b u t s o m e c a n

a c t a s p a t h o g e n s( - d is e a s e c a u s in g

) o r g a n is m s in t h e.b o w e l

P e r ip h e r a l b lo o d.e x a m in a t io n

B lo o d t e s t s

> F u ll b lo o d c o u n t a n d E S R lo o k in g f o r

, a n e m ia in f e c t io n o r in f la m m a t io n

> E le c t r o ly t e s t o . . a s s e s s lo s s e g lo w

, p o t a s s iu m m a g n e s iu m a n d c a lc iu m

> Ir o n s t u d ie s lo o k in g f o r ir o n d e f ic ie n c y d u e

t o b lo o d lo s s o r m a la b s o r p t io n

> 1 2 Vit a m in B t o a s s e s s m a la b s o r p t io n

Nursing Process

A S S E S S M E N T A S S E S S M E N T Lo w e r a b d o m in a l Lo w e r a b d o m in a lt e n d e r n e s st e n d e r n e s s

N o rm a l o r in c r e a s e d N o rm a l o r in c r e a s e d b o w e l s o u n d s b o w e l s o u n d s

Hydr at i on St at us Hydr at i on St at us , e v a lu a t io n f o r t h ir s t o r a l , e v a lu a t io n f o r t h ir s t o r a l

m u c o u s m e m b r a n e m u c o u s m e m b r a n e, , d r y n e s s s u n k e n e y e s a, , d r y n e s s s u n k e n e y e s a

, w e a k e n e d p u ls e a n d , w e a k e n e d p u ls e a n d lo s s o f s k in t u r g o r lo s s o f s k in t u r g o r

l iq u id s t o o l s h o u ld b e l iq u id s t o o l s h o u ld b e m e a s u r e d a n d r e c o r d e d m e a s u r e d a n d r e c o r d e d

a lo n g w it h a r e c o r d o f a lo n g w it h a r e c o r d o f .t h e f r e q u e n c y o f s t o o ls .t h e f r e q u e n c y o f s t o o ls

( n o t e t h e c o n s is t e n c y( n o t e t h e c o n s is t e n c y a n d a p p e a r a n c e a n d t h e a n d a p p e a r a n c e a n d t h e

p r e s e n c e o f m u c o u s o r p r e s e n c e o f m u c o u s o r)b lo o d )b lo o d

Heal t h Hi s t or y Heal t h Hi s t or y d e t e rm in e w h e t h e r t h e d e t e rm in e w h e t h e r t h e

p a t ie n t h a s b e e n in p a t ie n t h a s b e e n in c o n t a c t w it h a n y o n e w h o c o n t a c t w it h a n y o n e w h o

h a s r e c e n t ly h a d d ia r r h e a l h a s r e c e n t ly h a d d ia r r h e a ld is e a s ed is e a s e

w h a t t h e p a t ie n t h a s w h a t t h e p a t ie n t h a s ( r e c e n t ly e a t e n m e a l ( r e c e n t ly e a t e n m e a l

p r e c e d in g t h e il ln e s s a n d p r e c e d in g t h e il ln e s s a n d a b o u t a ll f o o d in t a k e in t h e a b o u t a ll f o o d in t a k e in t h e

3 4 ).p r e v io u s t o d a y s 3 4 ).p r e v io u s t o d a y s If t h e p a t ie n t is e m p lo y e d If t h e p a t ie n t is e m p lo y e d

in a f o o d p r e p a r a t io n in a f o o d p r e p a r a t io n.s e r v ic e .s e r v ic e

D I A G N O S I S D I A G N O S I S(nursing diagnoses)(nursing diagnoses)

D e f ic ie n t f lu id v o lu m e D e f ic ie n t f lu id v o lu m e r e la t e d t o f lu id lo s s r e la t e d t o f lu id lo s s t h r o u g h d ia r r h e a a n d t h r o u g h d ia r r h e a a n d.v o m it in g .v o m it in g

D e f ic ie n t k n o w le d g e D e f ic ie n t k n o w le d g e a b o u t t h e in f e c t io n a n d a b o u t t h e in f e c t io n a n d

t h e r is k o f t r a n s m is s io n t h e r is k o f t r a n s m is s io n t o o t h e r s t o o t h e r s

P L A N N I N G A N P L A N N I N G A N D G O A L S D G O A L S

To m a in t a in f lu id a n d To m a in t a in f lu id a n d .e le c t r o ly t e b a la n c e .e le c t r o ly t e b a la n c e

To in c r e a s e k n o w le d g e To in c r e a s e k n o w le d g e a b o u t t h e d is e a s e a n d a b o u t t h e d is e a s e a n d

.r is k o f t r a n s m is s io n .r is k o f t r a n s m is s io n

I N T E R V E N T I ON

*Correcting Dehydration Associated with Diarrhea

As s e s s t h e d e g r e e o fd e h y d r a t io n

Mild dehydration (patient exhibits dry mucous membranes of the mouth and increased thirst)

R e h y d r a t io n g o a l d e liv e r 5 0 a b o u t m L o f o r a l

( ) r e h y d r a t io n s o lu t io n O R S 1 4 -p e r k g o f w e ig h t o v e r a

.h o u r in t e r v a l

Moderate dehydration (sunken eyes, loss of skin turgor, and dry oral mucous membranes. Infants may have sunken fontanel)

R e h y d r a t io n g o a l 1 0 0 / a b o u t m L k g

4 .o v e r h o u r s

Severe Dehydration (signs of shock ie. Rapid thready pulse, cyanosis, cold extremities rapid breathing, or coma)

R e h y d r a t io n g o a l in t r a v e n o u s r e p la c e m e n t a s o r d e r e d u n t il

h e m o d y n a m ic a n d m e n t a l s t a t u s .r e t u r n t o n o rm a l

Wh e n im p r o v e m e n t , is e v id e n t t h e p a t ie n t c a n b e

. t r e a t e d w it h O R S

* R e s t r ic t f o o d s u n t il n a u s e a a n d .v o m it in g s u b s id e s

Increasing Knowledge and Preventing Spread of Infect ion

* Em p h a s iz e p r in c ip le s o f s a f e , f o o d p r e p a r a t io n w it h

s p e c ia l a t t e n t io n t o m e a t p r e p a r a t io n a n d c o o k in g

> a d e q u a t e p r o v is io n f o r s t o r a g e a n d r e h e a t in g t o

m e a t t e m p e r a t u r e .t h r e s h o ld s is im p o r t a n t

> it is im p o r t a n t t o u s e , , d if f e r e n t s u r f a c e s k n iv e s

a n d o t h e r e q u ip m e n t f o r . m e a t a n d n o n m e a t it e m s

> E x c r e t a m u s t b e .p r o p e r ly d is p o s e d

> C o n c u r r e n t a n d t e rm in a l d is in f e c t io n s h o u ld b e

.e m p lo y e d* D ia r r h e a l d is e a s e s s h o u ld

b e r e p o r t e d t o lo c a l h e a lt h d e p a r t m e n t s

* Th e n e e d f o r r e h y d r a t io n a n d r e f e e d in g s h o u ld b e

.t a u g h t t o p a r e n t s* G o o d h y g ie n e in t h e h e a lt h

c a r e d e liv e r y a n d h o m e .s e t t in g s m u s t b e a f o c u s

> t h e p r in c ip le s o f h a n d w a s h in g a n d g lo v e

u s e t h a t a r e e m p h a s iz e d w it h S t a n d a r d

P r e c a u t io n s

M o d a l I t I e s o f T r e a t m e n t

An t ib io t ic s s u c h a s, Am p ic il l in Te t r a c y c lin e

o r C o t r im o x a z o le is u s e f u l in s e v e r e c a s e s

o r w h e n t h e s p r e a d o f in f e c t io n t o o t h e r

p e o p le is l ik e ly a n d w h e n t h e p a t ie n t is v e r y

y o u n g IV m ig h t b e in f u s e d w it h

( n o rm a l s a lin e w it h) e le c t r o ly t e t o p r e v e n t

. d e h y d r a t io n An t i d ia r r h e a l d r u g s a r e

c o n t r a in d ic a t e d b e c a u s e t h e y d e la y

f e c a l e x c r e t io n t h a t c a n .le a d t o p r o lo n g f e v e r

: D ie t L iq u id o r s o f t d ie t , u n t il d ia r r h e a s t o p s t h e n r e t u r n t o n o rm a l

.d ie t

E V A L U A T I O N* E x p e c t e d P a t ie n t

O u t c o m e s3. A t t a in s f lu id b a la n c e

. a O u t p u t a p p r o x im a t e sin t a k e

. b M u c o u s m e m b r a n e s a p p e a r m o is t

. c N o rm a l s k in t u r g o r7. Ac q u ir e s k n o w le d g e a n d

u n d e r s t a n d in g a b o u t in f e c t io u s d ia r r h e a a n d

t r a n s m is s io n p o t e n t ia l. a Ta k e s p r o p e r p r e c a u t io n s t o p r e v e n t s p r e a d o f

in f e c t io n. b D e s c r ib e s p r in c ip le s a n d

t e c h n iq u e s o f s a f e f o o d, s t o r a g e p r e p a r a t io n a n d

c o o k in g

M e t h o d s o f P r e v e n t io n a n dC o n t r o l S a n it a r y d is p o s a l o f

.h u m a n f e c e s S a n it a r y s u p e r v is io n o f

, p r o c e s s in g p r e p a r a t io n a n d s e r v in g o f f o o d

p a r t ic u la r ly t h o s e e a t e n.r a w

Ad e q u a t e p r o v is io n a n d p r o t e c t io n f o r s a f e w a t e r

.s u p p lie s F ly c o n t r o l a n d s c r e e n in g

t o p r o t e c t f o o d s a g a in s t .f ly c o n t a m in a t io n

C o n s t r u c t io n o f s a f e.p r iv y

Em p h a s iz in g g o o d .p e r s o n a l h y g ie n e

P r o v is io n o f a d e q u a t e .h a n d w a s h in g f a c il it ie s

C o n t r o l o f in f e c t e d in d iv id u a l c o n t a c t s

.a n d e n v ir o n m e n t R e p o r t in g t o Lo c a l

.H e a lt h O f f ic e r R ig id p e r s o n a l

p r e c a u t io n s b y.a t t e n d a n t s

Is o la t io n o f p a t ie n t . d u r in g a c u t e il ln e s s

Th e f o llo w in g n e e d a d v ic e f r o m

E n v ir o n m e n t a l H e a lt h o f f ic e r s o r a

C o n s u lt a n t in C o m m u n ic a b le

D is e a s e C o n t r o l(C C D C ):

F o o d h a n d le r s w h o t o u c h u n w r a p p e d f o o d t o b e

c o n s u m e d r a w o r w it h o u t . f u r t h e r c o o k in g

- , H e a lt h c a r e n u r s e r y o r o t h e r s t a f f w h o h a v e d ir e c t c o n t a c t w it h p e o p le w h o a r e

s u s c e p t ib le t o in f e c t io n. Th is in c lu d e s s im p ly

. s e r v in g f o o d t o t h e m

5 C h ild r e n u n d e r y e a r s , a t t e n d in g n u r s e r ie s

, p la y g r o u p s n u r s e r y . s c h o o ls e t c

O ld e r c h ild r e n o r a d u lt s w it h p o o r s t a n d a r d s o f

p e r s o n a l h y g ie n e lik e , t h e m e n t a lly i l l

h a n d ic a p p e d o r t h e .e ld e r ly in f ir m

Thank You

Sources:

Bower, Albert G., Craft, Nina, and Pilant, Edith. Communicable Diseases: A Textbook for Nurses, Merriam and Webster, Inc. Manila, Philippines,

Eighth Edition.Mondejar, Dionesia and Navalez.

Handbook of Common Communicable and Infectious Diseases, C & E

Publishing, Inc. 1622 Quezon Avenue, South Triangle, Quezon City, 2006

http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/DYSENTERY,BACILLARY%20(Shigellosis).htm

http://www.adelaide.edu.au/mbs/research/ibp/research/shig/Shigella.jpg

http://www.healthphone.com/consump_english/a_healing_center/disorders_of_digestion/bacillary_dysentery.htm

http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/DYSENTERY,BACILLARY%20(Shigellosis).htm

http://www.amm.co.uk/files/factsabout/fa_shig.htm

***