Signs of severe dehydration
The primary critical condition described in clinical practice during acute intestinal infections is rapid dehydration. It develops against the background of profuse watery diarrhea and repeated vomiting.
Objective signs of fluid loss include:
- Changes in the skin and mucous membranes: the skin becomes cold and dry, and tissue turgor sharply decreases. The tongue becomes dry and is often coated with a thick muddy-white or gray coating.
- Respiratory and external manifestations: patients exhibit hoarseness, severe thirst, and facial pallor. Acrocyanosis develops—marked cyanosis of the lips and fingertips, indicating microcirculatory impairment.
- General condition: characterized by marked adynamia, lethargy, dizziness, a feeling of warmth, and chills.
Such a clinical picture can develop just a few hours after the onset of the disease, especially with a foodborne transmission route (for example, after consuming contaminated food while traveling).
Hemodynamic disorders
Uncompensated dehydration results in serious cardiovascular dysfunction. In severe cases, the pulse becomes rapid (up to 120 beats per minute) and of low volume.
Blood pressure critically drops, reaching 90/60 or even 90/50 mm Hg. Auscultation reveals marked muffling of heart sounds. These symptoms require emergency intervention, as they indicate the exhaustion of the body's compensatory mechanisms against the background of the infectious process.
Gastrointestinal tract involvement
Local changes depend on the clinical form of the disease and the pathogen (distinguishing Shigella sonnei and Shigella flexneri 2a).
In the classic variant, the following symptoms are observed:
- Pain syndrome: cramping abdominal pain in the lower abdomen or along the entire colon. In some cases, pain is localized in the epigastric and umbilical regions.
- Stool changes: ranging from profuse watery diarrhea without impurities to scanty bowel movements (10-12 times a day) containing a significant amount of mucus and streaks of blood.
- Specific signs: the appearance of painful false urges to defecate (tenesmus). On abdominal palpation, the sigmoid colon is often defined as a dense, spastic, and sharply painful cord in the left iliac region.
Diagnosis and management tactics
In acute shigellosis, the decision to initiate therapy is made empirically—based on clinical and anamnesis data, even before laboratory test results are obtained. Subsequently, the diagnosis is confirmed by stool culture and serological methods (e.g., indirect hemagglutination assay [IHA] with shigella antigen diagnosticum).
To manage complications and treat the condition, the following are used:
- Rehydration therapy: intravenous administration of polyionic electrolyte solutions (e.g., Chlosol solution in a volume of up to 3 liters).
- Antibacterial therapy: use of fluoroquinolones (e.g., ciprofloxacin).
- Symptomatic treatment: use of antispasmodics to relieve abdominal pain.
Timely rehydration makes it possible to normalize body temperature, heart rate, and blood pressure, stop nausea, vomiting, and diarrhea, and eliminate cyanosis by the end of the first day. An important stage in patient management is the precise definition of criteria for clinical recovery and conditions for safe discharge of the convalescent.
Briefly: answers to topical questions
What serological methods are used to confirm the diagnosis of shigellosis?
For serological confirmation of shigellosis, sources indicate the IHA method—indirect hemagglutination assay.
The clinical example presents a serological IHA study with Shigella sonnei antigen diagnosticum: titer 1:320 +++ on the 6th day of illness.
What are the extraintestinal complications of shigellosis?
Systemic and extraintestinal complications of shigellosis include:
- infectious-toxic shock and mixed shock;
- encephalic syndrome, fatal encephalopathy syndrome / Ekiri syndrome;
- cerebral edema and swelling;
- acute adrenal insufficiency;
- bacteremia;
- hemolytic-uremic syndrome: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure;
- acute cardiovascular failure;
- myocarditis and thromboendocarditis;
- pulmonary edema;
- thromboembolism of small and medium branches of the pulmonary artery;
- segmental thrombosis of the superior mesenteric artery;
- reactive arthritis and Reiter's syndrome.
Complications associated with the activation of secondary microflora: pneumonia, otitis media, urinary tract infections, liver abscesses.
What neurological complications can develop in severe shigellosis in children?
In severe shigellosis in children, neurological complications may include:
- encephalic syndrome — fatal encephalopathy syndrome, or Ekiri syndrome; it develops predominantly in children and immunocompromised individuals upon infection with Shigella sonnei, Shigella flexneri;
- cerebral edema and swelling.
What are the criteria for clinical recovery for the discharge of a convalescent after shigellosis?
Discharge of a convalescent after shigellosis is carried out based on a set of criteria.
- Clinical criteria — discharge is performed no earlier than 3 days after achieving stable normalization of body temperature and stool (complete clinical recovery).
- Bacteriological criteria — negative stool culture results are required (single or duplicate). Material collection for control testing is strictly performed no earlier than 2 days after the end of the antibiotic therapy course.
Class and exam questions
When should treatment be initiated in a patient with suspected shigellosis?
The decision to initiate therapy is made empirically based on the clinical picture and medical history, prior to obtaining the results of bacteriological and serological studies.
Which symptoms indicate the development of severe dehydration?
Dehydration is indicated by dry skin, decreased tissue turgor, hoarseness, severe thirst, acrocyanosis, as well as falling blood pressure and tachycardia.
What is the characteristic of stool during the development of a local inflammatory process in the intestine?
Stool becomes scanty, frequent (up to 10-12 times a day), contains mucus impurities and blood streaks, and is accompanied by painful false urges (tenesmus).
What else to study on this topic
- Assessment of the degree of dehydration by clinical signs
- Differential diagnosis of acute intestinal infections
- Features of the clinical picture of infections caused by Shigella flexneri and Shigella sonnei
- Criteria for clinical recovery and conditions for discharge from the hospital
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