General diagnostic principles
Establishing the correct diagnosis in suspected AII requires a comprehensive approach:
- Anamnesis collection: special attention is paid to epidemiological history (stay in endemic areas, contact with infected individuals, consumption of suspicious water and food) and medical history (chronic gastrointestinal diseases that reduce resistance).
- Physical examination: assessment of leading syndromes (intoxication, bulbar, signs of dehydration).
- Laboratory diagnostics: bacteriological culture (e.g., on Pavlova medium), serological methods (HAI, ELISA), PCR, and stool microscopy.
- Instrumental methods: sigmoidoscopy makes it possible to assess the condition of the mucous membrane (ulcers, plaque, infiltrates).
Cholera: clinical features
Cholera is a dangerous infection caused by vibrios. Distinctive features of the disease:
- Symptomatology: acute onset with profuse watery diarrhea, followed by vomiting (without preceding nausea).
- Pain syndrome: cramping abdominal pain is absent.
- Temperature: usually remains within normal limits.
- Complications: rapidly progressive dehydration. Blood test shows hemoconcentration.
Glucose-electrolyte solutions (Oralit, Regidron) are used to treat grade I–II dehydration.
Differential diagnosis of shigellosis and amebiasis
It is important to be able to differentiate AII based on the clinical presentation:
- Acute shigellosis (dysentery): acute onset, fever, chills. Characterized by cramping abdominal pain, tenesmus, and frequent loose stools mixed with blood and mucus. Palpation reveals a spastic, tender large intestine.
- Amebiasis: gradual onset; pronounced fever and severe pain are often absent. Stools are mushy, blood and mucus are mixed unevenly. Examination reveals a tender cecum and hepatomegaly. The causative agent is Entamoeba histolytica.
Treatment principles and indications for hospitalization
AII therapy is comprehensive in nature:
- Diet: diet table No. 4 in the acute period, with subsequent expansion.
- Etiotropic treatment: prescribing antibiotics (fluoroquinolones, cephalosporins) or specific drugs (e.g., a prolonged course of metronidazole for amebiasis).
- Pathogenetic therapy: rehydration (oral or intravenous) and detoxification play a leading role.
Hospitalization in an infectious diseases hospital is mandatory:
- According to clinical indications: severe forms, comorbid conditions.
- According to epidemiological indications: workers in designated occupations (food service, water utility staff), living in a dormitory or with children.
Briefly: answers to topical questions
What groups of antibacterial drugs are used for the etiotropic treatment of AII?
The following groups of parenteral drugs are recommended for the etiotropic treatment of AII:
- Fluoroquinolones;
- Aminoglycosides;
- Third-generation cephalosporins (ceftriaxone, cefotaxime, ceftazidime, cefoperazone/sulbactam);
- Carbapenems (meropenem).
Also, sources separately mention nosologically specific antibiotics: chloramphenicol for the treatment of yersiniosis and typhoid fever; erythromycin for campylobacteriosis and cholera.
How to clinically determine the degree of dehydration in acute intestinal infections?
The classification of dehydration severity in AII according to V.I. Pokrovsky is based on the percentage of body weight loss and corresponding clinical signs.
Objective examination reveals signs of dehydration: sharpened facial features, sunken eyes, decreased skin turgor and elasticity ("cholera fold"), maceration of the skin of the hands ("washerwoman's hands"), dry mucous membranes, hoarse voice, rapid weak pulse, drop in blood pressure, oliguria, scaphoid ("boat-shaped") abdomen, tonic convulsions.
Laboratory data are also analyzed to assess the degree of dehydration: CVP, hematocrit, plasma electrolyte levels, acid-base balance, and blood gas composition.
What pathogenetic types of diarrhea are distinguished in acute intestinal infections?
The following pathogenetic components (types) of diarrhea are distinguished in acute intestinal infections:
- Secretory component (occurs as a result of the enterotoxic action of the pathogen);
- Exudative component (develops due to mucosal epithelial invasion and inflammation);
- Hyperosmolar diarrhea (osmotic mechanism caused by secondary disaccharidase deficiency and accumulation of unhydrolyzed carbohydrates in the intestinal lumen).
What changes are detected during sigmoidoscopy in patients with shigellosis?
Changes detected during sigmoidoscopy in patients with shigellosis depend on the severity and form of the course:
- Mild course: catarrhal or catarrhal-hemorrhagic proctosigmoiditis and sphinctericitis.
- Moderate course: catarrhal-erosive proctosigmoiditis.
- Chronic course: mild inflammatory and atrophic processes.
What solutions are used for intravenous rehydration in severe dehydration?
Polyionic (crystalloid) solutions are used for intravenous rehydration in pronounced (severe) dehydration. These include:
- Trisol;
- Quartasol;
- Chlosol.
According to the rule, intravenous rehydration with these solutions is carried out prior to the administration of colloid solutions.
Cholera presents with neither pain, nausea, nor fever—only diarrhea and vomiting. Dysentery presents with pain, blood, mucus, and fever.
Class and exam questions
What is the mainstay of treatment for cholera?
Pathogenetic rehydration therapy is of primary importance. Glucose-electrolyte solutions are used.
What conditions should the colitis variant of acute dysentery be differentiated from?
With campylobacteriosis, yersiniosis, salmonellosis, as well as non-infectious diseases: ulcerative colitis and Crohn's disease.
What is the characteristic appearance of stool in cholera?
The stool quickly becomes watery and devoid of fecal matter.
What else to study on this topic
- Clinical classification and degrees of dehydration in cholera
- Fulminant course of cholera and infectious-toxic shock
- Balantidiasis: clinical features and association with pigs
- Course features and extraintestinal complications of amebiasis
- Pevzner diet across the dynamics of acute intestinal infections
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