1. BACILLARY DYSENTRY SHIGELLA SPECIES
Dr.Indumathi

2. KLEBSIELLA GRAM NEGATIVE NON MOTILE CAPSULATED
LACTOSE FERMENTING(MUCOID)
IMViC --++
FORMS GUT AND RESPIRATORY FLORA IN 5% NORMAL INDIVIDUALS

3. CLASSIFICATION 3 SPECIES”
K.pneumonia ; K.rhinoscleromatis and K.ozanae
PATHOGENIC LESIONS:
HAEMORRHAGIC NECROTIZING CONSOLIDATION OF LUNG (1%) :
UTI
BACTEREMIA & OTHER FOCAL INFECTION
NOSOCOMIAL INFECTION

4. PNEUMONIA FRIEDLANDER’S PNEUMONIA : CAP MIDDLE AGED AND OLD ALCOHOLICS
SEVERE RAPID ONSET
OFTEN FATAL
HIGH FEVER, CHILLS, CURRENT JELLY SPUTUM
ABSCESS, CAVITATION, EMPYEMA
LOBAR PNEUMONIA WITH DESTRUCTIVE CHANGES : USUALLY UPPER LOBE

5. KLEBSIELLA PNEUMONIA

6. RHINOSCLEROMA K.RHINOSCLEROMATIS AFRICA, ASIA, LATIN AMERICA
DESTRUCTIVE GRANULOMA OF NOSE AND PHARYNX
PURULENT NASAL DISCHARGE
CRUSTING LESIONS WITH NODULE
RESPIRATORY OBSTRUCTION
DIAGNOSIS BY HPE AND POSITIVE BLOOD CULTURE

7. RHINOSCLEROMA

8. OZENA K.OZAENAE FETID PROGRESSIVE ATROPHY OF NASAL MUCOSA
NASAL CONGESTION
PRIMARY ATROPHIC RHINITIS IN ELDERLY
NASAL BAD SMELL
HEADACHE

9. HISTORICAL REVIEW TERM DYSENTRY: BY HIPPOCRATES
FREQUENT PASSAGE OF STOOL WITH BLOOD AND MUCOUS
STRAINING AND PAINFUL DEFECATION
19TH CENTRURY : 2 FORMS OF DYSENTRY ACCURATELY SEPARATED
EPIDEMICS DYSENTRY IN MILITARY CAMPS, ASYLUMS, JAILS BY SHIGELLA
SPORADIC CASES OF DYSENTRY BY AMEOBA

10. SHIGELLA GRAM NEGATIVE SHORT RODS NON MOTILE ANAEROGENIC
NON CAPSULATED
GIT PATHOGEN
NON LACTOSE FERMENTER
COMPLEX ANTIGENIC STRUCTURE
NAMED AFTER SHIGA 1896

11. CLASSIFICATION
4 SPECIES/SUBGROUPS BASED ON BIOCHEMICAL AND SEROLOGICAL CHARACTERS
SHIGELLA DYSENTERIAE : 12 Serotypes
SHIGELLA FLEXNERI : 6 serotypes
SHIGELLA BOYDII : 18
SHIGELLA SONNEI : 17 Colicine types

12. EPIDEMIOLOGY : BACILLARY DYSENTRY
PREVALENT IN TROPICS/WORLD WIDE
SUMMER MONTHS
POOR SANITATION
OVERCROWDING /POVERTY
EPIDEMICS
MAN IS THE ONLY HOST : CASE/CARRIER :RESERVOIR
SHORT INCUBATION (48 HRS)

13. EPIDEMIOLOGY CYCLIC PATTERN OF DISEASE
EPIDEMICS DUE TO ONE SPECIES LASTING FOR 20-30YRS.
E.G. 20TH CENTURY : S.DYSENTERIAE
IN EUROPE
S.FLEXNERI
CURRENTLY S.SONNEI : IN INDUSTRIALISED COUNTRIES

14. EPIDEMIOLOGY INDIA ENDEMIC /HIGHLY COMMUNICABLE
FOUND IN ALL AGE GROUPS
ALL SPECIES : S.FLEXNERI PREDOMINANT(50-85%)
S.DYSENTERIAE(8-25%)
S.SONNEI (2-24%)
S.BOYDII(0-8%)
EPIDEMICS AND SERVERAL OUTBREAKS FROM 1974 : KERALA AND WEST BENGAL
MULTIPLE DRUG RESISTANT STRAINS : CAUSING EPIDEMICS

15. PATHOGENESIS SOURCE : MAN: CASE OR CARRIER
MODE OF SPREAD: CONTAMINATED FINGERS, FOOD, FLIES, FOMITES
PERSON TO PERSON TRANSMISSION
INFECTIVE DOSE: VIABLE BACILLI
HIGHEST CONCENTRATION IN STOOL DURING EARLY/ACUTE INFECTION 103 TO 109 VIABLE BACILLI PER GRAM OF STOOL
POST CONVALESCENT SHEDDING : LOW COUNTS 102 TO 103

16. PATHOGENESIS VIRULENCE FACTORS
1.INVASIVENESS : ASSOCIATED WITH BACTERIAL PROTEIN CODED IN PLASMIDS OR CHROMOSOME.
2. TOXIN PRODUCTION : EXOTOXIN THAT IS ENTERO,NEURO AND CYTOTOXIC : SHIGA TOXIN

17. PATHOGENESIS
INGESTED BACILLI ↓
TRANSIENTLY MULTIPLY IN SMALL INTESTINE CONCENTRATION OF 107 TO109 PER ML
ENTER THE DISTAL COLON (MULTIPLY) INVADE THE MUCOSAL CELLS,
MULTIPLY AND SPREAD TO ADJECENT CELLS(INTRACELLULAR SPREAD)
ACUTE INFLAMMATION AND MICROABSCESS/CAP THROMOBOSIS
SUPERFICIAL ULCERATION (SERPIGINOUS)
ENDOTOXIN PRODUCTION TO PRODUCE BOWEL IRRITATION AND DIARRHOEA WITH BLOOD/MUCUS AND TOXEMIA

19. PATHOGENESIS NO BLOOD STREAM INVASION
BACTERIA RAPIDLY PHAGOCYTOSED BY MACROPHAGES
ENTEROTOXIN : LOCAL MUCOSAL DESTRUCTION
CLINICALLY : DYSENTRY LASTS FOR 1 TO 7 DAYS SELF LIMITING
HIGH MORTALITY IN MALNOURISHED
COMPLICATIONS :HEMOLYTIC UREMIC SYNDROME : SHIGA TOXIN : RENAL FAILURE, TOXIC NEURITIS, ARTHRITIS
RARELY : IKARI SYNDROME : MASSIVE INFECTION AND EARLY DEATH IN CHILDREN

20. CLINICAL FEATURES FEVER : HIGH GRADE TOXEMIA ABDOMINAL CRAMPS
VOLUMINOUS WATERY DIARRHOEA
FOLLOWED BY SMALL VOLUME FREQUENT PASSAGE OF BLOODY STOOLS.
(OVER 10/DAY)
ABDOMINAL TENDERNESS
COMPLICATIONS: FEBRILE SEIZURES, SEPSIS, PNEUMONIA

21. LAB DIAGNOSIS SPECIMEN COLLECTION : STOOL CONTAINING MUCOUS/BLOOD
RECTAL SWAB
RECTAL CATHETERIZATION
RECOVERY IS BEST IN THE ACUTE STAGE WHERE BACILLI ARE SHED IN LARGE NUMBERS

22. LAB DIAGNOSIS TRANSPORT MEDIUM BGS/CARY BLAIR ENRICHMENT : SELENITE F
METHODS OF DIAGNOSIS
DIRECT MICROSCOPY
CULTURE
SLIDE AGGLUTINATION TEST

23. LAB DIAGNOSIS MACROSCOPY BRIGHT RED STOOL ADHERENT TO CONTAINER
ALKALINE
ODOURLESS
NO FAECAL MATTER
SMALL QUANTITY :

24. LAB DIAGNOSIS MICROSCOPY
NUMEROUS PUS CELLS : STAINED FEACAL SMEARS WITH METHYLENE BLUE (SINGLE MOST IMPORTANT LAB TEST OTHER THAN STOOL CULTURE)
NUMEROUS DISCRETE/ROULEUX RBCS
NO BACTERIA SEEN
PLENTY OF MACROPHAGES
GHOST CELLS : CELLS WITH NO NUCLEUS AND ONLY CYTOPLASMIC OUTLINE : PRESENT

25. LAB DIAGNOSIS CULTURE : MEDIA USED : FLUID : SELENITE F ENRICHMENT
SOLID: MAC CONKEY’S
DCA
SSA
STEPS : DIRECT PLATING + ENRICHMENT CULTURE
GROWTH FROM FLUID MEDIUM SUBCULTURED ONTO MA

26. LAB DIAGNOSIS COLONIES ON MA/DCA : NLF PALE AND TRANSLUCENT
COLONIES PICKED UP FOR THE FOLLOWING TESTS:
HANGING DROP : NON MOTILE
GRAM’S :GNB
BIOCHEMICAL TESTS : IMVIC ++-- ANEROGENIC FERMENTERS
SLIDE AGGLUTINATION WITH SPECIFIC HTS

27. BIOCHEMICAL TESTS SPECIES GLUCOSE LACTOSE MANNITOL INDOLE S.DYS ACID -V
S.FLEX +
S.BOYDI
S.SONEI

28. TREATMENT AND PREVENTION
ANTIBIOTICS TO BE GIVEN BECAUSE
1. PERSON TO PERSON TRANSMISSION : INFECTED PERSON IS THE RESERVOIR IN ORDER TO PREVENT THE CHAIN OF TRANSMISSION
GOOD SANITATION/SAFE DISPOSAL OF SEWAGE
SAFE WATER SUPPLY
SHIGELLA VACCINE (ORAL: STREP DEP MUTANT:LIVE ATTEN)4 DOSES ; PROTECTION 6 MONTHS. EXP IN HYPERENDEMIC AREAS.

29. SALMONELLA GASTROENTERITIS
* FOOD POISONING
ZOONOTIC INFECTION
ANIMAL OR ANIMALPRODUCTS: MEAT PRODUCTS, EGGS, CREAM, MILK (FOOD CONTAMINATION WITH RAT OR LIZARD DROPPINGS)
S.TYPHIMURIUM/S.ENTERITIDIS, S.NEWPORT
IP 24 HOURS DIARRHOEA, VOMITTING, PAIN ABDOMEN, FEVER