Clinical manifestations

The incubative period varies from several hours to 7 days, more frequently it is 2–3 days. After the onset of the disease vomiting may be present. The child becomes restless, loses appetite, complains of headache and abdominal pain. Frequently passed stools contain mucus and blood. In the first hours after the onset of disease stool has stercoral character, but by the end of the day or the second day of the disease stercoral masses disappear completely, stools become poor and contain turbid mucus and blood only. In this period the children complain of abdominal painful cramps in defecation, drawing pain on the side of sigmoid colon and anus. Tenesmus is a typical sign of dysentery. Tenesmus appears due to the simultaneous spasms of the sigmoid colon and anal sphincters. In frequent tenesmus the rectum mucous membrane prolapse may result.

The clinical manifestations of the disease reach their peak in the first three days. Symptoms of toxemia, pallor and dryness of the skin, in babies moderate reduction turgor, are found. On abdominal palpation tenderness and hardeneding are found through the surface immedialety over the sigmoid colon. Moderate leucocytosis, neutrophilia with the change to the left, insignificant increase of ESR in peripheral blood. The pathogen species have a certain influence on typical clinical manifestations, and severity of the disease.

Dysentery of Grigoriev-Shiga has the most severe course with acute colitic syndrome and neurotoxicosis. Dysentery Flexneri has a typical, less severe course with colitic syndrome. Dysentery Sonnei has a mild, frequently atypical course, that is why this type has the highest percentage as compared to other types. As the infection by Sh. Sonnei occurs through alimentary route, the disease has a course similar to alimentary toxicinfection (food poisoning) with signs of gastroenterocolitis. In this case, the disease has an acute onset with frequent vomiting, fever, abdominal pain. Watery stools appear presently becoming scarce and containing mucus and blood (typical for dysentery) on the second day after the onset of the disease.

Clinical type classification of dysentery is based on the signs, which have been proposed by A. A. Koltupin (type, severity, course). Typical and atypical forms are distinguished. In typical forms colitic syndrome is present constantly.

Obliterated, dyspeptic, subclinical, hypertoxic forms are refered to the atypical forms.

Typical forms of dysentery are divided into mild, moderate and severe. Such division depends on the presence and manifestation of toxemia symptoms (fever, convulsion syndrome, mental confusion, headache, weakness) and local alterations from gastrointestinal tract (number of stools per day, pain syndrome, tenesmus, rectum mucous membrane prolapse).

Mild form is the most frequent one. In this form patient’s general condition is not severe. In the majority of patients fever is not more than 38 º C in the first day, single vomiting, insignificant weakness and anorexia may be present. Stools occur 5 to 8 times daily, retain their stercoral character having addition of mucus and greenish in colons. Blood and tenesmus may be absent. Tenderness and hardened sigmoid colon is found on abdominal palpation, sphincter weakness may take place. Abdominal cramps while defecating may be present.

Moderate form of dysentery is characterized by moderate toxemia. In the first day of the disease fever may increase to 39°–40 °C, vomiting is recurrent from 2 to 3 times daily. Stools occur 10 to 15 times daily. Colitis syndrome has all typical signs. Stools lose their stercoral character and, contain mucus and blood only. Patients complain of abdominal cramps, tenesmus. The younger the babies, the more frequent signs of sphincteritis may be observed.

In the severe form of the disease there may be two variants of the course: type A — with the predominance of toxemia and type B — with the predominance of severe local intestinal lesions. In type A the disease has an acute onset with the fever of 40 °C and higher, appearance of numerous bouts of vomiting sometimes indomitable. On the background of hypertermia neurotoxicosis signs appear expressed by short-term convulsions and meningeal syndrome. At the same time cardiovascular system disorders appear: dull heart sounds, a drop in blood pressure, striking pallor of the skin, fall of temperature of limbs. Facies become sharp, tissue turgor and the body weight decrease. Enteric disorders appear after some hours or on the second day after the onset of the disease. Stools are passed frequently and contain much mucus and blood, all this is accompanied by tenesmus.

Severe dysentery course of type B is characterized by the predominance of intestinal lesions. The disease has an acute onset, fever reaches 39 °C. There are frequently, passed stools from the onset of the disease. The stools lose their stercoral characber and become scare, containing mucus and blood only. The patient are disturbed by persistent abdominal cramps and tenesmus. Paralysis of external anal sphincter appears, that is why blood stained turbid mucus is excreted through the anus. Rectum mucus membrane prolapse may occur. The abdomen is tense and painful, spasmodic and tense sigmoid colon is found on palpation.

The course of the disease may be acute, protracted or chronic. In the acute course the disease terminates with recovery after 1–2 weeks. In severe cases of the disease recovery occurs later. Full repair of mucous membrane of the large bowel comes about the end of the month after the onset of the disease a protracted course of the disease (up to 2–3 months) may occur in the weakened children having other concommitant viral or viral-bacterial infections. In these cases exacerbation of the disease and slow repair of the mucous membrane may occur. The chronic course of dysentery is guite rare at present.

For 1-year-old babies dysentery has some peculiarities. Common signs of the disease remain for this age, but colitic syndrome is not well expressed. Stools have enterocolitic or dyspeptic character. Stools always contain mucus, blood is not always present in feces. Abdomen is frequently moderately inflated. Toxemia at the early age is accompanied by high fever, recurrent vomiting. If frequent enterocolitic stools are present, dehydration with hemodynamic disorders may occur.

In babies younger than 12 months dysentery course is characterised by slow repair of the mucous membrane and delayed recovery. Dysentery complications can bring about rectum mucous membrane prolapse and intussusception.

As a secondary infection, otitis, pneumonia, stomatitis, infection of the urinary tract, intestinal dysbacteriosis may occur.

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