Bacillus difficile enteritis
Introduction
Introduction to Bacillus licheniformis enteritis The Clostridium difficile enteritis is caused by Clostridium difficile (C. difficile) and is often associated with the use of antibiotics, and is therefore also known as antibiotic-associated diarrhea. In severe cases, the colon has pseudomembrane formation called pseudomembranous colitis. Pseudomembranous enterocolitis is an acute mucosal necrotizing inflammation caused by exotoxin of Clostridium difficile in the small intestine and colon, and has pseudomembrane formation. Mainly manifested as diarrhea, abdominal pain, toxemia, shock and so on. basic knowledge The proportion of illness: 0.002% Susceptible people: good at 50-60 years old, slightly more women than men Mode of infection: contact infection Complications: intestinal obstruction
Cause
Causes of Bacillus licheniformis enteritis
Difficult bacilli are obligate anaerobic bacteria, Gram-positive, can form spores, no power. Bacteria can produce four metabolites: A toxin (enteric toxin), B toxin (cytotoxin), peristaltic change factor and unstable factor. Those closely related to the pathogenesis are A and B. The disease often occurs after major surgery or broad-spectrum antibiotics, but also in chronic wasting diseases such as chronic lung disease, chronic hepatitis, cirrhosis, aplastic anemia, leukemia, malignancy, diabetes, uremia, snake bites. Heart disease, especially heart failure and myocardial infarction, as well as intestinal obstruction, sepsis and so on. It has been confirmed that the disease is caused by the proliferation of Gram-positive anaerobic bacteria Clostridium difficile in the intestine, and the exotoxin can cause intestinal mucosal necrosis and form a pseudomembrane. Experiments have shown that Clostridium difficile toxin can cause pseudomembranous colitis in hamsters; this toxin has obvious cytotoxic effect in tissue culture and cross-reacts with Clostridium tuberculosis toxin, which can be Neutralizing anti-toxins. Broad-spectrum antibiotics, especially lincomycin (linamicin), clindamycin (clopidogrel), gentamicin, etc., because it can inhibit the growth of normal intestinal flora, it is difficult to distinguish fusiform spores The breeding of bacilli has created favorable conditions. Vancomycin and non-absorbed sulfonamides can effectively inhibit the growth of Clostridium. According to research, the exotoxin of Clostridium difficile produces locality in the intestinal mucosa. The Schwartzman reaction causes degeneration and ischemic necrosis of intestinal mucosa, submucosa and other tissues due to coagulation, thrombosis and vascular wall necrosis in small blood vessels, forming a pseudomembrane. In addition, exotoxin can stimulate the cAMP system of mucosal epithelial cells. Increase the secretion of water and sodium, and increase diarrhea.
Prevention
Bacillus bacillus enteritis prevention
The prevention of this disease lies in strict control of the indications for the use of antibacterial drugs, prohibition of the abuse of antibiotics, especially for elderly patients and the body's defense function decline. Antibiotics should be selected correctly according to the condition, bacteriology or drug susceptibility test, and the course of treatment should be strictly controlled.
Complication
Bacterial bacillus enteritis complications Complications, intestinal obstruction
Intestinal perforation, intestinal obstruction and toxic megacolon.
Symptom
Bacteriostatic bacillus enterovirus symptoms Common symptoms Drainage-like bloody stool fever accompanied by abdominal pain, ...
The disease usually occurs 5-10 days after the application of antibacterial drugs, and can also occur on the first day after administration or 6 weeks after the drug is discontinued. Common symptoms are diarrhea, abdominal pain, bloating, nausea and vomiting. All patients had diarrhea, mostly watery, mushy, bloody stools and pseudomembranes only found in 5% to 10%. Can have moderate fever and high fever; severe abdominal pain can be accompanied by muscle and rebound pain; peripheral white blood cells are also elevated. Due to mucosal inflammation and exotoxin stimulation, intestinal absorption is impaired and fluid infiltrates into the intestinal lumen. Shock can occur early, but more in the later stages. There may be oliguria or even renal insufficiency. There are often different degrees of fever, tachycardia, systemic weakness and other toxemia; some patients have excitement, paralysis, disorientation, confusion and lethargy. There may be obvious dehydration, metabolic acidosis, hypochloremia and hypokalemia, such as water and electrolyte metabolism disorders, severe cases are often accompanied by water and electrolyte disorders, and occasionally with intestinal perforation, toxic shock and megacolon, etc. . Clinically, early or mild cases of this disease are often referred to as antibiotic-associated diarrhea. In the later stages of the disease or in severe cases, such as pseudo-membrane, it is called pseudomembranous colitis.
Examine
Examination of Bacillus licheniformis enteritis
1. Peripheral blood count and neutrophil count.
2, fecal microscopic examination mainly see white blood cells, occult blood test can be positive.
3. The feces are cultured with Clostridium difficile and Staphylococcus aureus or other bacteria.
4, fecal filtrate toxin test 1: 100 or more has diagnostic significance; Clostridium cellulolytic anti-toxin neutralization test is often positive.
Diagnosis
Diagnosis and identification of Bacillus licheniformis enteritis
The clinical manifestations of this disease are lack of characteristics, so the diagnosis is difficult, and many cases were diagnosed at autopsy. In order to improve the early diagnosis rate, patients with broad-spectrum antibiotics or major surgery, such as abdominal pain, diarrhea, fever or worsening of the disease without explanation for the obvious reasons, should be alert to the possibility of the disease, and timely rectal, sigmoid colon Microscopic examination and intestinal mucosal biopsy. The first light examination was not confirmed and the condition was still not improved. Repeated endoscopy often helped to confirm the diagnosis. Histological examination: This disease often involves the lower colon, so rectal and sigmoidoscopy is one of the important diagnostic methods. The main evidence of intestinal mucosa seen under the microscope is edema, congestion, erosion, ulcer, or granular. A raised patch or a grayish-green or taupe pseudomembrane that is fused into a sheet. Lesions of the diseased mucosa often show acute or chronic inflammation. For example, the initial villus top lesion or the pseudomembrane close to the mucosal surface is helpful in diagnosing and distinguishing other colonic inflammation.
