Shigella is found worldwide. In 1979, a total of 20 135 cases of shigella have been reported by the Centre for Disease Control. Shigella is more common during the late summer, but the properties are less pronounced as Salmonella.
In developing countries with poor sanitary conditions and the population is dense, very easy transmission usually occurs via the faecal-oral route. Flies can also spread the bacteria through feces of people and settled on the food. Spread may also occur through inanimate objects, such as tools game. Usually infects children under the age of 10 years, the highest incidence rates are in the age group 1-4 years. Shigella is found only in humans and some primate species. The spread of shigellosis frequently occur person to person contact because infeksiusnya low dose (10-100 organisms) are able to cause illness. In general, the incubation period is short shigellosis is between 24 hours to 4 days. Symptoms usually appear between the first to the third infected. Personal hygiene is very important in the prevention of this disease and the people who interact in environments of poor sanitation have greater risk to cause a spark shigellosis. Thus, people who live in mental hospitals, prisons, military installations and Indian shelters, often stricken with this disease.
The cause of ShigellosisShigellosis is caused by the bacteria Shigella spp. The bacteria belonging to the genus Shigella is a gram-negative, rod shape, non-motile, facultative anaerobic and stalks and add yeast lactose biochemically very slow even not at all. Divided into 4 groups, namely serologic S.dysenteri (12 serotypes), S.flexnewri (6 serotypes), S.boydii (18 serotypes) and S.sonnei (1 serotype). In the tropics the most common found is S.dysenteri and S.flexneri, while S.sonnei more common in sub-tropical or industrial areas.
Pathophysiology of ShigellosisEntered only 200 bacillus Shigella and Shigella infections can lead to withstand the acidity of gastric secretion for 4 hours. After entering through the mouth and reaches the colon, these invasive bacteria in the colon multiply.
Shigella as a cause of diarrhea have 3 virulence factors, namely:
- Wall polysaccharides as antigens smooth
- Ability hold enterocytes invasion and proliferation
- Removing toxins penetrate cells after
Chemical structure of the cell wall of bacteria the body is able to act as antigen O (somatic) are important in the process of interaction with cells shigella bacteria enterocytes. Dupont (1972) and Levine (1973) argues that as Shigella and Salmonella after penetrating enterocytes growing in it, causing the cell damage enterocytes. Mucosal inflammation requiring metabolites results from both bacteria and enterocytes, thereby stimulating the process of endocytosis cells were not fagositosik to pull bacteria into intracellular vacuoles, which bacteria will multiply, causing cell rupture and the bacteria will spread to the surrounding area and cause damage to the intestinal mucosa . Invasive nature and the cleavage of the intracellular bacterial plasmid is located in a wide range of chromosomal Shigella bacteria.
This bacterial invasion resulted in the infiltration of polymorphonuclear cells and cause the death of epithelial cells, so there was a small area of peptic ulcer-causing invasion of red blood cells and plasma proteins out of the cell and into the lumen of the intestine and eventually into the outer joint feces. Shigella also release toxins (Shiga toxin) is nephrotoxic, cytotoxic (cell death in germ cells) and enterotoksik (stimulating the secretion of the intestines), causing epithelial cells to necrosis of the intestinal mucosa.
Symptoms of ShigellosisClinical symptoms of shigellosis are obtained at:
- A lot of watery diarrhea with blood and mucus.
- Sudden high fever until it reaches 42 ° C
- Abdominal pain, tenesmus
- Neusea and vomiting
- Dehydration appropriate degree
- Tachycardia and takipneu
- The duration of pain about 5-7 days.
- Patients with mild cases symptoms last for 3-5 days, then recover completely. In type fulminant severe, the patient may experience sudden collapse and followed by chills, high fever and vomiting followed by a decrease in temperature, severe toxemia and ended with the death of the patient.