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題名 | 桿菌性痢疾=Shigellosis |
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作者姓名(中文) | 陳垚生; | 書刊名 | 內科學誌 |
卷期 | 29:2 2018.04[民107.04] |
頁次 | 頁63-67 |
分類號 | 415.133 |
關鍵詞 | 志賀氏桿菌; 桿菌性痢疾; 志賀氏病; 急性腹瀉; Shiga毒素; 抗藥性; Shigella; Bacillary dysentry; Shigellosis; Acute diarrhea; Shiga toxin; Antimicrobial resistance; |
語文 | 中文(Chinese) |
中文摘要 | 志賀氏桿菌(Shigella spp)引發之急性腹瀉稱桿菌性痢疾(bacillary dysentery)或志賀氏病 (shigellosis),其為最具傳染性細菌之一,容易導致群聚感染;很少在非人類的靈長動物發生疾病。志賀氏桿菌有四種,在已開發國家以S. sonnei為主,而發展中國家以S. flexneri為主; 但以S. dysenteriae致病性較嚴重,在幼兒致死率近30%。推估全球每年發病人數為1.65億人,是發展中國家嬰兒腹瀉及相關死亡主因。主要傳播途徑為口糞傳染,經攝入受污染的食物或水、接觸受感染的物體、或性接觸而感染。易受感染族群,包括:日托中心幼童及其照顧者、國際旅客、男性同性戀、及人類後天免疫缺乏病毒感染者。潛伏期約為1-3天,症候為突發嚴重腹部絞痛、高燒、嘔吐、厭食、大量水樣腹瀉;隨後可能出現裡急後重、大便失禁和伴有血便的黏液性腹瀉。合併症以脫水為最常見,可伴隨嗜睡、譫妄、及癲癇等中樞神經病症;少見嚴重合併症有與產Shiga毒素菌株相關的溶血性尿毒症候群、感染後關節炎、直腸脫垂、及毒性巨結腸(toxic megacolon)等。實驗室診斷以糞便細菌培養與鑑定為主,亦可以快速分子生物學檢驗菌體或毒性基因。抗生素治療可依當地抗菌譜型態經驗性使用;因抗藥性問題,tetracyclines、ampicillin及TMP-SMX已建議不被納入初始經驗性治療選項;即使沒有治療,大多數病人在5至7日內康復。預防措施為注重手部衛生及飲食及飲水衛生。 |
英文摘要 | The acute diarrhea caused by Shigella spp. is called bacillary dysentery or shigellosis, which is a most effective contagious agent, facilitated by a very low inoculum of organisms, and can easily spread directly and result into cluster infection. It rarely occur in non-human primates other than humans. There are four Shigella species, mainly S. sonnei in developed countries, S. flexneri in developing countries, and S. dysenteriae causing most severe infection in young children with mortality rate of nearly 30%. The estimated annual global incidence of shigellosis is 165 million per year and it is the leading cause of infant diarrhea and related deaths in developing countries. The major routes of transmission are oral-fecal spread via exposure to contaminated food or water, or exposure to infected objects or sexual contact. Vulnerable populations include: day care center children and their care-givers, international travelers, men-sex-men, and HIV infected groups. The incubation period is about 1-3 days. Symptoms are usually sudden onset of severe abdominal cramping pain, high fever, vomiting, anorexia, and watery diarrhea; later followed by abdominal pain, tenesmus, urgency, fecal incontinence, small amounts of mucoid diarrhea, and bloody stools. Dehydration is the most common complication of shigellosis and can be associated with central nervous system disorders, such as drowsiness, delirium, and epilepsy; rare severe complications include hemolytic uremic syndrome associated with Shiga-toxin producing strains, post-infection arthritis, rectal prolapse, and toxic megacolon. Laboratory diagnosis mainly bases on bacterial culture and identification of stool, but also can be made by enzyme immunoassay, probe or PCR to directly detect bacteria or virulence genes. Selection of antibiotic therapy is available based on local antimicrobial resistance profiles. Antibiotics, such as tetracyclines, ampicillin, and TMP-SMX , are no longer recommended as initial empirical choice for global emergence of antimicrobial resistance. Even without treatment, most infected patients recover within 5 to 7 days. Preventive measures focus on hand hygiene and food and drinking water hygiene. |
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