Acute diarrhea with blood: diagnosis and drug treatment

Mara Alves da Cruz Gouveia , Manuela Torres Camara Lins , Giselia Alves Pontes da Silva
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Abstract

Objective

To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy.

Sources of Data: A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review.

Synthesis of Data

Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines.

Conclusions

Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost‐effective preventative measure in future.

急性带血腹泻:诊断与药物治疗
目的重申志贺氏菌在急性带血腹泻中的流行病学意义,综述其治疗方法,强调正确应用抗生素治疗的必要性。数据来源:除了世界卫生组织的科学文件和指南外,还在Medline和Scopus数据库中进行了搜索,确定了被认为与叙述性综述相关的综述文章和原始文章。不同的病原体与急性带血腹泻有关;志贺氏菌是最常见的。健康人的志贺氏菌病通常表现为中等强度,并在几天内消失。可能会发展为明显的痢疾,伴有血和粘液,下腹部疼痛和下坠。常规粪便细菌培养是病因诊断的金标准;然而,已经开发出新的分子测试,使医生能够启动有针对性的抗菌治疗,解决了目前由志贺氏菌耐药性增加引起的主要问题。预防战略包括母乳喂养、卫生措施、健康教育、水处理以及可能使用的疫苗。结论急性腹泻是5岁以下儿童死亡的重要原因,志贺氏菌病是全球范围内急性带血腹泻的主要原因。目前关注的是微生物对推荐抗生素的耐药性增加,这给治疗管理带来了额外的困难。虽然目前还没有针对志贺氏菌的疫苗,但几种候选疫苗正在进行临床试验,这可能是未来最具成本效益的预防措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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