Dysentery

Bacillary Dysentery (Shigellosis):

Bacillary dysentery is an acute bacterial disease that primarily affects the large and small intestine, leading to symptoms such as bloody mucoid diarrhea.

 It is important not to confuse bacillary dysentery with diarrhea caused by other bacterial infections, as one of the distinguishing characteristics of bacillary dysentery is the presence of blood in the stool, resulting from the invasion of the pathogen into the mucosa.

Cause:

• • Bacillary dysentery is caused by different types of Shigella bacteria, including Shigella sonnei, Shigella flexneri, and Shigella dysenteriae.

Mode of Transmission:

• • Bacillary dysentery can be transmitted directly through fecal material of a patient or carrier.
  • It can also be transmitted indirectly through contaminated food and water.
  • Infection can occur even after consuming a small number of bacteria, making household spread and transmission in institutions highly likely.
  • Young children are particularly susceptible to this infection.

Clinical Features:

• • Incubation period: 1-3 days (can extend up to 7 days).
  • Common symptoms include:
    • Sudden onset of mucoid bloody diarrhea.
    • Fever.
    • Nausea and vomiting.
    • Abdominal cramps.
    • Tenesmus (sensation of desire to defecate without producing significant amounts of feces).
    • Flatulence.
    • Headache and fatigue.
    • Dehydration.

Diagnosis:

• • Fresh stool samples are collected for culture and sensitivity testing, as well as microscopy to identify the causative bacteria.

Management:

• • Admission to a medical ward in isolation.
  • Strict personal hygiene (barrier nursing) to prevent infecting others.
  • Disinfection of the patient\’s bed and other items used.
  • Proper disposal of fecal matter and vomit into a pit latrine.
  • Regular monitoring of temperature, pulse, respiration, blood pressure, hydration levels, and level of consciousness.
  • Providing reassurance and support to the patient and relatives.
  • Fluid intake maintenance using Oral Rehydration Solution (ORS) or intravenous fluids in severe cases.
  • Antibiotic treatment with drugs like nalidixic acid or ciprofloxacin.
  • Implementing a BRAT diet (bananas, rice, applesauce, toast) to aid in recovery.
  • Use of a nasogastric tube for feeding and medication administration if oral intake is not possible.
  • Medications for managing nausea and vomiting, such as metoclopramide (plasil).
  • Close monitoring of hydration levels and maintenance of a fluid balance chart.

Prevention:

• • Maintain cleanliness in premises and kitchen utensils.
  • Proper disposal of rubbish.
  • Practice proper hand hygiene before eating or handling food, and after using the toilet or changing diapers.
  • Boil or treat drinking water.
  • Avoid high-risk foods like shellfish, raw or semi-cooked food.
  • Use clean washable aprons and caps during food preparation.
  • Thoroughly clean and wash food items, including fruits, in clean water.
  • Store perishable food in a well-covered refrigerator.
  • Ensure thorough cooking of food before consumption.
  • Consume food promptly or refrigerate leftovers and reheat thoroughly before eating.
  • Exclude infected individuals and asymptomatic carriers from handling food or providing care to children.

Amoebic Dysentery (Amoebiasis)

Amoebic dysentery is a parasitic infection of the gastrointestinal system that is caused by the parasite Entamoeba histolytica. 

The infection is most commonly acquired through oral-fecal contamination, which can occur by consuming contaminated food or water, or by coming into contact with contaminated feces and not washing your hands properly.

Symptoms of amoebic dysentery 

• Violent diarrhea, often with blood and/or mucus in the stools
• Severe colitis
• Frequent flatulence
• Dehydration
• Abdominal cramps and tenderness
• Slight weight loss
• Moderate anemia
• Moderate fever
• Mild fatigue
• Unrelated symptoms such as liver abscess, lung involvement, amoeboma swelling, and anal ulceration

Diagnosis

The diagnosis of amoebic dysentery is usually made by examining a stool sample under a microscope to look for cysts or motile organisms. Ultrasound scans may also be performed.

Treatment

The treatment of amoebic dysentery involves several steps:

1. Correcting any dehydration
2. Initiating a 10-day course of the antimicrobial drug metronidazole (Flagyl) or tinidazole to eliminate the infection
3. Administering amoebicidal (lumenal) drugs such as diloxanide furoate, paromomycin, or iodoquinol to eradicate any remaining parasites
4. Isolating infected individuals to prevent further spread of the infection
5. Emphasizing personal hygiene practices

Prevention

To prevent the occurrence and transmission of amoebic dysentery, the following preventive measures should be followed:

• Educate the public about proper handwashing before eating and appropriate fecal disposal practices.
• Ensure the proper management of carriers of the infection.
• Promote the use of clean drinking water and safe food handling practices.