Dysentery is an infection of the intestines that causes severe
diarrhoea. There are two distinct forms: bacillary dysentery, and amoebic dysentery.
Dysentery has many other names, but the most accurate of these is simply 'bloody
The bacterium responsible for epidemic dysentery is Shigella
dysenteriae; the other bacterial forms are Shigella flexneri, Shigella
sonnei and Shigella boydii.
Where is Dysentery
Wherever hygiene and water supplies are poor; thus it is
uncommon in the developed world, but can reach epidemic proportions in the developing
world, especially in refugee camps, following local disaters, and where poverty
rules and utiliies are non-existent or poorly maintained.
common is Dysentery?
Dysentery is endemic in many parts of the world, with
the majority of cases unreported and treated with traditional remedies.
is Dysentery transmitted?
Remarkably - and tragically - there is no simple
answer to this question. It is most likely that transmission is both person-to-person,
via contaminated objects and surfaces, and via contaminated water and food. Epidemics
usually occur in impoverished areas, where cleanliness is lacking, and sharing
of facilities is accompanied by overcrowding.
Dysentery be spread from person-to-person?
is most at risk from Dysentery?
Epidemic dysentery attacks people of all
ages, but old, frail people and children are at increased risk.
are the symptoms of Dysentery?
The symptoms include:
diarrhoea (sometimes with blood and mucous),
- nausea and vomiting,
pain often with cramps,
- fever and general malaise.
usually appear from a few hours to three days after infection.
are the long term effects of Dysentery?
Dysentery is a debilitating disease,
and may result in weakness and fatigue for a considerable time afterward, especially
if other problems co-exist, such as advanced years, poor nutrition, other diseases.
long term symptom of amoebic dysentery is lactose
intolerance, which usually lasts a matter of weeks but occasionally may be
What is the mortality rate for Dysentery?
dysentery epidemics are thought to carry a mortality rate of up to 15%; even with
appropriate treatment, epidemic mortality approaches 5%.
At least 100,000
people die from amoebic dysentery every year.
is Dysentery diagnosed?
In most cases, diagnosis can be confirmed by laboratory
tests on three stool samples. On occasion, sigmoidoscopy or colonoscopy may be
needed if the diagnosis is in doubt.
The stool culture will also provide
guidance on treatment.
Is there a treatment for
Shigellosis - Bacillary Dysentery
mainly of replacing fluids and salts lost due to the diarrhoea.
with severe dehydration may need intravenous fluids.
- Antibiotics may
be given if the person is very young, or very old, when the disease is severe,
and when there is a high risk of spreading the disease to other persons.
drugs may prolong the infection and should be avoided.
- It is very important
to avoid alcohol for the duration of treatment.
Laboratory tests will
indicate the appropriate antimicrobial, which is likely to be one of the following:
ciprofloxacin, norfloxacin, ampicillin, or cotrimoxazole may be given.
There is evidence of increasing antibiotic resistance, which may force
changes in antimicrobial therapy, with more limited options for those with
life threatening disease, and greater emphasis on symptomatic
Antimicrobial drugs are used to kill the parasites, laboratory
tests will give information on sensitivity, but the most commonly used antibiotics
are metronidizole and tinidazole.
Management also depends on:
- Drinking a rehydration solution containing salts and glucose, to
replace fluid losses from the diarrhoea.
- Painkillers and muscle relaxants
are given to treat stomach or abdominal pain.
- Complicated cases may require
- If dehydration is severe, intravenous fluids may be required.
is very important to avoid alcohol for the duration of treatment.
treatment of amoebic dysentery, regular stool tests will be taken to ensure that
the parasite is completely eradicated, as amoebiasis has a tendency to recur at
In epidemics, once the diagnosis has been confirmed in
a small number of people, all those with bloody diarrhoea should be treated similarly.
Where antimicrobials are scarce,WHO suggest that those most at risk of death must
take priority, in the following order: children less than two years old, older
people, those who are obviously malnourished and then those with complications,
such as dehydration or fever.
Is there a way
to prevent infection?
Dysentery spread largely because of poor hygiene
measures. So prevention is focussed very much on common sense hygiene measures:
Wash hands regularly through the day, particularly after using the toilet and
after contact with an infected person as well as before handling, eating or cooking
food, handling babies and assisted feeding.
- Contact with infected persons
should be kept to a minimum.
- Avoid sharing towels and facecloths.
the laundry of an infected person on the hottest setting possible.
drinking tap water in countries with poor sanitation systems or known waterborne
- Avoid ice cubes.
- Avoid salad, fruit and vegetables
that have been washed in local tap water.
- A child with dysentery should
not return to school until two whole days after symptoms have completely disappeared.
An adult with dysentery get advice before returning to work if they are employed
in food or healthcare occupation.
Homeopathic prevention advice includes
general precautions, such as care as to the water drunk, and avoiding chills,
while suggesting ipecacuanha and arsenicum as the specific medicines likely to
guard against an attack.
Is there a Dysentery vaccine?
There are reports of research, including a vaccine using a protein on the surface
of the amoeba that stimulates the body's immune system, but none are at an advanced
Can Dysentery be controlled environmentally?
enough is known or understood about dysentery to suggest that the disease could
be controlled environmentally at this stage.
However, the disease prevention
precautions suggested above could certainly reduce the
incidence and help to stop the spread of epidemics.
Like so many disease, education
and basic hygiene amenities in affected areas would be much more effective - and
cost effective - than treating disease epidemics.
legal protection for workers and others?
few countries would have specific
laws; but many will require the reporting of cases in the community, so workers
and visitors should be able to work and travel with access to appropriate information
- and may have redress against employers or organisers if denied this information.
can be learned from history?
We know that these diseases, like so many
others, are very largely preventable.
It is in the interests of all - those
in affected areas, and those from nonaffected areas who may wish to visit as tourists,
travellers or guest workers - that more research into the diseases is funded as
soon as possible.
Bibliography and Further
- Urvashi (2011) Antimicrobial Resistance Pattern of Shigella species
Over Five Years at a Tertiary-care Teaching Hospital in North India
J Health Popul Nutr. 2011 June; 29(3): 292–295
If your question has not been answered,
email me at the address below, and I'll try to get the information you seek.
If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.
Article written by Andrew Heenan BA (Hons), RGN, RMN