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Making Sense of ... Dysentery

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Dysentery

What is Dysentery?

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 diarrhoea'.

The bacterium responsible for epidemic dysentery is Shigella dysenteriae; the other bacterial forms are Shigella flexneri, Shigella sonnei and Shigella boydii.

Where is Dysentery usually found?

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.

How common is Dysentery?

Dysentery is endemic in many parts of the world, with the majority of cases unreported and treated with traditional remedies.

How 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.

Can Dysentery be spread from person-to-person?

Yes

Who is most at risk from Dysentery?

Epidemic dysentery attacks people of all ages, but old, frail people and children are at increased risk.

What are the symptoms of Dysentery?

The symptoms include:

  • watery diarrhoea (sometimes with blood and mucous),
  • nausea and vomiting,
  • abdominal pain often with cramps,
  • fever and general malaise.

Symptoms usually appear from a few hours to three days after infection.

What 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.

A long term symptom of amoebic dysentery is lactose intolerance, which usually lasts a matter of weeks but occasionally may be permanent.

What is the mortality rate for Dysentery?

Untreated 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.

How 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 Dysentery?

Shigellosis - Bacillary Dysentery

Treatment consists mainly of replacing fluids and salts lost due to the diarrhoea.

  • Those 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.
  • Antidiarrhoeal 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 relief.1

Amoebic Dysentery

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:

  • Bed rest
  • 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 hospitalisation.
  • If dehydration is severe, intravenous fluids may be required.
  • It is very important to avoid alcohol for the duration of treatment.
  • After 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 intervals.

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.
  • Wash the laundry of an infected person on the hottest setting possible.
  • Avoid drinking tap water in countries with poor sanitation systems or known waterborne infections.
  • 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?

No. 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 stage yet.

Can Dysentery be controlled environmentally?

Not 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.

Is there 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.

What 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 Information Sources

References

  1. 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

First Published: 08 September 2007
Last updated: 19 April 2012
© Andrew Heenan 2007 et seq
 

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