dysentery

dysentery

[dis-uhn-ter-ee]
dysentery, inflammation of the intestine characterized by the frequent passage of feces, usually with blood and mucus. The two most common causes of dysentery are infection with a bacillus (see bacteria) of the Shigella group, and infestation by an ameba, Entamoeba histolytica. Both bacillary and amebic dysentery are spread by fecal contamination of food and water and are most common where sanitation is poor. They are primarily diseases of the tropics, but may occur in any climate.

Bacillary Dysentery

It is estimated that in some parts of the tropics 80% of the children acquire bacillary dysentery before the age of five; the mortality rate is high among infants and the aged if the infection is not treated, preferably with a broad-spectrum antibiotic. In adults bacillary dysentery usually subsides spontaneously, but treatment is desirable to prevent recurrence.

Amebic Dysentery

Amebic dysentery is prevalent in regions where human excrement is used as fertilizer; in some such regions over half the population probably harbors the amebic cyst. The cyst is the inactive, resistant stage in which the ameba is transmitted from one host to another; the active form is that which causes damage. Both cysts and active amebas are excreted in the feces of an infected person, but only the cysts are hardy enough to survive outside the body. A person recovering from the infection, or one with an inactive case, passes mostly cysts; such a person is a more likely source of contamination than one with an active case. When cysts are ingested with contaminated food or water they are transformed in the intestine into active amebas. If these remain within the lumen of the intestine they are relatively innocuous, but if they invade the intestinal wall they cause ulceration, dysentery, and usually pain. In severe cases the resulting dehydration may lead to prostration.

Amebic dysentery may occur in acute or chronic form. In prolonged infections the amebas may invade the blood vessels of the intestine and be carried to other parts of the body, where they cause amebic abcesses. Abcesses of the liver and brain are especially dangerous; destruction of liver tissue is the most frequent complication of amebic dysentery. Infection by amebas, whether of the intestine alone or of other parts of the body, is called amebiasis. Infections are diagnosed by finding cysts or active amebas in the feces. However, the disease is easily misdiagnosed for several reasons. Entamoeba histolytica may be harbored without causing symptoms (although it may be passed on and cause the disease in others); it is easily confused with harmless amebas of the human intestine, especially Entamoeba coli; it commonly coexists with bacteria that may in some cases be the cause of the symptoms.

A combination of drugs is generally used to treat amebic dysentery: an amebicide (metronidazole or tinidazole) to eliminate the organism from the intestinal tract, an antibiotic to eradicate associated bacterial infection, and a drug to combat infection of the liver and other tissues. Preventive measures include the protection of water supplies from contamination and the washing of hands by food handlers.

Infectious intestinal disorder. It is characterized by inflammation, abdominal pain and straining, and diarrhea, often containing blood and mucus. Dysentery is spread in food or water contaminated by feces, often by infected individuals with unwashed hands. Bacillary dysentery (shigellosis), caused by Shigella bacteria, may be mild or may be sudden, severe, and fatal. Fluid loss causes dehydration. Advanced stages include chronic large-intestine ulceration. It is treated with antibiotics, fluid replacement, and sometimes blood transfusion. Amoebic (or amebic) dysentery, caused by the amoeba Entamoeba histolytica, has two forms, one much like bacillary dysentery and the other chronic and intermittent, sometimes with large-intestine ulcerations. It is treated with drugs that kill the amoeba.

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Dysentery (formerly known as flux or the bloody flux) is an infection of the digestive system that results in severe diarrhea containing mucus and blood in the feces. Dysentery is typically the result of unsanitary water containing micro-organisms which damage the intestinal lining. There are two major types of dysentery due to micro-organisms: amoebic dysentery, and bacillary dysentery mainly due to one of three bacteria. Dysentery can also be caused by certain medications; for example, some steroids can affect bowel movements.

Amoebic dysentery

Amoebic dysentery (or amebic dysentery) is caused by the amoeba Entamoeba histolytica.

Amoebic dysentery is transmitted through contaminated food and water. Amoebae spread by forming infective cysts which can be found in stools and spread if whoever touches them does not sanitize their hands. There are also free amoebae, or trophozoites, that do not form cysts.

Amoebic dysentery is well known as a "traveler's dysentery" because of its prevalence in developing nations, or "Montezuma's Revenge" although it is occasionally seen in industrialized countries. Liver infection, and subsequent amoebic abscesses can occur. Bleeding in stools may occur.

Bacillary dysentery

Bacillary dysentery is mostly commonly associated with three bacterial groups:

Symptoms and complications

Symptoms include frequent passage of faeces/stool, loose motion and in some cases associated vomiting. Variations depending on parasites can be frequent urge with high or low volume of stool, with or without some associated mucus and even blood.

Once recovery starts, early refeeding is advocated avoiding foods containing lactose due to temporary [can persist for years] lactose intolerance.

Treatment

The first and main task in managing any episode of dysentery is to maintain fluid intake using oral rehydration therapy. If this can not be adequately maintained, either through nausea and vomiting or the profuseness of the diarrhea, then hospital admission may be required for intravenous fluid replacement. Ideally no antimicrobial therapy is started until microbiological microscopy and culture studies have established the specific infection involved. Where laboratory services are lacking, it may be required to initiate a combination of drugs including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection. There are several Shigella vaccine candidates in various stages of development that could reduce the incidence of dysentery in endemic countries, as well as in travelers suffering from traveler's diarrhea.

Amoebic dysentery can be treated with metronidazole. Mild cases of bacillary dysentery are often self-limiting and do not require antibiotics, which are reserved for more severe or persisting cases; campylobacter, shigella and salmonella respond to ciprofloxacin or macrolide antibiotics.

See also

References

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