Dysentery

Dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the feces^[1] with fever and abdominal pain.^[2] If left untreated, dysentery can be fatal.

Signs and symptoms

In developed countries, dysentery is generally a mild illness, causing mild symptoms normally consisting of mild stomach pains and frequent passage of feces. Symptoms normally present themselves after one to three days and are usually no longer present after a week. The frequency of urges to defecate, the volume of feces passed, and the presence of mucus and/or blood depends on the pathogen that is causing the disease. Temporary lactose intolerance can occur, which, in the most severe cases, can last for years. In some caustic occasions, vomiting of blood, severe abdominal pain, fever, shock and delirium can all be symptoms.^[3][4][5][6]

Causes

Dysentery is usually caused by a bacterial or protozoan infection or infestation of parasitic worms, but can also be caused by a chemical irritant or viral infection. The most common cause of the disease in developed countries is infection with a bacillus of the Shigella group (causing bacillary dysentery). Infection with the amoeba Entamoeba histolytica can cause amoebic dysentery. This is more common in tropical areas, although has been found throughout the Gulf Coast of the United States, as well as Australia and parts of rural Canada. ^[7]

Treatment

Dysentery is initially managed by maintaining fluid intake using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. Ideally, no antimicrobial therapy should be administered until microbiological microscopy and culture studies have established the specific infection involved. When laboratory services are not available, it may be necessary to administer a combination of drugs, including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection.

If shigella is suspected and it is not too severe, the doctor may recommend letting it run its course -- usually less than a week. The patient will be advised to replace fluids lost through diarrhea. If the shigella is severe, the doctor may prescribe antibiotics, such as ciprofloxacin or TMP-SMX (Bactrim). Unfortunately, many strains of shigella are becoming resistant to common antibiotics, and effective medications are often in short supply in developing countries. If necessary, a doctor may have to reserve antibiotics for those at highest risk for death, including young children, people over 50, and anyone suffering from dehydration or malnutrition.

Amoebic dysentery usually calls for a two-pronged attack. Treatment should start with a 10-day course of the antimicrobial drug metronidazole (Flagyl). To finish off the parasite, the doctor will sometimes prescribe a course of diloxanide furoate (available only through the Centers for Disease Control and Prevention), paromomycin (Humatin), or iodoquinol (Yodoxin).

References