Dysentery

Introduction

When a person develops gastro-enteritis (infection of the gut) the stool becomes watery and frequent. But if the diarrhea contains blood and mucus, this is known as dysentery. Young children are more prone to get it.

Causative Agents

Main cause of dysentery is Shigella which is a bacteria. However, there are other microbes (germs) that can cause dysentery. These include Campylobacter, Entamoeba histolytica, E.coli (Escherichia coli) and Salmonella.

Pathogenesis / Action in the Body

If someone is infected with shigella, the bacteria can pass out in their faeces. Infection may be caught by drinking water contaminated with infected faeces, eating food prepared using contaminated water or by close contact with someone who has the infection.

Symptoms and Signs

Some people who get infected do not show any symptoms. But most do. The usual symptoms are diarrhea (which will often contain blood and mucus), painful abdominal cramps and fever. The symptoms tend to last for around five to seven days. Symptoms are more severe in very young and elderly patients.

Some can get dehydrated. When there is vomiting and frequent diarrhea. Dehydration means lack of fluid in the body.

Symptoms of dehydration in children – less urine, dry mouth, fewer tears when crying, sunken eyes, and weakness, are being irritable or lethargic. When dehydration becomes severe the child will get drowsy, pale, cold hands and feet, reduced urine output and fast shallow breathing. Since this is a medical emergency immediate medical attention is needed.

Complications

·         Dehydration and salt (electrolyte) imbalance in your body - Water and electrolytes are lost with stool.

·         Haemolytic uraemic syndrome - This is a serious condition where there is anaemia, a low platelet count in the blood, and kidney failure. It may be caused by toxins produced by shigella bacteria. It is a complication which is more common in children.

·         Reactive complications - Although Shigella infection is inside the gut, some parts of the body may react to the bacteria. The person can develop arthritis (Inflammation of the joints), Inflammation of skin and eyes(conjunctivitis or uveitis).

·         Lactose intolerance – When the lining of the gut is damaged by the infection the enzyme lactase (which digests the sugar called lactose) is not produced properly. Lactose intolerance leads to bloating, abdominal pain, wind and watery stools after drinking milk or any food containing lactose.

Management

When the symptoms are suggestive it is best to go to a qualified medical practitioner for treatment. A suitable antibiotic will be prescribed after taking a stool sample for investigation. The patient should take a lot of fluids to prevent dehydration. Usual meals can be taken. Things like yogurt, anamalu plantains and rice kanji (badi hal kanda) may help. Avoid cow’s milk. Breast feeding should be continued. Taking oral rehydration solution (Jeewani) helps to correct dehydration and electrolyte imbalance.

Prevention and Promotion

Practice hygienic measures

·         Wash hands with soap and water regularly especially after going to the toilet, before preparing meals and before eating

·         When eating leaves, fruits and raw vegetables make sure that they are washed well

·         Always drink boiled and cooled clean water

·         Cover food after preparing to prevent flies and cockroaches contaminating food

·         Food should be hygienically prepared. Avoid handling food when you have diarrhea.