Introduction

Dysentery is an inflammation of the intestine, especially in the colon. This can lead to severe diarrhoea with mucus or blood in the feces. Mild to severe abdominal pain or stomach cramps are typically experienced with tenesmus (painful straining to pass stool).

This illness is caused by eating food or drinking water that has been contaminated with human faeces. This can occur in both developed countries and in tropics.

There are two main types of dysentery ie Bacillary dysentery, caused by Shigella, Salmonella, E.coli etc or Amoebic dysentery (amoebiasis) caused by Entamoeba Histolytica. An amoeba is a protozoan (single celled) organism that constantly changes shape.

Signs and Symptoms

After one to three days of acquiring the infection, the symptoms of bacillary dysentery will begin to appear. Cases usually present with fever, abdominal pain and diarrhoea. Initially, diarrhoea is watery but later it becomes mixed with blood or mucus. Dehydration may occur rapidly. Neurological symptoms, such as delirium( confusion) seizures (fits) and other signs of central nervous system infections.

The onset of symptoms of amoebic dysentery is usually gradual over several weeks to months. Symptoms of amoebic dysentery include watery diarrhoea (containing blood, mucus or pus), vomiting, abdominal cramps and high grade fever. The symptoms also last longer than that of bacillary dysentery. Without treatment, the amoebas can persist in the bowel for months or even years. The infection can still be transmitted to other people and the diarrhoea can recur.

Diagnosis

To make diagnosis of dysentery, stool specimen is examined to see if it contains the infecting bacteria or amoebas.

If dysentery has caused further complications (eg. liver abscess), other investigations, such as an ultrasound, blood test or endoscopy, may be necessary.

Complications

Babies and young children can become dehydrated very fast. They should be offered a lot of fluids to replace those that have been lost, otherwise dysentery can be life threatening.

Other systemic complications of bacillary dysentery include septicaemia, pneumonia, haemolytic uraemic syndrome,urinary tract infection and rectal prolapse.

In bacillary and amoebic dysentery, the inflammation of the large intestine can be severe so as to weaken the wall causing fulminant colitis and toxic megacolon. This can progress to intestinal perforation and can be fatal.

Rarely, amoebic dysentery can invade to other parts of the body via the blood stream and cause an abscess. This most common organ involved is the liver.

Treatment

Most cases of bacillary dysentery will need antibiotic therapy. The decision to start antibiotic will depend on the type of infecting organism and the correct antibiotic therapy will be started by the doctors involved after reviewing the stool cultures.

Other treatment like use of anti -motility agent (to decrease the frequency of passing stool) is not recommended. There is also no recommendation on change of milk for babies unless the child has lactose intolerance.

Cases with amoebic dysentery will also require antibiotic therapy. Please consult your doctor if your children have these symptoms.

It is important to avoid dehydration by replacing any fluids that have been lost through diarrhoea. Oral rehydration solutions (ORS) are appropriate for those who can tolerate oral intake. In severe cases, fluid may need to be infused by intravenous drip in hospital.

Complications mentioned above will need specific treatment in a hospital setting.

Prevention

Dysentery is spread from person to person. Best way to prevent this disease is to practice GOOD PERSONAL HYGIENE.

To minimise the risk of getting the disease, measures that are outlined below should be followed.

There are:

• Care takers of children should wash their hands after defecation (passing motion) and after caring for infants who have defecated and always before preparing food/milk.
• Hands are washed with soap and water after using the toilet and after handling infected cases.
• If clean water supply is not readily available, please boil drinking water before using.
• Peel fresh fruits before eating and do not feed children with poorly cleaned raw vegetables.
• Do not let children eat unpasterised milk, cheese or dairy products.
• Minimise eating or feeding children foods bought from outside.
• Keep a minimum contact with an infected person (separate care of infected child from rest of children e.g. nursery)
• Wash the laundry of an infected person with hot water.
• When travelling, only drink bottled or canned beverages or boiled water.