Bacillary Dysentery (Shigellosis)

exp date isn't null, but text field is

This is caused by infection with the shigella bacterium which involves the small and large intestines. Infection is through ingestion of contaminated food and fluids.

Causes

Shigella dysenteriae, Shigella flexneri, Shigella sonnei and Shigella boydii all cause shigellosis transmitted through faeco-oral route. Of these, S. dysenteriae type 1 has the highest case fatality rate and causes epidemics.

Signs and symptoms

  • Frequent and painful passage of stools that consist of largely blood, mucus and pus.
  • Stomach cramps
  • Tenesmus (a repetitive urge to empty the bowels arising from a feeling of incomplete evacuation)
  • Urgency
  • Fever
  • Nausea and vomiting
  • Dehydration

Patients with increased risk of death:

  • Under 5 years
  • Over 50 years
  • Temperature over 38.5°C
  • Malnourished children
  • Severe dehydration

Differential diagnosis

  • Amoebic dysentery
  • Other causes of bloody diarrhoea

Complications

  • Electrolyte derangement (especially hypokalaemia and hyponatraemia)
  • Dehydration
  • Septicaemia
  • Severe rectal bleeding
  • Intestinal perforation
  • Reiter’s syndrome

Investigations

  • Stool microscopy, culture and sensitivity

Treatment objectives

  • Eradicate causative microorganisms
  • Correct dehydration if present
  • Correct electrolyte derangement 

Pharmacological treatment

First Line

Ciprofloxacin Oral

Adult:

500mg orally two times a day for 3 days. 

Child:

> 3 months:  15mg/kg orally two times daily for 3 days

Note: Ciprofloxacin is contraindicated in pregnant women

For pregnant women

Ceftriaxone IM/IV

1 g daily for 3-5 days

 

Second Line

Co-trimoxazole Oral

Adult:

960mg orally two times a day for 5 days

Child: 

6 weeks – 5 months:                120mg two times a day for 5 days

6 months – 5 years:                  240 mg two times a day for 5 days

6 -12 years:                               480mg two times a day for 5 days

 

Rehydration/correction of electrolyte derangement

Severe dehydration

Hospitalize and hydrate with IV sodium chloride 0.9% alternating with Darrow’s solution, depending on serum potassium.

Note: Do not give to children below 6 weeks of age

Prevention

  • Provide hand washing facilities in critical places
  • Educate the populace on frequent hand washing with soap and clean water
  • Provide safe drinking water
  • Ensure adequate disposal of human waste