Dysentery

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Dysentery is the passage of bloody diarrhoea or mucus or both in the stool. There are two types of dysentery:
• Bacillary
• Amoebic

Bacillary Dysentery

Bacillary dysentery is caused by the bacteria Shigella which has a short incubation period, usually being 2 days.

Clinical features:

  • Acute onset
  • Malaise
  • Fever
  • Watery diarrhoea
  • Bloody diarrhoea with mucus
  • Faecal urgency
  • Severe cramping abdominal pain
  • Nausea
  • Vomiting
  • Headache
  • Convulsions (in children)
  • Tenesmus
  • Mild or moderate dehydration

Diagnosis:

  • Stool Microscopy may show leukocytes 
  • Stool culture and susceptibility test

Treatment

Drugs:

The first drug of choice is Nalidixic Acid.

  • Adult: 1g orally 4 times a day for 7 days
  • Child: 50mg/ kg body weight orally in 4 divided doses for 7 days

OR

  • Ciprofloxacin - children 15mg/kg; adults 500mg twice daily for 3 days.
    Use of Ciprofloxacin in children is contraindicated except where the benefit outweighs the risk.

Complications of Shigella type 1 infection include:

  • Arthritis
  • Conjunctivitis
  • Colonic perforation
  • Septicaemia
  • Haemolytic uraemia syndrome
  • Metabolic disorders
  • Encephalopathy
  • Toxic megacolon and
  • Rectal prolapse in children

Prevention:

  • Drink clean, boiled/chlorinated water
  • Good sanitation
  • Good personal hygiene

in children

Amoebic Dysentery

Amoebic dysentery is caused by the parasite Entamoeba histolytica.

Clinical Features

  • Bloody diarrhoea with mucus
  • Low-grade fever
  • Dehydration is unusual

Diagnosis

  • Stool microscopy
  • Sero diagnosis

Treatment

Drugs

  • Metronidazole
    • Adult: 800mg orally 3 times daily for 5 days followed by Diloxanide furoate 500mg 3 times daily for 10 days (for the eradication of cysts)
    • Child: 1 – 3 years, 200mg orally 8 hourly for 5 days;
    • 3 – 7 years, 200mg orally 6 hourly for 5 days;
    • 7 – 10 years, 400mg orally 8 hourly for 5 days

OR

  • Tinidazole
    • Adult: 2g daily for 2 – 3 days.
    • Child: 50 – 60 mg/kg orally for 3 days.

Avoid the use of anti-diarrhoea agents

Supportive

  • Fluid replacement – Refer to chapter 1.5 in full Zambia STG
  • Analgesics

Complications

  • Fulminant colitis
  • Colon perforation
  • Peritonitis
  • Chronic infection
  • Stricture formation
  • Severe haemorrhage
  • Amoebic liver abscess
  • Amoeboma

Prevention

  • Good disposal of excreta - good pit latrines, flush toilets
  • Provision of clean water
  • Boiling water. This kills amoeba cysts if the water is boiled for at least 10 minutes.
  • Chlorination of water - effects variable on an amoeba.
  • Personal hygiene - washing of hands after use of the toilet, when preparing food and before eating.