Dysentery-the destroyer in disguise

Dysentery, in general is defined as an infectious disease, characterized by the inflammation of intestines, more specifically the colon, resulting in the passage containing mucous mixed with blood. Patients with this condition often complain of abdominal pain and fever.   

Lack of proper hygiene and the presence of poor sanitation are two of the most significant causes behind the spread of dysentery, which happens largely through contaminated food and beverage consumption.   

There are two common types of Dysentery: Bacterial Dysentery and Amoebic Dysentery.   
Both conditions can be diagnosed by checking the patient’s history regarding the duration during which the symptoms were present and the severity and also through a thorough physical examination.   

Your doctor will use a culture test using stool samples in order to detect and identify the real causative agent. This test will confirm diagnosis. With regard to some patients, a sample of the mucus from the colon lining or a tissue sample of the colon will also be obtained for further evaluation.   

Blood tests and the levels of serum electrolytes will be assessed to identify the risk of dehydration, which occurs as a result of on-going fluid loss. Additionally, other screening tests such as x-rays, CT scans, ultrasound examinations and MRI scans can be used in some patients who are at a risk of developing complications associated with lungs or the liver, especially in the case of amoebic dysentery. 

 
Since the two conditions are caused by two different types of microorganisms the signs and symptoms, method of diagnosis and treatment would often differ accordingly. Therefore, in this article we discuss these illnesses separately, so that next time you are diagnosed with one of them, you will know what to expect and what to do.   

QWhat is Amoebic Dysentery (Amoebiasis)?
It is defined as a type of Dysentery caused by Amoebic organisms resulting in great amount of fluid loss from the body.   

Entamoeba histolytica is the commonest amoeba, causing amoebic dysentery which enters the body in the form of a cyst via contaminated food or beverages. This cyst breaks into fragments after entering the digestive tract and converts in to an active organic form known as Trophozite. The disease arising this way would then invade the tissue linings of the colon or may even penetrate into the bloodstream, leading to severe conditions in lungs, liver and other important organs of the body. This invading process of Amoebic Dysentery is known as metastatic amebiasis.   

Q How can I know if I’ve developed Amoebic Dysentery?
The symptoms which develop slowly are characterized by,   
Diarrhoea associated with blood-mixed stools (blood dysentery).   
Fever (which may only be noted if complications such as liver abscesses are developed in the course of the disease).   

Chronic amoebic dysentery can result in severe inflammation of the colon, referred to as necrotizing colitis and an increased risk of colon rupture. So it is important to seek treatment before the condition leads to unwanted complications.   

QWhat is Bacillary Dysentery?
This is a type of Dysentery caused by a group of bacteria of the genus, Shigella, which is why this condition is also known as Shigellosis or Shigella dysentery. The four major strains of bacteria under the genus Shigella include, S. dysenteriae, S. boydii, S. sonnei and S. flexneri. All of them could cause Dysentery in more or less manners.   

Q How can these bacteria enter my body?
These pathogens enter the body along faeco-oral route-usually as a result of poor hygiene, improper food handling, low socio economic states etc. The bacteria, invading the colon tissues will secrete a harmful toxin, named Enterotoxin which then attacks the intestinal lining of the colon, resulting in pain and diarrhoea.   

QHow would I present?
You will be most likely to complain of:   
Diarrhoea with or without blood   
Abdominal pain and cramps   

Tenesmus (a feeling of incomplete defecation, where you will note a constant urge to pass stools even if nothing passes out when you go to the washroom)   
Mild to high fever   
Rectal pain   

Chronic bacillary dysentery if left untreated may cause severe conditions like hemolytic uremic syndrome which can result in kidney failure. Malnourished children, affected with the condition might lead to a spreading of bacteria all over blood resulting in, bacteremia, which is then referred to as Shigellosis.   

Therefore it is highly advisable to seek immediate medical advice when you come across similar signs and symptoms. 

 
Q How will I get treated?
Your doctor will take a history about how the disease started and proceeded, examine you and ask for certain tests in order to arrive at the exact diagnosis. Once the diagnosis is made, treatment will start immediately to avoid unnecessary consequences.   

The most common treatment for bacillary dysentery includes antibiotics such as Ciprofloxacin, Trimethoprim-sulfamethoxazole and Nalidixic acid. More importantly, Anti-diarrheal medications such as Diphenolate, Loperamide are strongly prohibited in these cases since they are known to exacerbate the situation.     

QWhat are the measures to be followed for prevention?
Washing hands properly after contact with potentially infected people, surfaces or goods.   
Careful washing of hands must be done before and after; eating or handling food, visiting the bathroom, touching surfaces in common use (public transportation, public washrooms etc.)

   
Use separate towels   
Make sure to disinfect toilets after use if a person in the family or group has dysentery.   
Wash all laundry which has come into contact with an infected person in hot water.   
Avoid crowded settings, food handling, childcare and health care, during and at least 48 hours after the infection has resolved.   

Eat the food hot or within 2 hours of preparation   
Store cooked food below 4 C or above 60 C and separate raw and cooked foods to avoid cross-contamination (salads, uncooked etc)   
If repeated outbreaks are noted in the area without any obvious infected person, make sure that such asymptomatic carriers do not handle food, feed or otherwise take care of children or handle anything which has to do with them.