Dysentery - Causes, Symptoms, Diagnosis, and Management

Introduction

The inflammation of the intestines, often causing diarrhea, is termed dysentery. Bacteria or parasites can cause it. It is highly infectious and can be passed to nearby people if proper precautions (like the proper washing of hands) are not taken.

What Is Dysentery?

Dysentery is intestinal inflammation leading to diarrhea with blood or mucous. Bacteria or parasites can cause it. Dysentery usually occurs due to the lack of proper hygiene. The condition can spread due to the intake of food or water that has been contaminated. Diarrhea and dysentery are commonly confused with being the same. A person has loose and watery stools in diarrhea. Diarrhea is a common condition. On the other hand, dysentery is an infection or inflammation of the intestines, resulting in blood in the watery stool. It is also called bloody diarrhea.

What Are the Symptoms of Dysentery?

Symptoms usually start to show up within one to three days after infection. The common symptom of dysentery is blood or mucous in loose stools. Symptoms may differ depending on the causative agent. Other common symptoms can include the following:

• Painful stomach cramps.

• Fever.

• Feeling unwell.

• Fatigue.

• Nausea.

• Dehydration.

What Are the Causes of Dysentery?

Based on the causative factors, dysentery is divided into two categories:

1. Bacillary Dysentery: This is the most common type of dysentery caused by a bacteria called Shigella. The condition is called shigellosis. In the U.S., about 500,00 people are affected by this condition every year.

2. Amoebic Dysentery: It is caused by a parasite called Entamoeba histolytica. This condition is common in tropical areas that lack good sanitation.

• Dysentery can be spread by someone already suffering from dysentery who has prepared food without properly washing his hands.

• Moreover, it can spread by contacting a surface (like a washbasin, sink, toilet seat, etc.) that the causative agents have contaminated.

• Swimming in contaminated water, like swimming pools, lakes, etc., can cause dysentery.

• The infection can be passed through a passive carrier (an infected person who does not show any symptoms).

• Sexual contact with a person suffering or recovering from the condition.

What Is Bacillary Dysentery?

The most common type of dysentery is bacillary dysentery. It is caused by a bacteria called Shigella. The bacteria may remain in the infected person’s stool for one to two weeks after the patient stops experiencing symptoms. Hence, patients, after recovery from this infection, should take care and follow proper hygiene methods to prevent the spread of the infection. Shigella outbreaks can occur in small social or community groups, like a children’s daycare facility.

What Is Amoebic Dysentery?

It is also called amoebiasis. A parasite called Entamoeba hystolytica is the cause of this type of dysentery. It is common in areas that do not have proper sanitation. Most people get infected with food or water contaminated with Entamoeba eggs. People who are at increased risk of getting the infection include:

• Pregnant women or women in the postpartum phase.

• Newborn.

• Those who are undergoing steroid therapy.

• Malnourished individuals.

• Cancer patients.

Very rarely, amoebiasis can lead to more complicated health issues like a liver abscess (pus collection in the liver). Nausea, vomiting, fever, pain in the upper right side of the abdomen, weight loss, enlarged liver, etc., can be the associated symptoms.

What Are the Conditions Similar to Dysentery?

The conditions similar to dysentery include:

1. Escherichia Coli Infection: It is a bacterial infection caused when people consume raw or uncooked food or food contaminated with feces. The common symptoms are abdominal cramps, diarrhea with or without blood, vomiting, fever, etc.

2. Hookworm Infection: It is an infection caused by a parasite called hookworm. It is common in tropical areas where the climate is warm and moist, and sanitation is generally poor. It is spread by walking barefoot on contaminated soil. People with mild infection may not necessarily show symptoms and can be passive carriers. The initial signs of the infection can include itching and rashes. Diarrhea, appetite loss, weight loss, anemia, fatigue, etc., can be the symptoms in people with severe infections.

3. Antibiotic Use: Excessive antibiotic use can cause a bacteria called Clostridiodes difficile. This can cause inflammation of the large intestine, leading to a condition called pseudomembranous colitis. Abdominal pain, diarrhea, fever, etc., can be the symptoms of this condition.

How Is Dysentery Diagnosed?

A proper case history should be taken for the diagnosis of dysentery. History and duration of the symptoms, recent travel, etc., should be asked. A physical examination should be done. If the patient has a recent travel history, a microscopic examination of the stool should be done to check for the amoeba. A colonoscopy might be advised to check the intestinal mucosa if the stool tests negative for amoebiasis. A person suspected of liver abscess might require aspiration of the fluid in the liver to confirm the diagnosis. If symptoms continue, imaging tests might be required to diagnose the condition.

How Is Dysentery Treated?

Dysentery usually resolves within three to seven days and may not require medical intervention. However, to prevent dehydration, plenty of fluids are required. Oral resuscitation solutions can be used to maintain the electrolyte balance. Abdominal cramps and diarrhea can be managed with medicines containing bismuth subsalicylate. Antiemetics like Loperamide should be avoided unless prescribed by the doctor, as it can worsen the condition. Medication to eliminate the parasite, like a combination of Metronidazole and Tinidazole, will be prescribed if it is amoebic dysentery.

What Are the Complications of Dysentery?

Complications with dysentery are usually associated with people with less immunity (immunocompromised patients). Some of the potential complications can include the following:

• Dehydration: Frequent vomiting and diarrhea can result in dehydration if the proper fluid intake and electrolyte balance are not maintained. This can be fatal and life-threatening in small children.

• Liver abscess.

• Postinfectious Arthritis (PIA): It can be a complication of Shigella infection. Joint pain, inflammation, and stiffness of the joints can be the symptoms.

• Hemolytic Uremic Syndrome: It is a rare complication of the Shigella infection, leading to inflammation and damage to the small blood vessels in the kidney.

Conclusion:

Dysentery outbreaks are usually a result of poor sanitation. Proper washing of hands and hygiene practices helps prevent the disease's spread. An infected person should avoid contact with the public for at least a week after the symptoms disappear. Care should be taken to use canned or packaged water for drinking and cooking while traveling in underdeveloped or developing countries. Fruits that can be peeled should be preferred. Food that does not have a peel should be avoided or cooked well before consumption.