| ID | 379 |
|---|---|
| Name | BACILLARY DYSENTERY (Shigellosis) |
| Cause | Shigellosis is a form of bacterial diarrhea caused by gram-negative bacteria Shigella species. It esults from contaminated food, poor sanitation conditions, or direct person to person contact. Shigella can cause infection in all age groups |
| Signs Symptoms | Severe diarrhea, fever, stomach pain, nausea and vomiting |
| Diagnosis | Infection is diagnosed when a laboratory identifies Shigella bacteria in the stool (poop) of an ill person |
| Investigations | Investigations: 1. Microscopic examination of stool shows- plenty of pus cells, R. B. C., ingested R. B. C. in the macro-phages. 2. Stool culture- positive for shigella in most cases. |
| Management | Ciprofloxacin as first line treatment, and pivmecillinam, ceftriaxone, or azithromycin as second line treatment |
| Introduction | Bacillary dysentery (or shigellosis) is a common disease, caused by shigella an invasive organism leading to an acute inflammation of the large gut characterised by diarrhoea with blood and mucous in the stools. It is often self-limited and mild but occasionally may develop serious form. Different types of shigella that cause bacillary dysentery are- in the developing countries S. flexneri & S. dysenteric-1 are the predominant strains, which causes more severe form of the disease in comparison to S. sonnei, or S. boydii which are common strains in the developed world. |
| History | |
| Etiology | see under cause |
| Clinical Features | Clinical features: 1. Abrupt onset of passage of loose stools for numberless time. No fecal matters only blood and mucus, bright red in colour, odourless. 2. Marked tenesmus and lower abdominal cramps. 3. Systemic- fever, chills, anorexia, malaise, headache, lethergy. 4. In more severe cases- thirst, dry tongue, oliguria, intense headache due to meningism and sometimes coma and convulsion. 5. There is tenderness in the abdomen mostly in lower part. 6. Arthritis or iritis may complicate bacillary dysentery (Reiter’s syndrome). |
| Preventions | Practice good hygiene. Wash your hands thoroughly with soap and warm water after going to the bathroom and before handling food. Other steps to reduce your risk of infection include: Don't share personal items with other people, such as towels |
| Treatment | Treatment: 1. Rest in bed. 2. Correction of dehydration- same as acute diarrhoea. 3. Antimicrobial treatment- Ceftriaxone i.m or i.v 50-100mg/kg/day. Or, Ciprofloxacin orally 20-30mg/kg/day, b.i.d. x 7-10 days. (Ciprofloxacin usually not recommended for children, but where benefit out weighs risk). Or, Ampicillin l00mg/kg/day q.i.d doses x 5 days. Or, Co-trimoxazole: IMP lOmg/kg/day & SMX 50mg/kg/day b.i.d x 7 days. Or, Nalidixic Acid 55mg/kg/day, q.i.d doses x 5-7 days. Or, Pivmecillinam 40-50mg/kg/day, q.i.d doses x 7 days. 4. Anemia (if any)- blood transfusion may be needed in severe anemia, in mild to moderate anemia, oral iron therapy is sufficient. 5. Treatment of complications- see under acute diarrhoea. |
| Complications | Dehydration. Constant diarrhea can cause dehydration. ... Seizures. Some children with a shigella infection have seizures. ... Rectal prolapse. ... Hemolytic uremic syndrome. ... Toxic megacolon. ... Reactive arthritis. ... Bloodstream infections (bacteremia). |
| Prognosis | |
| Types | S. sonnei flexneri boydii a dysenteriae |
| Classification | |
| Observation | |
| Pathology |
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