August 29, 2014
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Infection

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Dysentery



The Facts on Dysentery

Many people have spent a tropical vacation with a bad stomach bug. They might have had dysentery, a painful intestinal infection that is usually caused by bacteria or parasites. Dysentery is defined as diarrhea in which there is blood, pus, and mucous, usually accompanied by abdominal pain.

There are two main types of dysentery. The first type, amoebic dysentery or intestinal amoebiasis, is caused by a single-celled, microscopic parasite living in the large bowel. The second type, bacillary dysentery, is caused by invasive bacteria. Both kinds of dysentery occur mostly in hot countries. Poor hygiene and sanitation increase the risk of dysentery by spreading the parasite or bacteria that cause it through food or water contaminated from infected human feces.

Causes of Dysentery

Dysentery can have a number of causes. Bacterial infections are by far the most common causes of dysentery. These infections include Shigella, Campylobacter, E. coli, and Salmonella species of bacteria. The frequency of each pathogen varies considerably in different regions of the world. For example, shigellosis is most common in Latin America while Campylobacter is the dominant bacteria in Southeast Asia. Dysentery is rarely caused by chemical irritants or by intestinal worms.

Intestinal amoebiasis is caused by a protozoan parasite, Entamoeba histolytica. The amoeba can exist for long periods of time in the large bowel (colon). In the vast majority of cases, amoebiasis causes no symptoms - only 10% of infected individuals become ill. It is uncommon except in the world's tropical zones, where it is very prevalent. People can become infected after ingesting feces that contain somebody's excreted parasites. People are at high risk of acquiring the parasite through food and water if the water for household use isn't separated from waste water. The parasites can also enter through the mouth when hands are washed in contaminated water. If people neglect to wash properly before preparing food, the food may become contaminated. Fruits and vegetables can be contaminated if washed in polluted water or grown in soil fertilized by human waste.

The Shigella and Campylobacter bacteria that cause bacillary dysentery are found all over the world. They penetrate the lining of the intestine, causing swelling, ulcerations, and severe diarrhea containing blood and pus. Both infections are spread by ingestion of feces within contaminated food and water. If people live or travel in an area where poverty or overcrowding may interfere with good hygiene and sanitation, they are at risk of being exposed to invasive bacteria. Young children (ages 1 to 4) living in poverty are most likely to contract shigellosis, campylobacteriosis, or salmonellosis.

Having sex that involves anal contact may spread amoebic and bacillary dysentery. This is especially true if the sex included direct anal or oral contact, or oral contact with an object (e.g., fingers) that touched or was in the anus of an infected person.





Symptoms and Complications of Dysentery

The main symptom of dysentery is frequent near-liquid diarrhea flecked with blood, mucus, or pus. Other symptoms include:

  • sudden onset of high fever and chills
  • abdominal pain
  • cramps and bloating
  • flatulence (passing gas)
  • urgency to pass stool
  • feeling of incomplete emptying
  • loss of appetite
  • weight loss
  • headache
  • fatigue
  • vomiting
  • dehydration

Other symptoms may be intermittent and may include recurring low fevers, abdominal cramps, increased gas, and milder and firmer diarrhea. You may feel weak and anemic, or lose weight over a prolonged period (emaciation). Mild cases of bacillary dysentery may last 4 to 8 days, while severe cases may last 3 to 6 weeks. Amoebiasis usually lasts about 2 weeks.

Bacillary dysentery symptoms begin within 2 to 10 days of infection. In children, the illness starts with fever, nausea, vomiting, abdominal cramps, and diarrhea. Episodes of diarrhea may increase to as much as once an hour with blood, mucus, and pus in the child's stool. Vomiting may result in rapid and severe dehydration, which may lead to shock and death if not treated. Signs of dehydration include an extremely dry mouth, sunken eyes, and poor skin tone. Children and infants will be thirsty, restless, irritable, and possibly lethargic. Children may also have sunken eyes and may not be able to produce tears or urine, the latter appearing very dark and concentrated.

Complications from bacillary dysentery include delirium, convulsions, and coma. A very severe infection like this can be fatal within 24 hours. However, the vast majority of infections are self-limited and resolve spontaneously without treatment.

People with amoebic dysentery may experience other problems associated with amoebiasis. The most frequent complication results when parasites spread to the liver, causing an amoebic abscess. In this case, you would have a high fever and experience weight loss and right shoulder or upper abdominal pain. If the infection of the bowel is especially virulent, the intestinal ulcerations may lead to bowel perforation and death. The parasites may rarely spread through the bloodstream, causing infection in the lungs, brain, and other organs.

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