An infectious disease of the large bowel, dysentery is characterized by acute diarrhea, gripping abdominal pains, and an uncomfortable desire

to empty the bowel. Dysentery may be accompanied by dehydration, weight loss and rise in temperature. There are two main types of dysentery, bacillary and amoebic. Bacillary Dysentery This is caused by bacteria of shigella group (named after the Japanese physician Kiyoshi Shiga), bacillary dysentery is the most common and violent form and is worldwide. It is particularly common in younger children living in the tropics and the orient. Causes and Occurrence Bacillary dysentery is spread by eating contaminated food. Crowded living conditions, lack of sanitation and inadequate hygiene also greatly increase the likelihood of epidemics. It is unusual for the pollution of the water supply to be the cause of the spread of bacillary dysentery as the Shigella bacteria do not survive for long periods in water. Symptoms Once the bacteria have been ingested, they pass through the bowel to the colon (large intestine) where they multiply rapidly. An inflammation of the lining of the colon occurs and the symptoms of the conditions usually develop within 48 hours. Fever, severe abdominal pain and bloody diarrhea are the main features. Other symptoms, such as weakness, drowsiness, nausea and vomiting tend to be particularly severe in the young and the elderly, due to a greater risk of dehydration and often less access to appropriate medical care. The bacterial seldom invade other tissues of the body and symptoms usually settle within a week. Despite this, about 10% of affected people have relapses if they are not treated. A few become 'carriers' (that is they excrete the bacteria for a considerable time without having any significant symptoms themselves). Treatment The aim of treatment is to prevent dehydration through excessive fluid loss. It is usually adequate to give the affected person clear fluids only, for a few days. If there is vomiting, intravenous fluids are sometimes needed as the risk of dehydration is high. Antibiotic treatment is generally reserved for more severe cases, to shorten the duration of the illness, to avoid a relapse or to prevent the carrier state from developing. Treatment of carriers may

become difficult as the bacteria often develop resistance to certain antibiotics; therefore antibiotics are not used for all cases. The basis of treatment is hygienic living and the adequate disposal of feces.

Shigellosis (Bacillary Dysentery)

Pathophysiology
Shigellosis is a bacterial diseases caused by a group of bacteria called Shigella species, aerobic and gram-negative bacilli that can be transmitted through a fecal-oral route with an incubation period varying from 1 to 7 days (AAP, 2006c).

Clinical Manifestations
The symptoms include bloody or non-bloody diarrhea, fever, and stomach cramps starting a day or two after the exposure to the bacterium (CDC, 2005). The CDC (2005) also explains that a severe infection with high fever may result in seizures in children younger than 2 years old. Infected persons without symptoms may pass the bacteria to other people.

Screening Tests
Shigella infections can be diagnosed by laboratory tests to identify Shigella in the stools of an infected person, and blood cultures are recommended for severely ill, immunocompromised, or malnourished persons due to a possible risk for bacteremia (AAP, 2006c).

Management Regimens
The CDC (2005) suggests that antibiotics, such as ampicillin, trimethoprim/sulfamethoxazole (Bactrim or Septra), nalidixic acid, or ciprofloxacin can be used as treatments for severe cases to eradicate the bacteria and shorten

the illness; shigellosis usually resolves in 5 to 7 days without treatments, and using antibiotics can make the bacteria more resistant. However, antidiarrheal agents are contraindicated because they may prolong the course of illness (AAP, 2006c).

Bacillary dysentery or Shigellosis is a common cause of gastro-enteritis worldwide and can cause bloody diarrhea (called dysentery) or non-bloody diarrhea. The sight of blood in stools can be frightening and the patient may seek immediate treatment. Worldwide estimates report that shigellosis is responsible for approximately over 600,000 deaths and above per year. The majority of these happen in the developing countries and 2/3rd of the victims are children under the age of 10 years. Diarrheal outbreak due to shigella occurs in areas of overcrowding where sanitation is poor such as jails, mental hospitals, refugee camps, daycare or in primary schools. Outbreaks are also reported among homosexuals.

The Shigella bacteria enter the host's system through the epithelial lining of the large intestine and destroy the intestinal mucosa. The bacteria cause a highly contagious diarrhea. Depending on the physical condition and age of the host, even as few as ten bacterial cells are enough to trigger an infection. Watery loose stool is the classical symptom of Shigella infection. Some strains of bacteria produce toxins that cause 'hemolytic uremic syndrome'. Evaluating the stool under a microscope confirms the diagnosis. Most cases of shigellosis do not require

hospitalization. Children, elderly and the immuno - compromised need antibiotic treatment. Intake of plenty of fluids is an absolute requirement in case of dysentery. Death from bacillary dysentery is unusual. It may, however, occur in neglected, undiagnosed or extreme cases. It is more commonly prevalent in the following Children who suffer from mal-nutrition In patients with co-existing debilitating conditions Or in the elderly population. Shigellosis may be prevented to a large extent by diligently following hygienic practices. Read more: Shigellosis-Causes-Symptoms-Diagnosis-Treatment-Prognosis-Prevention-FAQ | Medindia http://www.medindia.net/patients/patientinfo/Shigellosis.htm#ixzz2WLNm0uKp The number of Shigella bacteria required to cause an infection is small. As little as 10 to 100 organisms can cause dysentery. Shigellosis is often found to occur in crowded places such as day care centers, nursing homes, refugee camps, and other places where the sanitation is poor. Poor hygiene or eating contaminated food may cause this illness.

"This is not surprising: (Day care) exposes babies and toddlers to large numbers of biological strangers, many of whom are not toilet trained and who drool, making day care a breeding ground for infectious disease." - 'Day Careless', by Maggie Gallagher,a Nationl Review, 26-Jan-1998
Shigellosis mostly occurs among toddlers or young children who are not completely toilet trained. School or playmates of infected children and also their family members are also at greater risk of developing the infection. Infected food handlers, who fail to wash their hands adequately with soap after using the toilet, are likely to contaminate the food that they handle, thus spreading the infection. Vegetables, harvested from a field contaminated with sewage, also help to spread the infection. Shigellosis can result from drinking or swimming in contaminated water. Water bodies may get contaminated with sewage and any one who swallows the contaminated waters while swimming, or drinks it directly, is likely to become affected Feces infected with Shigella bacteria become the breeding ground of flies, which then goes on to contaminate the food. Sex, especially oral or anal sex is likely to spread the disease. Homosexual men have a greater chance of developing shigellosis.

Every year, approximately, 18,000 cases of shigellosis are reported in the United States alone, where it is more widespread in the summer months than in winter.

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species of the Genus Shigella, which are pathogens to both man and other primates, are Shigella sonnei, Shigella flexneri, Shigella dysenteriae, and Shigella boydii. The passage of infection is via the fecal - oral route.

Microscopic view of Shigella bacteria www.shigellablog.com The bacterium injects IpaD protein to gain entry into the cell. Subsequently, using IpaB and IpaC proteins, the bacteria causes lysis of the vacuolar membranes. They multiply within the lumen of the gut. For its motility, the bacterium uses IcsAprotein and successfully progresses forward in cell-to-cell propulsion. They spread to adjacent cells and deep into the lamina to produce a toxic substance called "exotoxin". This toxin induces water and electrolyte loss from the intestinal cells leading to their dehydration. The extend of virulence in Shigella infection is determined by the Invasion of the wall of the large intestine by the bacteria, Inflammatory reaction associated with the infection, and Quantity of the toxic "exotoxin" that is produced. The infected cells are destroyed and slough off leading to the formation of ulcers in the intestine. White Blood Cells (WBCs) attack this area and are prominently visible when viewed under a microscope.
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The onset of the disease is sudden and is usually characterized by painful abdominal cramps and watery stools.

The symptoms of shigella infection may manifest itself within a short period of 12

hours of ingestion or it may take as long as 2-3 days or even 7 days to show up. The symptoms may last for several days or even weeks.

Abdominal cramps, low grade fever followed by diarrhea which can soon become bloody is the usual presentation of the condition.

Symptoms and Signs

Vomiting Diarrhea Dysentery Tenesmus Dehydration

Summary Abdominal Loose, Stools Straining Low Nausea Vomiting Seizures,

of

all

the

symptoms pain

of

shigellosis and

are

as

follows

cramps stools (dysentery) movement fever

frequent with during grade mucus/blood/pus bowel

in

the

case

of

young

children

On a global scale, Shigella is one of the pathogenic causes of reactive arthritis, an autoimmune condition.

Read more: Shigellosis - Symptoms | Medindia http://www.medindia.net/patients/patientinfo/shigellosissymptoms.htm#ixzz2WLP33AGwA.

Stool Examination

Stool (Fecal) examination is the most preferred diagnostic method. Fresh, unstained samples of faeces are examined under a microscope. Majority of the laboratories do not carry out specialized examinations unless instructed to do so. These special tests, however, will help to distinguish the subtypes of the bacteria involved. This in turn helps to treat the infection effectively. B. Cultured Test Feces are inoculated into the culture media that enhance the growth of the bacteria and confirmation of the bacterial presence is based on its characteristic growth in the media. Deoxycholate Agar (DCA) or MacConkey Agar media is used. C. Antigen Antibody Test Serological investigation with species-specific sera helps to confirm characteristic bacterial colonies. This test is then carried out with type -specific sera.
Read more: Shigellosis - Diagnosis | Medindia http://www.medindia.net/patients/patientinfo/shigellosisdiagnosis.htm#ixzz2WLPjKNPPThe primary focus of Shigella treatment is to replenish the loss of body fluids by giving oral rehydration salt solution. Sometimes intravenous fluid administration may be required. Young children, older individuals, the immunosuppresed and severely infected persons with bacillary dysentery may require an antibiotic therapy comprising mostly of the following drugsAmpicillin Co-trimoxazole Tetracycline Ciprofloxacin Fluoroquinolones Anti-diarrheal agents are best avoided, as they are likely to worsen the illness. It is better to consult a

doctor in case of Shigella infection.

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Prognosis of the bacillary dysentery or shigellosis is generally good and most patients make a full recovery.

However in patients who have low immunity children, elderly or patients with HIV infection, the prognosis is more guarded unless timely treatment is administered. Diarrheal diseases are a major cause of deaths among the young children in the world from the developing countries. In the event of complications like Hemolytic Uremic Syndrome (HUS) developing the prognosis depends on the availability of support treatment like dialysis. The prognosis of Shigellosis may depend on the duration of the disease, complications, result of the outcome, and the chances for recovery, time for recovery, survival and death rate. Therefore a prediction on the prognosis of shigellosis is not conclusively possible.
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Hygienic practices help in prevention of dysentery caused by Shigella infection

Educating the public on the importance of frequent hand-washing after using toilet or before serving food can prevent outbreaks of shigellosis and gastroenteritis worldwide. Shigella spreads by food getting contaminated with fecal matter. Hygienic practices, such as washing hands thoroughly using soap and water is a must especially after Visiting the toilet After changing diapers Before food preparation Before eating a meal Salads should be thoroughly washed before consumption It is important to properly store salads and cooked food which are refrigerated

For a traveler to a tropical or developing country, the best dictum to follow is "boil it, cook it, peel it, or forget it". Travelers should also avoid eating salads, drinking pooled water and stick to drinking bottled water.."

How does the shigella infection spread? When individuals with Shigellosis wash themselves after a visit to the toilet, their fingers can easily contaminate objects such as toilet door, taps, towels and flush. When another person touches the contaminated objects they get infected. People with the symptoms of shigellosis should avoid using public toilet for they are prone to spread the infection Remember that many child day care centres can become a health hazard if proper measures are not followed.
In Science Shams and Bible Bloopers, David Mills describes daycare centres as follows: The typical daycare center...spreads far more infection and communicable disease than the county jail."

Preventive measures in 'Child Care Centres' Soiled diapers should be properly disposed Hand washing of children and toddlers should be supervised after they visit the toilet Area where diapers are changed should be properly disinfected and regularly cleaned Children suffering from diarrhea should not be allowed in day-care centres Insects infesting the fecal matter of an infected person can spread the bacterium around. Therefore insect - control methods should be practiced. Adequate chlorination of the water supply can to a large extent control bacillary dysentery epidemics. It is important to drink water free from bacterial contamination. It is ideal to thoroughly boil water before drinking it. Pasteurization of all milk and dairy products should be practiced Milk and water for infant feeding all should always be boiled. Bottles and teats should similarly be cleaned and changed if necessary.
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