Anda di halaman 1dari 42

Bacillary

Dysentery
Shigellosis
Prepared by:
Ma. Danica C. Consuelo
BSN III-B
Mr. Richard Bartolata
professor
DEFINITION
The term dysentery is
used in connection with
various intestinal
disturbances. The modifying
word bacillary is employed
to denote that form of
dysentery caused by specific
bacilli of the dysentery
group.
Bacillary Dysentery is
an acute bacterial
infection of the
intestine.
It is a contagious
infection, occurs in
epidemics
and occurs more
frequently in the
summer and fall.
Epidemics are most
frequent in
overcrowded
populations with
inadequate sanitation.
Patients with mild
undiagnosed infections
have only transient
diarrhea or no
intestinal symptoms.
Severe infections are
E t I o l o g I c A g e n t
The causative agent is a bacteria of
the Shigella (Kiyoshi Shiga ) group,
a short, nonmotile, gram negative
organism
There are four serologic groups:
1. Shigella dysenteriae (Group A)
considered as the most
infectious
their habitat is almost
exclusively the GIT of man
they rarely invade the blood
stream, and are cultured from
Scanning
Electron
Micrograph of
Shigella
dysenteriae
Gramnegative,
enteric,
facultatively
anaerobic, rod
prokaryote;
causes bacterial
dysentery. This
species is most
often found in
like other gram negative
bacilli, they develop
resistance against
antibiotics
2. Shigella flexneri (Group B)
predominant in developing
countries
common in the Philippines
3. Shigella boydii (Group C)
4. Shigella sonnei -the
commonest but also the
mildest form. Many milder
cases are probably never
diagnosed and so never
reported, so the true
incidence may be
substantially higher.

Scanning Electron
Micrograph of Shigella sonnei
Gramnegative, facultatively
anaerobic, rod prokaryote;
causes shigellosis (bacterial
dysentery). This species is most
often linked to infection from
food.
I n c u b a t I o n P e r I o d
Seven hours to seven
days with an average
of three to five days.
Period of Communicability
The disease is
communicable during the
acute phase and until the
microorganism is absent
from the bowel discharges,
usually within a few weeks
even without specified
therapy. A few individuals
became carriers for a year
or two.
Mode of Transmission
The organism is transmitted
through ingestion of contaminated
food or drinking contaminated
water or milk.
It is transmitted by flies or through
other objects contaminated by
feces of the patient.
Fecaloral transmission is
possible.
Handto mouth transfer of
contaminated material
Swimming in infected
waters.
Eating contaminated food
with human sewage (either
directly or via contaminated
water) especially with cold
uncooked foods such as
In developing countries, Shigella is
a common infection because of
inadequate sewage disposal and lack
of effectively treated water
supplies. It is a cause of severe,
potentially fatal, infection in
children. Shigella is of major
importance in refugee camps or
following natural disasters, when
once again disposal of sewage and
the provision of clean water may
be extremely difficult. It has been
suggested that in developing
countries flies may spread the
infection from person to person, as
the disease is commonest at the
P a t h o l o g y
After the incubation period,
the organism invades the
intestinal mucosa and causes
inflammation. The organism
invades the cells lining the
large bowel and multiplies
there, killing the cell; this is
the cause of the symptoms
produced. However, it
occasionally invades the
bowel beyond the surface
Dirty,
fibrinous
sloughing
areas or
ulcers are
formed
Within the
few days,
the stool
may contain
pus, mucus
and blood.
Clinical Manifestations
Fever especially in children
Tenesmus, nausea, vomiting,
and headache
Colicky or cramping abdominal
pain (days to weeks) associated
with anorexia and body
weakness.
Diarrhea with bloodymucoid
stool that is watery at first
Rapid dehydration and loss of
C o m p l I c a t I o n s
Rectal prolapse particularly
in undernourished children.
Nonsuppurative arthritis
with one or several joints
involved (accompanied with
fever and a serous effusion
into the joint, which has
sometimes been found to
contain Shigas bacillus).
Anemia
Parotitis (due to secondary infection
from mouth organism)
Bacteraemia occurs primarily in
malnourished children
Hemolysis (destruction of RBC)
Ulceration in the intestine can lead to
severe blood loss
In rare cases, the bacteria may enter the
bloodstream from the digestive tract and
infect other body organs, such as
kidneys, gallbladder, liver or heart and
joints. This may cause shock and death.
Shock marked by a weak pulse, coldness,
sweating, and irregular breathing, and
resulting from a situation such as blood
loss
Diagnostic Procedures
Fecalysis or microscopic
examination of the stool.
Rectal swab a laboratory
test to isolate and identify
organisms in the rectum
that can cause
gastrointestinal symptoms
and disease. Normally, many
organisms are present in the
lower gastrointestinal (GI)
tract, but some can act as
pathogens (diseasecausing
organisms) in the bowel.
Peripheral blood examination.
Blood tests
>Full blood count and ESR
looking for anemia, infection
or inflammation
>Electrolytes to assess loss
e.g. low potassium, magnesium
and calcium
>Iron studies looking for iron
deficiency due to blood loss or
malabsorption
>Vitamin B12 to assess
malabsorption
Nursing
Process
A S S E S S M E N T A S S E S S M E N T
Lower abdominal tenderness Lower abdominal tenderness
Normal or increased bowel sounds Normal or increased bowel sounds
Hydration Status Hydration Status
evaluation for thirst, oral mucous evaluation for thirst, oral mucous
membrane dryness, sunken eyes, a membrane dryness, sunken eyes, a
weakened pulse, and loss of skin weakened pulse, and loss of skin
turgor turgor
liquid stool should be measured liquid stool should be measured
and recorded along with a record and recorded along with a record
of the frequency of stools. of the frequency of stools.
(note the consistency and (note the consistency and
appearance and the presence of appearance and the presence of
Health History Health History
determine whether the patient has determine whether the patient has
been in contact with anyone who has been in contact with anyone who has
recently had diarrheal disease recently had diarrheal disease
what the patient has recently eaten what the patient has recently eaten
(meal preceding the illness and about (meal preceding the illness and about
all food intake in the previous all food intake in the previous 3 3 to to 4 4
days). days).
If the patient is employed in a food If the patient is employed in a food
preparation service. preparation service.
D I A G N O S I S D I A G N O S I S
(nursing diagnoses) (nursing diagnoses)
Deficient fluid volume related to Deficient fluid volume related to
fluid loss through diarrhea and fluid loss through diarrhea and
vomiting. vomiting.
Deficient knowledge about the Deficient knowledge about the
infection and the risk of infection and the risk of
transmission to others transmission to others
P L A N N I N G A N D G O A L S P L A N N I N G A N D G O A L S
To maintain fluid and electrolyte To maintain fluid and electrolyte
balance. balance.
To increase knowledge about the To increase knowledge about the
disease and risk of transmission. disease and risk of transmission.
I N T E R V E N T I O N
*Correcting Dehydration Associated with Diarrhea
Assess the degree of dehydration
'''' ''-'u ':-'u ''- '
+vv- ++-u- +v -u'
'u--' '-)
Rehydration goal deliver about 50mL
of oral rehydration solution (ORS) per
1 kg of weight over a 4hour interval.
''- ''-'u '-vuu
-. '-- -'u v.
-u' ' -' +vv-
++-u- 'u-u- +- -
-vuu u-u')
Rehydration goal about
100mL /kg over 4 hours.
6 |'-'u '-'u- - ' |-:''
-' :v'-. -u-'-. '' +''-
-:'' -'u. +-)
Rehydration goal intravenous replacement
as ordered until hemodynamic and mental
status return to normal.
When improvement is
evident, the patient can be treated with
ORS.
*Restrict foods until nausea and vomiting
subsides.
Increasing Knowledge and Preventing Spread of
Infection
*Emphasize principles of safe food
preparation, with special attention to
meat preparation and cooking
>adequate provision for storage and
reheating to meat temperature
thresholds is important.
>it is important to use different
surfaces, knives, and other
equipment for meat and nonmeat
items.
> Excreta must be properly
disposed.
>Concurrent and terminal
disinfection should be employed.
*Diarrheal diseases should be
reported to local health
departments
*The need for rehydration and
refeeding should be taught to
parents.
*Good hygiene in the health care
delivery and home settings must be
a focus.
M o d a l I t I e s o f T r e a t m e n t
Antibiotics such as Ampicillin,
Tetracycline or Cotrimoxazole is
useful in severe cases or when
the spread of infection to other
people is likely and when the
patient is very young
IV might be infused with normal
saline (with electrolyte) to
prevent dehydration.
Anti diarrheal drugs are
contraindicated because they
delay fecal excretion that can
lead to prolong fever.
Diet: Liquid or soft diet until
diarrhea stops, then return to
normal diet .
E V A L U A T I O N
*Expected Patient Outcomes
1. Attains fluid balance
a. Output approximates intake
b. Mucous membranes appear moist
c. Normal skin turgor
2. Acquires knowledge and understanding
about infectious diarrhea and
transmission potential
a. Takes proper precautions to prevent
spread of infection
b. Describes principles and techniques
of safe food storage, preparation
and cooking
Methods of Prevention and Control
Sanitary disposal of human feces.
Sanitary supervision of processing,
preparation and serving of food
particularly those eaten raw.
Adequate provision and protection
for safe water supplies.
Fly control and screening to
protect foods against fly
contamination.
Construction of safe privy.
Emphasizing good personal hygiene.
Provision of adequate hand washing
facilities.
Control of infected
individual contacts and
environment.
Reporting to Local Health
Officer.
Rigid personal precautions by
attendants.
Isolation of patient during
acute illness.
The following need advice from Environmental
Health officers or a Consultant in Communicable
Disease Control (CCDC):
Food handlers who touch
unwrapped food to be consumed
raw or without further cooking.
Healthcare, nursery or other
staff who have direct contact with
people who are susceptible to
infection .This includes simply
serving food to them.
Children under 5 years attending
nurseries, play groups, nursery
schools etc.
Older children or adults with
poor standards of personal
hygiene like the mentally ill,
handicapped or the elderly
infirm.
Thank You
Sources:
Bower, Albert G., Craft, Nina, and Pilant,
Edith. Communicable Diseases: A
Textbook for Nurses, Merriam and
Webster, Inc. Manila, Philippines,
Eighth Edition.
Mondejar, Dionesia and Navalez.
Handbook of Common Communicable
and Infectious Diseases, C & E
Publishing, Inc. 1622 Quezon
Avenue, South Triangle, Quezon City,
2006
http://www.rxmed.com/b.main/b1.illnes
s/b1.1.illnesses/DYSENTERY,BACILL
ARY%20(Shigellosis).htm
http://www.adelaide.edu.au/mbs/resear
ch/ibp/research/shig/Shigella.jpg
http://www.healthphone.com/consump
_english/a_healing_center/disorders_
of_digestion/bacillary_dysentery.htm
http://www.rxmed.com/b.main/b1.illnes
s/b1.1.illnesses/DYSENTERY,BACILL
ARY%20(Shigellosis).htm
http://www.amm.co.uk/files/factsabout/f
a_shig.htm
***