A Family Doctor's Tale - SHIGELLA DYSENTERY

DOC I HAVE SHIGELLA DYSENTERY

Shigella Dysentery is an acute invasive infection  of the lining of the intestines caused by a bacteria of the genus Shigella resulting in leakage of fluid from the cell into the intestine(diarrhea), abdominal pain and vomiting.

The causes of Shigella Dysentery are:
4 subspecies of Shigella has been recognised as causative agents:

1.Group A :Shigella dysenteriae

2.Group B :Shigella flexneri

3.Group C :Shigella boydii

4.Group D :Shigella sonnei (most common in North America, Europe and Japan

Humans are the only known reservoir of Shigella infection.

Transnission occurs most often by close personal contact through hands or soiled clothing or fecal-oral contamination.

The bacteria pass through the gastric acid barrier relatively easily and proliferate in lower ileum and colon.

Multiplication of bacteria occurs within the epithelial cells followed by micro-abscesses on the villi of intestine.

Stools can contain red blood cells and white blood cells.

There may blood in the stools.

Since the infection is superficial, bacteremia is rare and perforation of the colon seldom occurs.

The symptoms of Shigella Dysentery are:
Incubation period is one to two days.

In the early phases lasting one to three days, the main symptoms of Shigella Dysentery are:
1. watery diarrhea with blood and mucus
2. cramping abdominal pain
3. fever up to 40 degrees centigrade
4. headache and bodyaches
5. serious fluid loss especially in children
6. loss of appetite and energy

In the later stages:
1.bowel movements quantity decreases but still contain blood and mucus
2.fever has subsided
3.decreased appetite and energy
4.weight loss
5.convulsions may occur in children

Shigella Dysentery can be transmitted by:
Shigella Dysentery can be highly contagious. The germs are commonly transmitted by people with unwashed hands.

People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.

Doctors generally diagnose Shigella Dysentery based on

1.the symptoms and a physical examination.

2.stool sample to test for shigella and microscopic examination.

Microscopic examination shows the presence of red blood cells and polymorphs white blood cells.

Treatment of Shigella Dysentery is by:

1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.

Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.

The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness

Mild dehydration can be treated by drinking liquids.

Severe dehydration may require intravenous fluids and hospitalization.

Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

2.Antibiotics is necessary,the choice of which depends on the sensitivity of bacteria to the antibiotic.

3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).

The following steps may help relieve the symptoms of Shigella Dysentery
1.Allow your gastrointestinal tract to settle by not eating for a few hours.


2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.


3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes.

4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.


5.Avoid dairy products, caffeine, and alcohol until recovery is complete.


6.Get plenty of rest.

Prognosis of Shigella Dysentery is:
50% of Shigella dysentery develop full blown symptoms as above

25% will only have watery diarrhea

Symptoms usually improve within one to 2 days after the onset of treatment.

Outcome is usually excellent with appropriate treatment.

Prevention of Shigella Dysentery is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated