Dysentery

Overview of Dysentery

Bacillary dysentery is much more common in children than amebic dysentery.

Epidemiology of Dysentery

• Ram, P.K., et al. "Declines in case management of diarrhoea among children less than five years old." Bulletin of the World Health Organization, vol. 86, no. 3, 2008, pp. 161-240.

  • This article reviews the management of diarrheal diseases, including dysentery, in children under five in India. [7] 

• Singh, Jaiprakash, et al. "Epidemiological profile of dysentery in a rural community of western Uttar Pradesh, India." Journal of Communicable Diseases, vol. 42, no. 2, 2010, pp. 131-135.

  • This study provides an epidemiological profile of dysentery in a rural community in western Uttar Pradesh, highlighting the prevalence and risk factors. [8]

• Kumar, Shyamal, et al. "Epidemiological study of diarrhoeal diseases among children under five years in the urban slum of Kolkata." Indian Journal of Public Health, vol. 51, no. 4, 2007, pp. 233-234.

  • This research focuses on the epidemiology of diarrheal diseases, including dysentery, among children under five in the urban slum areas of Kolkata. [9]

Causes of Dysentery 

The bacteria causing bloody diarrhea are

• Shigella species
• Enteroinvasive
• Enterohemorrhagic E. coli
• Salmonella
• Campylobacter jejuni
• flexneri is the commonest organism reported in developing countries and S. dysenteriae is associated with epidemics of dysentery.
• Medications – e.g. Rifaximin, Sulfasalazine
• Cancer
• Yersinia [4]

Types of Dysentery

The people experiencing dysentery either develop amoebic dysentery and bacterial dysentery.

1. Bacterial Dysentery or Bacillary Dysentery

• This type of dysentery is a result of infection with bacteria from Salmonella, Shigella, Campylobacter, or enterohemorrhagic E. coli.
• The diarrhea from Shigella is also called shigellosis. Shigellosis happens to be the most common type of dysentery.

      2. Amoebic Dysentery

• Also known as amoebiasis, amoebic dysentery is caused by a single-celled parasite infecting the intestines.
• This type of dysentery is a rare occurrence in the developed world and is mostly found in the tropical locales with poor sanitation.
• A person can also become infected if they are traveled to a country where it is an endemic.(5)

Risk factors of Dysentery

• The children are at a higher risk of shigellosis but it can occur at any age. It can easily spread from person to person and through contaminated food and water.
• It usually spreads from close contact with an infected person at home, in schools, in day care centers and in nursing homes.
• Amoebic dysentery is mostly spread by eating contaminated food or drinking polluted water in tropical areas with poor sanitation.(5)

Pathogenesis

Dysentery is caused when the bacteria escape the epithelial cell phagolysosome, multiply within the cytoplasm, and destroy host cells. Shiga toxin causes hemorrhagic colitis and hemolytic-uremic syndrome by damaging endothelial cells in the microvasculature of the colon and the glomeruli, respectively. [10]

Pathophysiology

• Dysentery results from viral infections, bacterial infections, or parasitic These pathogens typically reach the large intestine after entering orally, through ingestion of contaminated food or water, oral contact with contaminated objects or hands, and so on.
• Each specific pathogen has its own mechanism or pathogenesis, but in general the result is damage to the intestinal lining, leading to the inflammatory immune response.
• This can cause elevated temperature, painful spasms of the intestinal muscles (cramping), swelling due to water leaking from capillaries of the intestine (edema), and further tissue damage by the body’s immune cells and the chemicals, called cytokines, they release to fight the infection.
• The result can impaire nutrient absorption, excessive water and mineral loss through the stools due to breakdown of the control mechanisms in the intestinal tissue that normally remove water from the stools, and in severe cases the entry of pathogenic organisms into the bloodstream.
• Some microorganisms – for example, bacteria of the genus Shigella– secrete substances known as cytotoxins, which kill and damage intestinal tissue on contact.
• Viruses directly attack the intestinal cells, taking over their metabolic machinery to make copies of themselves, which leads to cell death.[4]

Clinical Features

After a short incubation period (1–4 days), there is a sudden onset of abdominal pain, fever, and watery diarrhea. A day or so later, as the infection involves the colon, the stools become scant and contain blood and mucus. Severe dehydration and electrolyte loss may occur. In shigellosis, sigmoidoscopy reveals an inflamed, engorged mucosa with punctate exudations or ulcers. [10]

Sign & Symptoms

• A child with bacillary dysentery presents with fever and diarrhea.
• Diarrhea may watery to start with, but then shows mucus blood mix with stools.
• There is tenesmus, which refers to ineffectual defecation along with straining and suprapubic discomfort.
• The illness may complicate by dehydration, dyselectrolytemia, hemolytic uremic syndrome, convulsions, toxic megacolon, intestinal perforation, rectal prolapse also, very rarely, Shigella encephalopathy. [1]

Clinical examination of Dysentery

Vitals

Pulse

• Tachycardia may be present

Blood Pressure

• Hypotension may be present

Skin

• Skin may appear dry and skin pinch may be delayed due to dehydration.

HEENT

• The mouth and lips may appear dry due to dehydration.

Abdomen

• Lower abdominal tenderness may also be present.[4]

Diagnosis of Dysentery

• Your healthcare provider will diagnose dysentery. They’ll ask about your symptoms, conduct a physical exam and order tests.(6)

Prognosis of Dysentery

• With correct treatment, most cases of amoebic and bacterial dysentery subside within ten days, and most individuals will achieve a full recovery within two to four weeks after beginning proper treatment.
• If the disease is left untreated, the prognosis varies with the immune status of the individual patient and the severity of disease.
• Extreme dehydration can prolong recovery and significantly raises the risk for serious complications.[4]

Differential Diagnosis of Dysentery 

Dysentery must be distinguished from

• Inflammatory bowel disease (ulcerative colitis, Crohn disease),
• Ischemic colitis,
• Amebiasis. [10]

Complication

• Shock
• Delirium
• Hemolytic uremic syndrome
• Thrombotic thrombocytopenic purpura
• Reactive arthritis [4]

Investigation

• Stool culture and sensitivity should be sent for before starting empirical antibiotics.
• CBC
• If your healthcare provider suspects you have dysentery, they’ll order a stool culture.
• To conduct a stool culture, your healthcare provider will give you a special container and a disposable spoon. The next time you have to poop, you’ll place plastic wrap or newspaper across the rim of your toilet to collect your poop. You can also poop into a different container. You’ll then use the disposable spoon to collect a small sample, put it in the special container and return it to your healthcare provider.
• Your healthcare provider will send your sample to a lab. There, lab workers will test your sample for the presence of bacteria, parasites or ova (parasite egg cells).
• You may have to provide samples of your poop over several days.
• Your healthcare provider may also recommend a sigmoidoscopy. A sigmoidoscopy can help your healthcare provider confirm the diagnosis or rule out other causes of your symptoms. During a sigmoidoscopy, your healthcare provider will use a special scope to examine the inside of your lower (sigmoid) colon and rectum.(6)

Treatment of Dysentery

• Administration of ORS
• Continuation of oral diet
• zinc supplementation
• Antibiotics are the components of treatment
• Based on safety, low cost and efficacy, ciprofloxacin is the first line antibiotic for shigellosis.
• Intravenous ceftriaxone should be the first line of treatment in a sick child.
• Oral azithromycin can be used for shigellosis but the experience is limited.
• Amebic dysentery is less common among children.
• Tinidazole or metronidazole is the drug of choice.
• Any young child presenting with blood in stools and persistent abdominal pain should be suspected to have intussusception and evaluated accordingly.[1]

Prevention of Dysentery

• Wash hands regularly using soap and water particularly before & after using bathroom and food preparation.
• Drinking water only from reliable sources such as bottles and cans that are well-sealed
• Ensuring that food is cooked in good conditions
• Cleaning the top of rim after opening the bottle and before drinking from it
• Avoiding ice cubes as its water source may be unknown
• Using purified water for cleaning the teeth
• Being careful while changing a baby’s diaper.
• Preventing yourself from swallowing water while swimming
• Avoid unpasteurized milk, cheese or dairy products
• Drinking tap water which is boiled for at least 1 minute or filtered through a 1-micron filter with chlorine or iodine tablets added
• Eating washed and peeled fruit or vegetables. (5)

Homeopathic Treatment of Dysentery

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes 

• The medical history of the patient, 
• Physical and mental constitution, 
• Family history, 
• Presenting symptoms, 
• Underlying pathology, 

• Possible causative factors etc. 

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. 

What Homoeopathic doctors do? 

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’? 

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. 

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines. 

Homeopathic Medicines for Dysentery

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor. 

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).  

Medicine:

Aconite

• It may be used, esp. if the disease occurs in Autumn, when warm days are followed by cold nights.
• In the incipient stages such troubles may be promptly checked by it esp. when they are ushered in with a high temperature.
• The high fever is associated with great thirst, good deal of colicky pains and restlessness.
• The stools are scanty, bloody and slimy and are evacuated with much tenesmus. If it fails, it is followed well by Merc.

Aloe

• It is useful, when there is griping pain in the hypogastrium, before stool.
• The stools consist of blood and mucus, coming out in jelly-like masses.
• The griping may or may not cease after stool. In addition, an extraordinary amount of mucus is expelled.

Arsenic Alb

• Indicated in most serious cases, whose exciting causes are: Sudden chilling of the stomach and bowels by ice-water or ice- cream; alcoholic drinks in excess; certain poisons as the ptomaine of sausage meat that has been spoiled; rancid fat; spoiled butter or fat that has undergone decomposition; and lobster salads at certain seasons of the year.
• The patient is very sick, as if near death’s door but he is restless and complains of burning thirst and yet exhibits an intolerance of water.
• Burning pains The discharges from the bowels are brownish or blackish, and horribly offensive.

Baptisia

• You will have to give it, when the discharges are offensive, bloody and attend by tenesmus, but with a significant absence of pain, showing an alarming depression of vitality.[3]

Cantharis

• It is of use, when the discharges are bloody and slimy and mix with flakes, that look like scrapings from intestines, but in reality, fibrinous formations, resulting from the inflammation.
• Colic-like pains of a cutting, burning, griping or wandering character, doubling the patient up.
• Tenesmus mark and is almost always associated with dysuria.

Capsicum

• It is good for Dysentery occurring in moist weather and best indicate in stout flabby persons.
• The stools are bloody and slimy and contain shaggy pieces; they are frequent, but small in quantity and attended with violent tenesmus and burning in both rectum and bladder.
• The pains and other symptoms increase by the slightest draft of either warm or cold air.
• There is thirst, but drinking of water causes shuddering and increases the pains. [3]

Carbo Veg

• It indicate in very severe cases, with great weakness and Hippocratic face, when: The discharges from the bowels are brown, watery and slimy and both stools and flatus are horribly offensive.
• The abdomen greatly distend and tympanic.
• There burning pains situated deep in abdomen, usually in one or the other of the bends of the colon.
• The pulse is weak and intermittent.
• In typhoid conditions as a sequel to Dysentery, it presents a more perfect picture of collapse and there are tympany, cold legs, esp. up to the knees, filiform pulse, cool breath, absence of discharges from the bowels or involuntary, putrid, bloody, purulent diarrhoea. The patient is, as if, near death.

Cinchona

• It indicate in severer cases, when putrid or gangrenous changes occur .
• The discharges are cadaverous smelling, and are of a dark or of a chocolate color, with coldness, great debility and Hippocratic face; the movements from the bowels provoke by every attempt to eat and drink.
• The abdomen greatly distend and tympanitic Belching gives but temporary relief.

Colchicum

• It indicate in the discharges from the bowels are frequent, watery and bloody containing white flakes or shreds, and followed by violent tenesmus, constriction of the anus and spasm of the sphincter ani, tormenting the patient more than the urging during stool.

Colocynth

• The stools slimy and bloody-contain the so-call scrapings of intestines, made worse by any attempt to eat or drink.
• They precede by violent tenesmus which ceases after stools.
• Pains are atrocious-griping, cutting, stabbing colicky pains, which force the patient to bend double or to press firmly against the abdomen; they more often precede the stool and relieve afterwards, although they may sometimes continue after stool.[3]

Dioscorea

• Just before and during stool severe pain in sacral region and bowels, of a writhing drawing character; the pains radiate upward and downward, until the whole body and extremities, even the fingers and toes, become involved with spasms, eliciting shrieks from the patient.
• Spasmodic pains in the bowels, with unusually severe tenesmus.
• Tools like abdomen, but lumpy, with straining and burning in rectum, and sensation as if the faeces were hot during the stool nearly fainting.

Gambusia

• Chill and pain in back; bitter taste in the mouth, burning of the tongue; soreness all over; watery stools attended with colic or green mixed mucus, with burning tenesmus and prolapses ani; offensive, frequent and copious stools, coming out all at once, giving great relief.

Kali bich

• It indicate when the disease occurs periodically in the Spring, or in the early part of Summer.
• The stools are brownish and watery and mixed with blood and mucus and attended with great tenesmus.
• The distinctive symptom is the appearance of the tongue, which is dry, smooth, red and cracked.[3]

Mercurious

• Excoriating discharges; cutting in the lower part of the abdomen, at night; the abdomen is externally cold to the touch;
• Cutting stitch in the lower abdomen, from right to left, and aggravated by walking;
• Faecal putrid taste in the mouth; nausea; with vertigo obscured vision, and flashes of heat offensive perspiration
• The pains increase before the stool and during the stool, with violent tenesmus;
• The pains rather increase after a stool, and sometimes they extend to the back, during the stool, hot sweat on the forehead, which soon becomes cold and sticky; frequent discharge of pure blood or bloody green mucus, like stirred eggs, screams during stool (in children). Aggravation during night till about 3 A.M.

Nitric Acid

• In general, Diphtheric dysentery burning in rectum towards perineum, with ineffectual urging; straining without stool; stools bloody, with tenesmus; putrid, mucous.
• Moreover, After which the tenesmus continues, followed by headache; dryness of throat.
• Lastly, Violent thirst, intermittent pulse; anxiety and general uneasiness, exhaustion.

Nux Vomica

• Stools, small, slimy, bloody, with urging.
• Tenesmus ceasing after stool, like pitch with blood.
• Pressing in loins also upper part of sacral region, with sensations if broken; longing for brandy.
• Milky sours on stomach; great debility with over sensitiveness of all the senses; hypochondriac mood.

Sulphur

• It will be the remedy in acute diseases when after the administration of Merc. the tenesmus and blood have ceased, but the mucus still persists.
• A very strong characteristic symptom, which often indicates it in Dysentery, etc.
• The lips are of a rich color or the redness of the various orifices of the body.
• It best-adapt to chronic or persistent cases, esp. when tenesmus continues from one evacuation to another.
• When the bleeding and tenesmus have abated, the stools are still slimy, with frequent sudden urging; or particularly after tenesmus has ceased, mucus and blood still discharge.[3]

Diet & Regimen of Dysentery

• Avoid dairy products. If you have lactose intolerance, then dairy products can be a major cause of diarrhoea and should be avoided in general.
• Do steer clear of too much fiber. Fiber is incredibly healthy when it comes to your everyday diet.
• Eat a simple diet. The traditional anti-diarrhoea diet was the "BRAT" diet, which stood for bananas, rice, applesauce, and toast.
• Wash your hands regularly. When you do wash, scrub your palms, the back of your hands, between your fingers, and under your nails, and do it for at least 20 seconds
• Stay hydrated. Above most other things, replenishing the fluids that can be lost during severe diarrhoea is an important step to take.[2]

Do’s & Don’ts

Dysentry do’s & Don’ts

Do’s:

• Do seek medical attention: If you experience symptoms of dysentery, such as bloody diarrhea, fever, or abdominal pain, seek medical attention promptly. Early diagnosis and treatment are crucial.
• Do practice good hygiene: Wash your hands frequently with soap and water, especially after using the toilet and before handling food. This can help prevent the spread of the infection.
• Do stay hydrated: Drink plenty of fluids to replace those lost through diarrhea. Oral rehydration solutions (ORS) are particularly helpful.
• Do follow your doctor’s instructions: Take any prescribed medications as directed and complete the full course of treatment.

Don’ts:

• Don’t self-medicate: Avoid taking antibiotics or other medications without a doctor’s prescription. Inappropriate use of antibiotics can lead to antibiotic resistance.
• Don’t prepare food for others: If you have dysentery, avoid preparing food for others to prevent the spread of the infection.
• Don’t ignore symptoms: If your symptoms worsen or do not improve after a few days, seek further medical attention.
• Don’t travel while ill: Avoid traveling while experiencing symptoms of dysentery to prevent spreading the infection to others.

Terminology

Bacillary dysentery: This is the most common type of dysentery, caused by bacteria of the Shigella genus.

Amebic dysentery: This type is caused by a single-cell parasite called Entamoeba histolytica.

Diarrhea: This is the frequent passage of loose, watery stools.

General Terms:

• Dysentery: Inflammation of the intestines resulting in bloody diarrhea.
• Diarrhea: Frequent passage of loose, watery stools.
• Tenesmus: Painful, ineffectual urge to defecate.
• Colic: Severe abdominal pain.
• Fever: Elevated body temperature.
• Thirst: Strong desire for fluids.
• Prostration: Extreme exhaustion and weakness.
• Remedy: A homeopathic medicine used to treat specific symptoms.
• Potency: The strength or dilution of a homeopathic remedy.
• Repertory: A reference book used to find remedies based on symptoms.
• Materia Medica: A reference book containing detailed information about homeopathic remedies.

Specific Symptoms and Corresponding Remedies:

• Aconite: Sudden onset, intense fear, restlessness, thirst.
• Belladonna: High fever, flushed face, dilated pupils, throbbing headache.
• Mercurius corrosivus: Violent colic, bloody stools with mucus, burning pain, tenesmus.
• Arsenicum album: Burning pain, restlessness, thirst for small sips, anxiety.
• Colocynthis: Cramping pain relieved by bending double, irritability.
• Chamomilla: Irritability, restlessness, wants to be carried, one cheek red, the other pale.

Other Terms:

• Miasm: A predisposition to certain diseases, believed to be inherited.
• Aggravation: A temporary worsening of symptoms after taking a remedy, considered a positive sign of healing.
• Constitutional remedy: A remedy based on a person’s overall physical and mental characteristics, not just the specific disease symptoms.

References use for Article Dysentery

1. Paediatrics 8^th Edition – O.P. Ghai
2. https://www.lybrate.com/topic/diet-for-dysentery
3. Therapeutic Pointers To Some Common Diseases By E.A. Farrington.
4. https://www.wikidoc.org/index.php/Dysentery_physical_examination
5. Dysentery Types, Causes, Symptoms, Diagnosis & Treatment (hlives.com)
6. Dysentery: Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)
7. Ram, P.K., et al. "Declines in case management of diarrhoea among children less than five years old." Bulletin of the World Health Organization, vol. 86, no. 3, 2008, pp. 161-240.
8. Singh, Jaiprakash, et al. "Epidemiological profile of dysentery in a rural community of western Uttar Pradesh, India." Journal of Communicable Diseases, vol. 42, no. 2, 2010, pp. 131-135.
9. Kumar, Shyamal, et al. "Epidemiological study of diarrhoeal diseases among children under five years in the urban slum of Kolkata." Indian Journal of Public Health, vol. 51, no. 4, 2007, pp. 233-234.
10. Jawetz, Melnick, & Adelberg’s Medical Microbiology, 28th Edition, by Geo. F. Brooks, Karen C. Carroll, Janet S. Butel, Stephen A. Morse, Timothy A. Mietzner (2019), Published by McGraw Hill Professional

Also Search As

Keywords and Phrases:

• Disease-specific: Shigellosis, Amebiasis (types of dysentery)
• Symptom-focused: Bloody diarrhea, Mucous stool, Abdominal cramps, Fever with diarrhea
• Cause-oriented: Bacterial dysentery, Parasitic dysentery, Waterborne illness
• Location-based: Dysentery outbreak, Traveler’s diarrhea
• Treatment-related: Dysentery antibiotics, Rehydration therapy
• Prevention-focused: Food safety, Water sanitation

Search Techniques:

• Boolean Operators: Combine keywords with "AND" (e.g., dysentery AND treatment) to narrow results, or "OR" (e.g., shigellosis OR amebiasis) to broaden them.
• Quotation Marks: Enclose phrases in quotes (e.g., "bloody diarrhea") to search for exact matches.
• Wildcards: Use an asterisk () to find variations of a word (e.g., dysenter for dysentery, dysenteric).

Additional Resources:

• Government Health Agencies: Websites of organizations like the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), or your local health department often have reliable information on dysentery.
• Medical Associations: Organizations like the American Medical Association (AMA) or the British Medical Association (BMA) may have articles or resources on their websites.
• News Outlets: Reputable news sources can provide information on current outbreaks or research developments related to dysentery.

Search Engines:

• General search engines: Use Google, Bing, or DuckDuckGo and enter keywords like "dysentery," "symptoms of dysentery," "treatment for dysentery," or "causes of dysentery."
• Specialized search engines: Google Scholar or Microsoft Academic can be used to search for scholarly articles and research papers on dysentery.

Medical Websites and Databases:

• Reputable medical websites: Websites like Mayo Clinic, WebMD, MedicalNewsToday, and Healthline often have articles on dysentery.
• Medical databases: PubMed, a database of biomedical literature, can be used to search for scientific articles on dysentery.

Academic Journals:

• Specialized journals: Journals like "Clinical Infectious Diseases," "The Lancet," and "The New England Journal of Medicine" often publish research on dysentery.
• University libraries: University libraries often have access to these journals, either online or in print.

Libraries:

• Local libraries: Public libraries may have books or magazines with information on dysentery.
• Medical libraries: Medical libraries often have more specialized resources on dysentery.

Health Organizations:

• World Health Organization (WHO): The WHO website has information and publications on dysentery.
• National health organizations: Your country’s health department or ministry may also have information on dysentery.

Tips for searching:

• Use specific keywords: Instead of just searching for "dysentery," try using more specific terms like "bacterial dysentery," "amebic dysentery," or "dysentery outbreak."
• Combine keywords: Use Boolean operators like AND, OR, and NOT to refine your search. For example, search for "dysentery AND treatment" to find articles specifically about treatment options.
• Filter your results: Most search engines and databases allow you to filter results by date, type of publication, or other criteria.
• Check the source: Always make sure the information you find is from a reliable and trustworthy source.