Dysentery

DYSENTERY

            It is an infection of the intestinal tract characterized by severe diarrhea with blood and mucus. Dysentery is caused by bacteria (bacillary) or protozoa (Amoebic).

Types

a)      Bacillary dysentery or Shigellosis

Is an acute bacterial infection of the lining of the small and large intestine caused by a bacteria of the genus Shigella and is transmitted through contact with a patient or carrier or by ingestion of contaminated foods and water by their feces. (More)

b)     Amoebic dysentery

It is a protozoan infection Entamoeba histolytica resulting to an ulceration and perforation of the intestines. In some serious and rare cases, the patient may develop an abscess in the liver (Amoebic or tropical abscess), brain, testes and lungs.

The appearance of the symptoms is depending on the immunity of a person or carrier.

Some may develop days or even years after the infection.

The disease is mostly confined in the tropical and subtropical countries. (More)

Causative Agent

1.      Bacillary dysentery- Shigella

2.      Amoebic dysentery- Entamoeba histolytica

Mode of Transmission

      Eating contaminated foods

      Hand to mouth transfer of contaminated materials,

      flies, objects and soiled with discharges of infected person/ contaminated water.

Signs and Symptoms

            Symptoms develop after 1-6 days after the infection.

• Chills, fever
• Nausea and Vomiting
• Colicky abdominal pain with tenderness
• Diarrhea with tenesmus – painful straining during defecation or feeling to defecate. (watery, mucoid, with blood streaks)

Diagnostic Exam

• Stool exam- should be submitted 1 to 2 hrs after collection because organism will dry.
• Occult blood test/Guaiac Test

Nursing Care

·         Monitor the patient input and output by assessing the frequency, amount, and consistency of stool

·         Replacement of fluids and electrolytes through an IVF or ORESOL

·         Enteric precaution must be implemented.

·         Pre-anal care should also consider.

·         Examine the source of infection (food, water, milk etc)

Prevention

·         A vaccine called TAB may give temporary immunity to disease in case of epidemic

• Good sanitation/ hygienic practices
• Safe water supply – boil water for drinking
• Handwashing to prevent spread and contracting the disease.
• Avoid 5 F’s

Treatment: Cotrimoxazole

	Cholera	Bacillary D.	Amoebic D.
Synonym	El tor	Shigellosis	Amoebiasis
Causative Agent	Vibrio comma Vibrio cholerae >Bacteria	Shigellosis Shigella Dysenteriae > Bacterial	Entamoeba Hystolitica > Protozoan
Mode of Transmission	Fecal/oral Contaminated water Sea shells, oysters	Fecal/oral Fresh raw vegetables	Fresh/raw vegetables Fresh raw vegetables
Symptoms	Explosive -diarrhea, vomiting > dehydration > death – rigor mortis sets in (stiffening of muscle) ATP – responsible for stiffening of muscle Washer woman’s hand	Fever, diarrhea a. stool – solid (initial) b. mucoid blood streak > some signs of dehydration	> On & off diarrhea greenish stool > Mucoid blood streak > Bubbly > Flatulence
Pathognomonic Sign	RICE WATERY STOOLS	MUCOID BLOOD STREAKED STOOL
Treatment	Tetracycline	Cotrimoxazole	Metronidazole

Management

-          Monitor patient’s intake and output of fluid.

-          Check the amount, consistency, and frequency of stool and vomitus

-          Assess the patients level of dehydration

-          Replace fluids & electrolytes loss with IVF as ordered or give ORESOL100ml fluids as an alternative.

-          Do handwashing to prevent the spread of contamination.

-          Enteric precaution must be implemented

-          Peri-anal care should also be performed.

-          Avoid gas forming fatty foods

-          Proper disposal of excreta

-          Proper preparation of food/food sanitation

-          Advise patient to increase fluid intake

Special Precautions

-          Do not give tetracycline to children ages below 8 years old as it may cause permanent staining of the teeth.

-          Never give Tetracycline to pregnant women for the reason that it inhibits the growth and development of fetus long bone.

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Posted in: Communicable Diseases