Dysentery/Bloody diarrhea

Dysentery is the bloody diarrhea.

1. DR ABDUL SAMI MPHIL EASTERN MEDICINE The I slamia U niversity of B ahawalpur Pakistan

2. dysentery Dysentery is bloody diarrhoea , i.e. any diarrhoeal episode in which the loose or watery stools contain visible red blood cells. Dysentery is most often caused by Shigella species (bacillary dysentery) or Entamoeba histolytica (amoebic dysentery ). A painful intestinal infection that is usually caused by bacteria or parasites. Dysentery is defined as diarrhea in which there is blood, pus, and mucous, usually accompanied by abdominal pain.

3. Types of dysentery There are two main types of dysentery . The first type , amoebic dysentery or intestinal amoebiasis , is caused by a single-celled, microscopic parasite living in the large bowel. The second type , bacillary dysentery, is caused by invasive bacteria. Both kinds of dysentery occur mostly in hot countries.

4. Epidemiology Prevalence of amebic infection varies with level of sanitation and generally higher in tropics and subtropics than in tempearate climates. *Worldwide prevalence is about 10% to 50% *Cyst passers are important source of infection The true estimated prevalence of E. histolytica is close to 1% worldwide. Entamoeba histolytica is the second leading cause of mortality due to parasitic disease in humans. (The first being malaria). Amebiasis is the cause of an estimated 50,000-100,000 deaths each year.

5. LIFE CYCLE

6. Amebiasis (Amebic Dysentery) Causal agent: Entamoeba histolytica is well recognized as a pathogenic amoeba . History: Loosh was first described in 1875 Geographic Distribution: Worldwide, with higher incidence of amebiasis in developing countries.  In industrialized countries, risk groups include travelers and recent immigrants.

7. Risk factors People in developing countries that have poor sanitary conditions Immigrants from developing countries Travellers to developing countries People who live in institutions that have poor sanitary conditions HIV-positive patients

8. TRANSMISSION 1-driect contact of person to person . 2- Food or drink contaminated with feces containing the cyst. 3- Use of human feces (night soil) for soil fertilizer. 4- contamination of foodstuffs by flies, and possibly cockroaches.

9. Incubation period 3 days in severe infection; several months in sub-acute and chronic form. In average case vary from 3-4 weeks.

10. Entamoeba histolytica T wo forms – T rophozoite (vegetative)-fragile Cyst -this is the infective stage -survives for weeks. -infective dose can be a single cyst source of infection is a case or carrier -1.5*107 cysts per day reservoir is only human –several years resistant to chlorine in normal conc. readily killed by freezing or heating(55°C)

11. Trophozoite Cyst

12. Clinical findings - 1% of cases - inflammatory thickening of intestinal wall Diarrhea Skin elasticity increases easily hold in fingers Abdominal pain or cramps Fever Dehydration, Length of symptoms 2 to 4 weeks Anemia, Weight loss, Anorexia

13. Acute amoebic dysentery Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus . Diarrhea, watery and foul-smelling stools often containing blood-streaked mucus. Nausea, flatulence and abdominal distension, and tenderness in the right iliac region over the colon

14. Chronic dysentery Attack of dysentery lasting for several days, usually succeeded by constipation. Tenesmus accompanied by the desire to defecate. Anorexia, weight loss and weakness. Liver maybe enlarged. The stools at first are semi-fluid but soon become watery, blood, and mucoid . Vague abdominal distress, flatulence, constipation or irregularity of the bowel. Mild anorexia, constant fatigue and lassitude Abdomen lost its elasticity when picked---up between fingers. On sigmoidoscopy , scattered ulceration with yellowish border .

15. complication Extra-intestinal Amoebic liver abcess via portal system 5% of invasive disease 10 times more common in men Pleuropulmonary - direct spread from liver abcess (10%) - haematogenous spread Brain - abrupt onset & rapid progression - death in 12-72 hrs

16. diagnosis Medical History: Food history, Travelling history. Defecation per day. Blood In stool. Physical and symptomatic investigation. Lab Investigation. Stool culture Hb level to see anemia Ultrasound Sigmoidoscopy

17. treatement Fluid replacement therapy if more dehyderation . Anti biotics Anti inflamatory drugs. Anti hemorrhagic drugs.

18. prevention wash your hands with soap and warm water after using the toilet . wash your hands before handling, eating or cooking food. avoid sharing towels. wash the laundry of an infected person on the hottest setting as possibl . Avoid to drink tape water and drink sterrile water. Avoid food and drink sold by street vendors. Avoid to drink tape water during travelling.