Dysentery
Disease Details
Family Health Simplified
- Description
- Dysentery is an infection of the intestines that causes severe diarrhea with the presence of blood and mucus in the stool.
- Type
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Dysentery is an infectious disease that causes severe diarrhea with blood and mucus. It is primarily caused by bacterial or protozoan pathogens, most commonly by *Shigella* species (bacterial dysentery) and *Entamoeba histolytica* (amoebic dysentery).
Dysentery is not a genetic disorder and does not involve genetic transmission. It is typically spread through contaminated food or water, or direct person-to-person contact. - Signs And Symptoms
- The most common form of dysentery is bacillary dysentery, which is typically a mild sickness, causing symptoms normally consisting of mild abdominal pains and frequent passage of loose stools or diarrhea. Symptoms normally present themselves after 1–3 days, and are usually no longer present after a week. The frequency of urges to defecate, the large volume of liquid feces ejected, and the presence of blood, mucus, or pus depends on the pathogen causing the disease. Temporary lactose intolerance can occur, as well. In some occasions, severe abdominal cramps, fever, shock, and delirium can all be symptoms.In extreme cases, people may pass more than one liter of fluid per hour. More often, individuals will complain of diarrhea with blood, accompanied by extreme abdominal pain, rectal pain and a low-grade fever. Rapid weight loss and muscle aches sometimes also accompany dysentery, while nausea and vomiting are rare. In many cases there can be cascading cramps that affect the muscles surrounding the entire upper intestine; sometimes severe enough to cause the lining of the intestine to separate from the wall, leading to systemic infection.On rare occasions, the amoebic parasite will invade the body through the bloodstream and spread beyond the intestines. In such cases, it may more seriously infect other organs such as the brain, lungs, and most commonly the liver.
- Prognosis
- With correct treatment, most cases of amoebic and bacterial dysentery subside within 10 days, and most individuals 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 delay recovery and significantly raises the risk for serious complications including death.
- Onset
- The onset of dysentery typically occurs within 1 to 3 days after infection. Symptoms often start suddenly and can include diarrhea with blood or mucus, abdominal pain, fever, and a feeling of incomplete bowel evacuation.
- Prevalence
- Dysentery, an inflammatory disease of the intestine causing severe diarrhea with blood, varies in prevalence globally. It is most common in regions with poor sanitation and limited access to clean water, particularly in parts of Africa, Asia, and Latin America. Prevalence rates can be high in these areas, affecting both children and adults.
- Epidemiology
- Insufficient data exists, but Shigella is estimated to have caused the death of 34,000 children under the age of five in 2013, and 40,000 deaths in people over five years of age. Amoebiasis infects over 50 million people each year, of whom 50,000 die (one per thousand).
- Intractability
- Dysentery is not inherently intractable. It can often be treated effectively with appropriate medical intervention, such as antibiotics for bacterial causes or antiparasitic medications for amoebic causes. Hydration and supportive care are also crucial. Persistent or severe cases may require more intensive treatment and management.
- Disease Severity
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Dysentery is an infectious disease that induces severe diarrhea with the presence of blood and mucus in the stool. The severity of dysentery can vary widely:
- **Mild cases**: Include symptoms like diarrhea, mild abdominal pain, and fever.
- **Severe cases**: Can lead to significant dehydration, intense abdominal pain, high fever, and can be life-threatening if not treated promptly.
Severe cases often require hospitalization and intravenous fluids to manage dehydration and electrolyte imbalances. It is crucial to seek medical attention if dysentery is suspected, especially in vulnerable populations such as young children and the elderly. - Healthcare Professionals
- Disease Ontology ID - DOID:12384
- Pathophysiology
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Dysentery is an inflammatory disease of the intestine, particularly the colon, resulting in severe diarrhea with blood and mucus. The pathophysiology of dysentery involves:
1. **Infectious Agents**: The primary causative agents include bacteria (e.g., Shigella species, certain strains of Escherichia coli) and amoebae (e.g., Entamoeba histolytica). These pathogens invade the intestinal mucosa.
2. **Mucosal Invasion**: The pathogens breach the intestinal epithelial barrier, leading to tissue destruction and inflammation.
3. **Immune Response**: The body mounts an immune response, resulting in the recruitment of inflammatory cells to the site of infection. Cytokines and other inflammatory mediators are released.
4. **Ulceration and Exudate Formation**: This immune response leads to ulceration of the colon and the formation of pus and mucus.
5. **Toxin Production**: Some bacteria release toxins (e.g., Shiga toxin in Shigella) that further damage the mucosa and can have systemic effects.
6. **Decreased Absorption and Increased Secretion**: The disruption of the mucosal surface impairs absorption and increases secretion of fluids and electrolytes, contributing to diarrhea.
7. **Blood and Mucus in Stool**: The necrotic mucosa and inflammatory exudate result in the presence of blood, mucus, and pus in the stool.
The combination of these pathological processes leads to the characteristic symptoms of dysentery, including severe abdominal pain, fever, and frequent, small-volume, bloody diarrhea. - Carrier Status
- Carrier status is not applicable (nan) for dysentery, as it is an acute infectious disease primarily characterized by severe diarrhea with the presence of blood and mucus in the feces. It is caused by bacterial, protozoan, or parasitic infections, most commonly by Shigella (shigellosis) or Entamoeba histolytica (amoebiasis). There isn't a chronic carrier state similar to that found in some other infectious diseases.
- Mechanism
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Dysentery is an inflammatory disorder of the intestine, particularly of the colon. It primarily results in severe diarrhea with the presence of blood and mucus in the stool. Dysentery can be caused by various pathogens, most commonly bacteria like Shigella (shigellosis) and protozoa like Entamoeba histolytica (amoebiasis).
**Mechanism:**
1. **Bacterial Dysentery (Shigellosis):**
- **Invasion and Colonization:** Shigella bacteria invade the epithelial cells of the colon. They utilize a type III secretion system to inject virulence factors directly into host cells.
- **Intracellular Spread:** Once inside epithelial cells, Shigella uses actin-based motility to spread from cell to cell, causing extensive tissue damage and inflammation.
- **Inflammation and Immune Response:** The invasion prompts an acute inflammatory response, leading to the release of cytokines and recruitment of immune cells. This results in tissue destruction, predominantly in the colon, producing characteristic symptoms like bloody diarrhea.
2. **Amoebic Dysentery (Amoebiasis):**
- **Adhesion and Cytotoxicity:** Entamoeba histolytica trophozoites adhere to the colonic mucosa using surface proteins such as Gal/GalNAc lectin.
- **Tissue Invasion:** The amoebae then secrete enzymes like cysteine proteases that degrade the extracellular matrix and host tissues, allowing deeper invasion into the colon.
- **Evading Immune Response:** Entamoeba histolytica can evade the host's immune system by degrading antibody molecules and resisting complement-mediated lysis, further contributing to tissue damage and inflammation.
**Molecular Mechanisms:**
1. **Shigellosis:**
- **Virulence Plasmid:** Shigella carries a large virulence plasmid that encodes a type III secretion system and various effector proteins (e.g., Ipa proteins) critical for epithelial cell invasion.
- **Shiga Toxin:** Some strains produce Shiga toxin, an AB5 toxin that inhibits protein synthesis in host cells, leading to cell death and contributing to the severity of symptoms.
2. **Amoebiasis:**
- **Gal/GalNAc Lectin:** This surface lectin facilitates trophozoite adherence to host cells and is essential for colonization and invasion.
- **Amebopore:** Pore-forming peptides released by E. histolytica create pores in the host cell membranes, causing cell lysis.
- **Cysteine Proteases:** These enzymes degrade host tissues and immune components, aiding in tissue invasion and immune evasion.
Understanding these mechanisms provides insight into the pathogenicity of dysentery and informs the development of targeted treatments and preventative measures. - Treatment
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Dysentery is managed by maintaining fluids using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. In ideal situations, no antimicrobial therapy should be administered until microbiological microscopy and culture studies have established the specific infection involved. When laboratory services are not available, it may be necessary to administer a combination of drugs, including an amoebicidal drug to kill the parasite, and an antibiotic to treat any associated bacterial infection. Laudanum (Deodorized Tincture of Opium)] may be used for severe pain and to combat severe diarrhea.
If shigellosis is suspected and it is not too severe, letting it run its course may be reasonable – usually less than a week. If the case is severe, antibiotics such as ciprofloxacin or TMP-SMX may be useful. However, many strains of Shigella are becoming resistant to common antibiotics, and effective medications are often in short supply in developing countries. If necessary, a doctor may have to reserve antibiotics for those at highest risk for death, including young children, people over 50, and anyone suffering from dehydration or malnutrition.Amoebic dysentery is often treated with two antimicrobial drugs such as metronidazole and paromomycin or iodoquinol. - Compassionate Use Treatment
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Compassionate use treatments and off-label or experimental treatments for dysentery typically come into consideration when standard therapies are not effective or available. Dysentery, an infection of the intestines resulting in severe diarrhea with blood, is most commonly caused by bacteria (such as Shigella) or amoebas (such as Entamoeba histolytica).
1. **Compassionate Use Treatment:**
- Compassionate use may involve the administration of investigational drugs that are not yet approved for market but have shown promise in clinical trials. For dysentery, this might include newer antibacterial or antiparasitic agents.
2. **Off-Label Treatments:**
- Off-label use of antibiotics: Certain antibiotics may be used off-label based on clinical judgment, such as using higher doses or different combinations of known antibiotics that are not typically the first line of treatment for dysenteric pathogens.
- Probiotics: While primarily used to manage symptoms, some clinicians might use high doses of specific probiotics off-label to aid in restoring gut flora balance.
3. **Experimental Treatments:**
- Fecal Microbiota Transplantation (FMT): This is an emerging area where fecal matter from a healthy donor is transplanted to a patient with dysbiosis (microbial imbalance) that can occur in severe dysentery cases. FMT aims to re-establish a healthy microbiome.
- Novel antimicrobial agents: Experimental drugs targeting specific bacterial pathways or biofilms are under investigation. These include synthetic antibiotics and antimicrobial peptides that are in various stages of research.
Clinical trials are continuously ongoing for various treatments, and participation in such trials might be an option for some patients. - Lifestyle Recommendations
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Lifestyle recommendations for managing and preventing dysentery include:
1. **Hydration**: Drink plenty of purified water, oral rehydration solutions, or electrolyte drinks to prevent dehydration.
2. **Diet**: Eat a balanced diet that includes easily digestible foods such as bananas, rice, applesauce, and toast (BRAT diet). Avoid dairy, fatty, and high-fiber foods until recovery.
3. **Personal Hygiene**: Wash hands thoroughly with soap and water, especially after using the restroom and before eating or preparing food.
4. **Safe Food Practices**: Ensure that food is cooked thoroughly and avoid eating raw or undercooked foods. Be cautious with street food.
5. **Sanitation**: Maintain proper sanitation and avoid contact with contaminated water. Use clean and sanitized bathroom facilities.
6. **Rest**: Get plenty of rest to help your body recover.
7. **Avoid Alcohol and Caffeine**: These can cause further dehydration and should be avoided during recovery.
8. **Seek Medical Advice**: If symptoms persist or are severe, consult a healthcare professional for appropriate treatment. - Medication
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For dysentery, the choice of medication largely depends on whether the cause is bacterial or amoebic.
1. **Bacterial Dysentery (e.g., Shigella):**
- Common antibiotics include Ciprofloxacin, Azithromycin, or Ceftriaxone.
2. **Amoebic Dysentery (caused by Entamoeba histolytica):**
- The primary treatment is Metronidazole or Tinidazole, often followed by a luminal agent like Paromomycin to eradicate cysts in the intestines.
Always consult a healthcare provider for diagnosis and appropriate treatment. - Repurposable Drugs
- Repurposable drugs for dysentery include antimicrobial agents typically used to treat bacterial infections. Some examples are ciprofloxacin and metronidazole, which can target the bacterial pathogens causing dysentery, such as Shigella and Entamoeba histolytica. Always consult a healthcare professional before using any medication.
- Metabolites
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Dysentery primarily involves the infection of the intestines, leading to severe diarrhea with the presence of blood and mucus. The metabolites involved in the pathology of dysentery can vary depending on the causative agent (such as bacteria like Shigella or Entamoeba histolytica). Generally, bacterial or amoebic metabolites play a role in tissue invasion, immune evasion, and inflammation. These metabolites often include toxins, proteases, and other enzymes that aid in the damage and invasion of intestinal tissues.
Regarding "nan" (not a number), it seems unrelated to the biological, pathological, or chemical discussion of dysentery and its metabolites. If you meant to inquire about something specific, please clarify. - Nutraceuticals
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Nutraceuticals for dysentery can help support overall health and potentially alleviate some symptoms. Common nutraceuticals that may be considered include:
1. **Probiotics**: Help restore and maintain healthy gut bacteria.
2. **Prebiotics**: Support the growth of beneficial gut bacteria.
3. **Oral rehydration salts (ORS)**: Help prevent dehydration.
4. **Zinc supplements**: Improve immune function and gut health.
5. **Aloe vera**: Has anti-inflammatory properties that may soothe the intestines.
6. **Curcumin (found in turmeric)**: Possesses anti-inflammatory and antimicrobial properties.
7. **Peppermint oil**: Can help alleviate gastrointestinal discomfort.
Always consult a healthcare provider before starting any new supplements or treatments. - Peptides
- Dysentery is an intestinal infection causing severe diarrhea with blood and mucus. It is primarily caused by bacteria (such as Shigella or certain E. coli strains) or parasites (like Entamoeba histolytica). While peptides are short chains of amino acids, their direct role in the treatment of dysentery is not established in clinical practice. Instead, treatment typically includes rehydration, antibiotics for bacterial causes, and antiparasitic medications for parasitic causes.