Dysentery

The most common form of dysentery is bacillary dysentery, which is typically a mild sickness, causing symptoms normally consisting of mild gut pains and frequent passage of stool 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 caustic occasions, severe abdominal cramps, fever, shock, and delirium can all be symptoms.[2][11][12][13]

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.[14]

Cross-section of diseased intestines. Colored lithograph c. 1843

Dysentery results from bacterial, or parasitic infections. Viruses do not generally cause the disease.[7] 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 linings, leading to the inflammatory immune responses. This can cause elevated physical temperature, painful spasms of the intestinal muscles (cramping), swelling due to fluid leaking from capillaries of the intestine (edema) and further tissue damage by the body's immune cells and the chemicals, called cytokines, which are released to fight the infection. The result can be impaired 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. Anemia may also arise due to the blood loss through diarrhea.

Bacterial infections that cause bloody diarrhea are typically classified as being either invasive or toxogenic. Invasive species cause damage directly by invading into the mucosa. The toxogenic species do not invade, but cause cellular damage by secreting toxins, resulting in bloody diarrhea. This is also in contrast to toxins that cause watery diarrhea, which usually do not cause cellular damage, but rather they take over cellular machinery for a portion of life of the cell.[15]

Some microorganisms – for example, bacteria of the genus Shigella – secrete substances known as cytotoxins, which kill and damage intestinal tissue on contact. Shigella is thought to cause bleeding due to invasion rather than toxin, because even non-toxogenic strains can cause dysentery, but E. coli with shiga-like toxins do not invade the intestinal mucosa, and are therefore toxin dependent.

Definitions of dysentery can vary by region and by medical specialty. The U. S. Centers for Disease Control and Prevention (CDC) limits its definition to "diarrhea with visible blood".[16] Others define the term more broadly.[17] These differences in definition must be taken into account when defining mechanisms. For example, using the CDC definition requires that intestinal tissue be so severely damaged that blood vessels have ruptured, allowing visible quantities of blood to be lost with defecation. Other definitions require less specific damage.

A diagnosis may be made by taking a history and doing a brief examination. Dysentery should not be confused with hematochezia, which is the passage of fresh blood through the anus, usually in or with stools.

Efforts to prevent dysentery include hand washing and food safety measures while traveling in areas of high risk.[4]

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.

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.[22]

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.[23]

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.[20] Amoebiasis infects over 50 million people each year, of whom 50,000 die (one per thousand).[24]

The seed, leaves, and bark of the kapok tree have been used in traditional medicine by indigenous peoples of the rainforest regions in the Americas, west-central Africa, and Southeast Asia in this disease.[25][26][27] Bacillus subtilis was marketed throughout America and Europe from 1946 as an immunostimulatory aid in the treatment of gut and urinary tract diseases such as rotavirus and Shigella,[28] but declined in popularity after the introduction of consumer antibiotics.

A Red Army soldier dies of dysentery after eating unwashed vegetables. This is a common way of contracting dysentery. From a health advisory pamphlet given to soldiers.

• 685 – Constantine IV, the Byzantine emperor, died of dysentery in September 685.
• 1183 – Henry the Young King died of dysentery at the castle of Martel on 11 June 1183.
• 1216 – John, King of England died of dysentery at Newark Castle on 18 October 1216.[29]
• 1270 – Louis IX of France died of dysentery in Tunis while commanding his troops for the Eighth Crusade on 25 September 1270.
• 1307 – Edward I of England caught dysentery on his way to the Scottish border and died in his servants' arms on 6 July 1307.
• 1322 – Philip V of France died of dysentery at the Abbey of Longchamp (site of the present hippodrome in the Bois de Boulogne) in Paris while visiting his daughter, Blanche, who had taken her vows as a nun there in 1322. He died on January 3, 1322.
• 1376 – Edward the Black Prince son of Edward III of England and heir to the English throne. Died of apparent dysentery in June, after a months-long period of illness during which he predicted his own imminent death, in his 46th year.
• 1422 – King Henry V of England died suddenly on 31 August 1422 at the Château de Vincennes, apparently from dysentery,[30] which he had contracted during the siege of Meaux. He was 35 years old and had reigned for nine years.
• 1536 – Erasmus, Dutch renaissance humanist and theologian. At Basel.[31]
• 1596 – Sir Francis Drake, vice admiral, died of dysentery on 28 January 1596 whilst anchored off the coast of Portobelo.[32]
• 1605 – Akbar, ruler of the Mughal Empire of South Asia, died of dysentery. On 3 October 1605, he fell ill with an attack of dysentery, from which he never recovered. He is believed to have died on or about 27 October 1605, after which his body was buried at a mausoleum in Agra, present-day India.[33]
• 1675 – Jacques Marquette died of dysentery on his way north from what is today Chicago, traveling to the mission where he intended to spend the rest of his life.[34]
• 1676 – Nathaniel Bacon died of dysentery after taking control of Virginia following Bacon's Rebellion. He is believed to have died in October 1676, allowing Virginia's ruling elite to regain control.[35]
• 1680 - Shivaji, founder and ruler of the Maratha Empire of South Asia, died of dysentery on 3 April 1680. In 1680, Shivaji fell ill with fever and dysentery, dying around 3–5 April 1680 at the age of 52 on the eve of Hanuman Jayanti. He was cremated at Raigad Fort, where his Samadhi is built in Mahad, Raigad district of Maharashtra, India.[36] [37]
• 1827 – Queen Nandi kaBhebhe, (mother of Shaka Zulu) died of dysentery on October 10, 1827.[38]
• 1896 – Phan Đình Phùng, a Vietnamese revolutionary who led rebel armies against French colonial forces in Vietnam, died of dysentery as the French surrounded his forces on January 21, 1896.[39]
• 1930 – The French explorer and writer, Michel Vieuchange, died of dysentery in Agadir on 30 November 1930, on his return from the "forbidden city" of Smara. He was nursed by his brother, Doctor Jean Vieuchange, who was unable to save him. The notebooks and photographs, edited by Jean Vieuchange, went on to become bestsellers.[40][41]
• 1942 – The Selarang Barracks incident in the summer of 1942 during World War II involved the forced crowding of 17,000 Anglo-Australian prisoners-of-war (POWs) by their Japanese captors in the areas around the barracks square for nearly five days with little water and no sanitation after the Selarang Barracks POWs refused to sign a pledge not to escape. The incident ended with the surrender of the Australian commanders due to the spreading of dysentery among their men.[42]

• Cholera, a bacterial infection of the small intestine which produces severe diarrhea requiring Laudanum (Deodorized Tincture of Opium known as DTO) Not to be confused with paregoric.
• Oregon trail, a pioneering computer game in which dysentery was a prominent cause of death.