Dysentery

Dysentery is a debilitating condition that affects countless individuals worldwide, particularly in regions with poor sanitation and limited access to clean water. This gastrointestinal disorder manifests through a range of distressing symptoms, most notably bloody diarrhoea, which can rapidly lead to dehydration and other complications if left untreated. Understanding the causes, types, and preventive measures associated with dysentery is crucial for effectively managing this public health concern.

What is Dysentery?

Dysentery is a painful infection in the intestines that causes loose, watery stools with blood and mucus. The primary causes of this condition are bacterial and parasitic infections, which can be transmitted through consuming contaminated food or water, inadequate hygiene practices, or close contact with infected individuals.  

In addition to bloody diarrhoea, dysentery symptoms may include fever, abdominal cramps, and a persistent urge to pass stool, even when the bowels are empty (tenesmus). The seriousness of these symptoms can vary depending on the type of dysentery and the individual's overall health.

Dysentery is an infection of the intestines that causes diarrhoea and abdominal pain. It is mainly caused by two types of pathogens:

• Amoebic Dysentery: Also called amoebiasis, this is caused by the parasite Entamoeba histolytica. It is common in tropical areas with poor sanitation and contaminated water.
• Bacillary Dysentery: This type is caused by bacteria, most commonly Shigella species (shigellosis). Other bacteria, like Campylobacter and certain Escherichia coli (E. coli) strains, can also cause bacillary dysentery.

Dysentery causes inflammation of the intestines, leading to digestive discomfort and other symptoms. The symptoms vary based on the type of dysentery you have.

1. Amoebic Dysentery

Most people with amoebic dysentery have no symptoms. When symptoms appear, they are usually mild and may include:

• Diarrhoea
• Low-grade to moderate fever
• Nausea and vomiting
• Weight loss
• Upset stomach

In rare cases, the parasite can spread to other parts of the body, such as the liver, causing an abscess.

2. Bacillary Dysentery

Bacillary dysentery usually causes more severe symptoms, including:

• Diarrhoea containing blood or mucus
• High fever
• Nausea and vomiting
• Painful stomach cramps

Severe cases can lead to serious complications, such as extreme intestinal inflammation, widening of the large intestine (toxic megacolon), and acute kidney injury (AKI). These conditions require immediate medical attention.

Dysentery is an infection of the intestines mainly caused by bacterial or parasitic pathogens. These infections lead to inflammation of the large intestine, resulting in severe diarrhoea often accompanied by blood and mucus.

There are two primary types of dysentery, each caused by different pathogens and transmitted in distinct ways:

1. Bacillary Dysentery (Shigellosis)

Bacillary dysentery is primarily caused by Shigella species, a highly contagious pathogen that spreads through direct or indirect contact with contaminated materials. It is mainly transmitted via the faeco-oral route [Aslam et al., 2024]. A person may contract Shigella in the following ways:

• Poor Hand Hygiene: Failing to wash hands thoroughly after using the restroom can spread bacteria to objects and surfaces.
• Touching Contaminated Surfaces: Contacting surfaces contaminated with Shigella and then touching the mouth, nose, or eyes can introduce the bacteria into the body.
• Ingesting Contaminated Food or Water: Consuming food or beverages that have been exposed to Shigella bacteria can lead to infection.
• Swimming in Contaminated Water: Swallowing water from lakes, rivers, or pools where the bacteria are present.
• Sexual Contact: Engaging in oral-anal contact or poor hygiene during sexual activity can transmit the bacteria.

2. Amoebic Dysentery (Amoebiasis)

Amoebic dysentery is caused by the Entamoeba histolytica parasite, which thrives in areas with poor sanitation and contaminated water supplies (Amebic Dysentery). Infection typically occurs when a person ingests food or water tainted with faecal matter containing Entamoeba cysts (eggs).

People at greater risk of developing severe amebic dysentery include:

• Pregnant or Postpartum Women: Hormonal changes and weakened immunity can increase susceptibility.
• Young Children and Older Adults: More vulnerable due to weaker immunity.
• Individuals Taking Corticosteroids: These medications suppress the immune system, making the body less capable of fighting infections.
• Malnourished Individuals: Poor nutrition weakens the immune response, increasing vulnerability to infections.

People Living with Cancer: Cancer and its treatments often compromise immunity, heightening the risk of severe infections.

Several factors can increase an individual's risk of contracting dysentery, including:

• Travel to high-risk areas with poor sanitation.
• Living or working in environments with inadequate waste management and contaminated water supplies.
• Close living conditions, such as in families, schools, and nurseries, where the infection can spread easily.
• A weakened immune system, which makes individuals more susceptible to severe infections and complications.

Dysentery can result in various complications, particularly if left untreated or in individuals with weakened immune systems. Some of these complications include:

• Dehydration: Persistent diarrhoea can lead to significant fluid loss, especially in young children, older adults, and immunocompromised individuals. Severe dehydration may require urgent medical care.
• Electrolyte imbalance: Diarrhoea can disrupt the balance of electrolytes in the body, such as sodium, potassium, and chloride. This imbalance can worsen dehydration and lead to further health complications, affecting heart rhythm, muscle function, and other critical processes.
• Malnutrition: Extended episodes of dysentery can hinder the body's ability to absorb essential nutrients, resulting in malnutrition and weakness. This is particularly detrimental for children, as it can impede their growth and development.
• Systemic infection: In severe cases, the bacteria or parasites responsible for dysentery may enter the bloodstream, leading to a systemic infection known as sepsis. This life-threatening condition requires immediate medical attention.
• Rectal prolapse: Chronic straining during bowel movements due to dysentery can result in rectal prolapse, where part of the rectum protrudes through the anus. This condition may necessitate surgical intervention.

Practising good hygiene and taking preventive measures can significantly reduce the risk of dysentery. Here are some key steps:

• Wash your hands thoroughly with soap and running water after using the restroom and before handling or eating food.
• Use hand sanitiser if soap and water are unavailable.
• Do not share toothbrushes, towels, drinking glasses, or other personal items with others.
• Only use water that is sanitised or sterile for drinking, cooking, or brushing your teeth.
• Use bottled water, chlorine tablets, or boil water for at least one minute to make it safe.
• Wash all fruits and vegetables with clean, running water before consumption.
• Peel fruits and vegetables when possible, or thoroughly cook them if peeling is not an option.
• Avoid consuming food from unhygienic or unverified sources (including street vendors in high-risk areas).
• Cook all food thoroughly to eliminate harmful pathogens.
• Drink only bottled or canned beverages, and use bottled water for brushing your teeth.
• Avoid ice cubes unless they are made from sterilised water.
• Do not consume fountain drinks or unpasteurised dairy and juice products in areas where dysentery is common.
• Avoid close contact with people who have dysentery.
• Do not share towels, cups, or personal items with someone who is infected.
• Drink beverages only from sealed, safe sources to reduce contamination risk.

To determine if you have dysentery, your healthcare provider will typically order a stool test, including stool microscopy and stool culture. This process involves stool sample collection. Your healthcare provider will give you a sterile container and a disposable spoon for collecting a stool sample.

To collect the sample:

• You can use plastic wrap or newspaper placed over the toilet rim or another clean container. 
• Using the disposable spoon, transfer a small portion of your stool into the container and return it to your healthcare provider.

The stool sample is sent to a laboratory, where technicians test it for bacteria, parasites, or parasite eggs (ova) that could indicate dysentery. In some cases, you may need to provide stool samples over several days for accurate results.

If needed, your healthcare provider may perform a sigmoidoscopy. This procedure involves using a specialised scope to examine the inside of the lower colon (sigmoid colon) and rectum. A sigmoidoscopy can help confirm a dysentery diagnosis or rule out other potential causes of your symptoms.

The treatment for dysentery depends on whether it is amebic or bacillary in nature. Below are the key treatment approaches based on the type:

1. Amebic Dysentery

Amebic dysentery, caused by the parasite Entamoeba histolytica, requires eliminating the parasite from the body. Your doctor may prescribe metronidazole, a highly effective antimicrobial that targets parasitic infections. This is typically followed by a luminal agent (e.g., diloxanide furoate or paromomycin) to eliminate residual cysts and prevent recurrence.

If nausea occurs, supportive measures (such as antiemetic medicines like ondansetron) may be used.

2. Bacillary Dysentery

Bacillary dysentery, caused by bacterial infections (such as Shigella or certain E. coli strains), can often resolve on its own within a week. However, in more severe cases, appropriate antibiotics such as azithromycin or ciprofloxacin (based on local resistance patterns) may be prescribed.

If dehydration becomes a concern, electrolyte replacement therapy using oral rehydration salts (ORS) is essential. In severe cases, IV (intravenous) fluids may be required.

3. Self-Care Tips for Managing Dysentery

• Avoid antimotility agents (e.g., loperamide, diphenoxylate) in cases of bloody diarrhoea unless advised by a doctor, as they may worsen the infection.
• Stay hydrated by drinking fluids containing essential electrolytes (sodium, potassium, magnesium, and chloride) to prevent dehydration.
• Use pain relievers like acetaminophen or NSAIDs to reduce fever and discomfort.
• Take antisecretory agents like mesalazine or sulfasalazine if recommended by your doctor to reduce intestinal inflammation and excessive fluid secretion.

4. Recovery Timeline: When Will You Feel Better?

• Amebic Dysentery (Amebiasis)

Most individuals start feeling better within 5–7 days of appropriate treatment, though full recovery may take longer. It is crucial to complete the full course of medication to prevent recurrence.

• Bacillary Dysentery

Recovery from bacterial dysentery typically occurs within a week. Many mild cases improve without antibiotics, but in severe cases, antibiotic treatment (e.g., norfloxacin, cotrimoxazole) can lead to improvement within a few days.

Living with dysentery involves taking precautions to prevent the spread of the infection and making lifestyle adjustments to support recovery. Here are some of the points to consider:

• Staying hydrated is crucial, so drink plenty of fluids like water and rehydration drinks to combat the fluid loss from diarrhoea.
• Avoid caffeine and alcohol, as they can worsen dehydration. 
• Practice good hygiene, especially frequent handwashing after using the toilet and before handling food, to prevent spreading the infection.
• Stay home from work or school until you have been diarrhoea-free for at least 48 hours (especially important in bacterial dysentery such as shigellosis).
• If you work with children, prepare food, or work in healthcare, wait until the diarrhoea has fully stopped before returning. 
• Avoid sharing personal items like towels or cups with others. 
• After recovering, thoroughly clean your home, washing bedding and clothes in hot water and disinfecting frequently touched surfaces to kill any remaining dysentery-causing germs.

It is essential to consult a doctor if you experience symptoms like bloody diarrhoea with mucus, painful abdominal cramps, fever, nausea, vomiting, or significant weight loss. Signs of dehydration, such as excessive thirst, reduced urination, weakness, or dizziness, also require immediate medical attention. Seek medical care if symptoms persist beyond 2–3 days, worsen, or if you are unable to maintain hydration. Inform your doctor of any recent travel to areas where dysentery is common. Seek urgent care for complications such as severe dehydration, altered consciousness, sepsis, toxic megacolon, or rectal prolapse. 

• Dysentery is an intestinal infection that causes severe diarrhoea, often accompanied by abdominal pain, fever, and bloody stools.
• The two main types of dysentery are bacillary (bacterial) dysentery, caused by Shigella bacteria, and amoebic dysentery, caused by the parasite Entamoeba histolytica.
• Dysentery diagnosis involves physical examination, symptom review, and laboratory tests such as stool and blood samples.
• Treatment for bacterial dysentery may include antibiotics, while amoebic dysentery requires antiparasitic medications.
• Supportive care, including rest and oral rehydration (ORS), is essential in managing dysentery.
• Antidiarrhoeal medicines should be avoided in bloody diarrhoea unless advised by a doctor.
• Practising good hygiene and avoiding contaminated food and water can help prevent the spread of dysentery.
• Seek medical attention if dysentery symptoms persist, worsen, or are accompanied by severe pain, high fever, or bloody stools.