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Tuesday, April 15, 2008

Dysentery

Dysentery (formerly known as flux or the bloody flux) is an infection of the digestive system that results in severe diarrhea containing mucus and blood in the feces and is typically the result of unsanitary water containing micro-organisms which cause significant inflammation of the intestinal lining. There are two major types of dysentery due to micro-organisms: amoebic dysentery, and bacillary dysentery mainly due to one of three bacteria (diaria). Dysentery can also be caused by certain medications; for example, some steroids can impact bowel movements.

Amoebic dysentery is caused by the amoeba Entamoeba histolytica. Amoebic dysentery is transmitted through contaminated food and water. From ingestion, the infecting organisms move into the intestines via the stomach. Amoebae spread by forming infective cysts which can be found in stools and spread if whoever touches them does not sanitize their hands. There are also free amoebae, or trophozoites, that do not form cysts.

Amoebic dysentery is well known as a "traveler's dysentery" because of its prevalence in developing nations, or "Montezuma's Revenge" although it is occasionally seen in industrialized countries. Liver infection, and subsequent amoebic abscesses can occur.

Bacillary dysentery is mostly commonly associated with three bacterial groups:
* Shigellosis is caused by one of several types of Shigella bacteria.
* Campylobacteriosis caused by any of the dozen species of Campylobacter that cause human disease.
* Salmonellosis caused by Salmonella enterica (serovar Typhimurium).

Symptoms:
Symptoms include frequent passage of feces/stool, loose motion and in some cases associated vomiting. Variations depending on parasites can be frequent urge with high or low volume of stool, with or without some associated mucus and even blood.

Once recovery starts, early refeeding is advocated avoiding foods containing lactose due to temporary lactose intolerance.

Treatment:
The first and main task in managing any episode of dysentry is to maintain fluid intake using oral rehydration therapy. If this can not be adequately maintained, either through nausea and vomiting or the profuseness of the diarrhea, then hospital admission may be required for intravenous fluid replacement. Ideally no antimicrobial therapy is started until microbiological microscopy and culture studies have established the specific infection involved. Where laboratory services are lacking, it may be required to initiate a combination of drugs including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection.

Amoebic dysentery can be treated with metronidazole. Mild cases of bacillary dysentry are often self-limiting and do not require antibiotics, which are reserved for more severe or persisting cases; campylobacter, shigella and salmonella respond to ciprofloxacin or macrolide antibiotics.

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