Bacterial dysentery, shigellosis, or shigella dysentery is a notifiable infection of the intestine that, in its severe variant, can lead to death in up to 10 percent of affected patients. This colon infection is caused by bacteria of the genus Shigella. Bacterial dysentery should not be confused with amoebic dysentery, which particularly affects travelers to tropical and subtropical regions.
What is bacterial dysentery?
Bacterial dysentery involves an infestation with one of a total of four different Shigella species, with type A Shigella dysenteriae being the most severe form of the disease with a high fatality rate. Bacterial dysentery leads to severe inflammation of the colon and causes severe diarrhea after an incubation period of two to seven days. Up to thirty bowel movements per day take place, severely weakening the sufferers. Infection occurs through blood or urine and contact with contaminated objects, hands, water and food is sufficient. Because the Shigella bacterium is acid-resistant, bacterial dysentery is not stopped by stomach acid or reduced in pathogen count on its way to the intestines.
Causes
The source of infection of bacterial dysentery is usually another ill person and his or her excretions. Bacterial dysentery is transmitted by smear infection. Only a few shigellae are sufficient for reinfection. The bacterium passes largely unimpeded through the stomach and eventually enters the colon, where, in type A, it produces a toxin that causes bacterial dysentery. For bacterial dysentery, hygienic conditions and antecedent health conditions are a major factor in its spread. Particularly in emergency situations after disasters, where many people are together in a confined space under poor hygienic conditions, bacterial dysentery spreads rapidly and can be contained only with considerable effort. Physically weakened people, the elderly, and young children are particularly at risk.
Symptoms, complaints, and signs
Bacterial dysentery causes sudden and severe symptoms. Within the first two days of illness, there is usually a watery [[diarrhea] with abdominal pain, nausea] and vomiting. Depending on the causative pathogen, diarrhea either resolves without consequence or develops into bloody or mucopurulent diarrhea. This is accompanied by symptoms such as abdominal cramps, painful bowel movements and colic. The loss of fluid is manifested by impaired consciousness and external changes such as sunken skin, eye rims and torn corners of the mouth. Usually, bacterial dysentery causes fever] characterized by sweating and other distinct symptoms. If severe, shigellosis can cause severe pain. In extreme cases, the intestine ruptures and blood poisoning occurs. The above symptoms appear after one to two days in bacterial dysentery and resolve within a week if the course is positive. Any complications delay the healing process and are manifested by a rapid increase in the feeling of illness. In most cases, those affected are very pale and no longer able to perform. The individual symptoms occur in shigellosis in varying degrees, but can be clearly attributed to the infectious disease.
Diagnosis and course
Characteristic of bacterial dysentery are initially watery, then mucous-bloody diarrhea accompanied by collic-like abdominal pain as well as the painful urge to defecate and fever. Bacterial dysentery is initially diagnosed as suspected on the basis of these symptoms and possible external accompanying circumstances, such as contact with people who have already contracted the disease. For a confirmed diagnosis, a laboratory test for Shigella bacteria in the stool must be performed. This distinguishes bacterial dysentery from diseases with similar symptoms such as salmonella infection or food poisoning. Once the diagnosis is established, prompt notification is made to the appropriate authorities, as bacterial dysentery is a notifiable disease under the Federal Disease Control Act.
Complications
Severe complications are rare with bacterial dysentery. However, in the absence of treatment or with inadequate treatment, the disease can cause various secondary symptoms. For example, gastrointestinal symptoms often result in deficiency symptoms and dehydration, which in turn cause circulatory problems.In addition, shigellosis can lead to the formation of cysts and ulcers in the colon, often resulting in dilatation of the intestine. Rarely, the intestinal wall ruptures as a result, sometimes leading to life-threatening complications. Bacterial Ruh can also cause complications outside the intestine: if the mucosal barrier in the intestine is damaged too much, other bacteria can take hold in the organism. As a result, Reiter’s syndrome with conjunctivitis, urethritis and joint inflammation may occur. Furthermore, dysentery can cause hemolytic uremic syndrome and increase the risk of arthritic joint changes. In turn, the symptoms typical of dysentery, such as fever, abdominal cramps, and colic, can also cause problems. This is the case when the abdominal cramps promote mentioned colon damage. At risk for complications are especially young children, elderly people and patients with pre-existing conditions. Specialist clarification should be bacterial dysentery in any case.
When should you go to the doctor?
Bacterial dysentery is highly contagious and should therefore be treated immediately. The diarrheal illness is best identified by its characteristic symptoms (fever, abdominal cramps, painful urge to defecate). If one or more of these symptoms occur after a longer trip abroad (especially India, North Africa and Turkey), it is probably bacterial dysentery. An immediate visit to the doctor should then be made simply because of the obligation to report the disease. If bacterial dysentery remains untreated, it can also take a severe course and in rare cases lead to death. A physician must be consulted at the latest when circulatory problems occur or ulcers are noticed in the intestine. Patients with a chronic intestinal disease or an immune deficiency should immediately discuss new or unusually severe complaints with the responsible physician. Pregnant women, the elderly and children must also be examined quickly to avert a severe course. If physical or mental failure symptoms are already noticeable, the emergency physician must be called. In the event of circulatory collapse and coma, first aid measures must be administered until the rescue service arrives.
Treatment and therapy
Regardless of the type of shigella, bacterial dysentery is treated with antibiotics suitable for this purpose. A distinction must be made between adults and children in the choice of antibiotic, as some effective drugs are approved only for adults. It should also be noted that bacterial dysentery quickly develops resistance and no longer responds to previously effective agents. In addition, treatment depends on the general condition of the patient and the course of the disease. If it is mild bacterial dysentery, treatment for bacterial dysentery is limited to the prescription of bed rest and a suitable diet. This applies to patients in good general health who can manage bacterial dysentery by their own efforts. If there is a large loss of fluids due to the diarrhea, bacterial dysentery is treated with infusions. Strict adherence to patient and contact hygiene is important in bacterial dysentery. Contaminated clothing and bedding should be touched only with protective clothing, and careful disinfection of hands should be maintained before and after each contact. Bacterial dysentery can thus be contained in its spread.
Outlook and prognosis
If bacterial dysentery is treated early, the prospects for cure are good; after about a week, symptoms of the intestinal infection cease. Once the disease is successfully overcome, affected individuals first have a temporary defense that protects them from being re-infected. In milder forms, the disease may even proceed without any symptoms worth mentioning. The pathogens are transmitted in the stool. As a rule, the symptoms disappear on their own about 4 weeks later. In some people, the bacteria settle in the colon for a long time and cause them to infect other people, but without developing symptoms themselves. Bacterial dysentery usually runs its course without further problems, but can lead to complications in people with a weakened immune system (children, the elderly, the chronically ill or people with an immune deficiency).Thus, the prolonged diarrhea due to the loss of fluids and electrolytes can cause circulatory problems and even circulatory failure if the disease is not treated in time. Due to the inflammation of the intestinal mucosa, ulceration may occur, causing the intestine to dilate. In the worst case, the intestinal wall ruptures and can cause life-threatening complications.
Prevention
Bacterial dysentery is an infectious disease that can only be prevented by particularly strict hygiene measures. People who are in affected areas must avoid all contact with the excretions of those who are ill or slowly recovering. Suitable protective clothing is important. For all other possibilities of infection, extensive hand washing before and after going to the toilet reduces the risk of infection. However, bacterial dysentery cannot be completely ruled out.
Follow-up
Bacterial dysentery usually takes a good course. The disease heals completely. Re-infection is not possible for a limited time. The body has built up immunity to the disease. Follow-up care to prevent a new infection is therefore usually not advisable. The situation is different for patients who frequently travel to warm countries with inadequate hygienic conditions. After the first occurrence, they should ask their attending physician for information on everyday tips. Those affected bear a high degree of personal responsibility. Basic rules of conduct include not eating food that has not been boiled. Contact with flies can also promote bacterial dysentery. The disease can be transmitted through sexual contact, which is why follow-up care should also take third parties into account. If the typical symptoms reappear, the doctor will examine a stool sample. If the diagnosis of “bacterial dysentery” comes up again, it is important to compensate for the loss of fluids due to the diarrhea. Antibiotics can shorten the course of the disease and prevent complications. In general, children and the elderly should exercise great caution in countries with low standards of hygiene. Their immune systems are much more susceptible to infection with bacterial dysentery.
What you can do yourself
With bacterial dysentery, you should always go to the doctor. Medical treatment can be supported by some self-help tips and home remedies. As a first measure, the diet must be adjusted. Foods such as gruel, white bread, steamed vegetables and baby porridge are easy on the intestines and have a calming effect on irritated intestinal flora. Sweet and fatty foods as well as alcohol and coffee, on the other hand, should be avoided. In general, flatulent foods and fatty fish and meat should be avoided during the acute phase of the disease. In general, patients should drink and eat enough to compensate for the loss of fluids and electrolytes. Patients who are already in poor physical condition should take additional nutritional supplements and appropriate fluid replacement. Alternatively, natural remedies are available. Blueberry or huckleberry, for example, have a preventive effect against dysentery and cholera and can be taken either as tea or in the form of medicinal preparations. Equally effective are applications with sage, fennel and chamomile. In consultation with the doctor, healing earth or Schüßler salts can also be tried. Last, increased personal hygiene with regular hand washing helps stop the spread of bacterial dysentery.
