Download - Amoebiasis and Dysentery
Diseases affecting the Gastrointestinal Tract
Amoebiasis (Amoebic Dysentery)
A protozoal infection of man initially involving the colon but may spread to soft tissues by contiguity or hematogenous or lymphatic dissemination most commonly to the liver or lungs.Is the third leading cause of death from parasitic disease worldwide.
Etiologic Agent(Entamoeba Hystolitica)
Prevalent in ill-sanitated areas
Common in warm climate
Acquired by swallowing
Cyst survive a few days outside the body
Cyst pass to the large intestine and hatch into trophozites. Pass into mesenteric veins, to the portal vein, to the liver, thereby forming amoebic liver abscess.
Two developmental stages
1. Trophozoites/vegetative form
A facultative parasite that may invade tissue or they are found in the parasitized tissues and liquid colonic contents.
2. Cyst Are passed out with
forms or semi-formed stools and are resistant to environmental conditions.
Considered as the infective stage in the life cycle of Entamoeba Hystolitica
Incubation period:
3 days in severe infection; several months in sub-acute and chronic form. In average case vary from 3-4 weeks.
Period of communicability:
For duration of the illness.
Mode of transmission
™Fecal-oral transmission™Direct contact™Indirect contact- by ingestion of food
especially uncooked leafy vegetables or contaminated with fecal material containing E. Hystolitica cycts.
Clinical manifestationA. Acute amoebic dysentery
Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus.
Diarrhea, watery and foul-smelling stools often containing blood-streaked mucus.
Diarrhea, watery and foul-smelling stools often containing blood-streaked mucus.
Nausea, flatulence and abdominal distension, and tenderness in the right iliac region over the colon.
B. Chronic amoebic dysentery Attack of dysentery lasting for several
days, usually succeeded by constipation. Tenesmus accompanied by the desire to
defecate. Anorexia, weight loss and weakness. Liver maybe enlarged. The stools at first are semi-fluid but soon
become watery, blood, and mucoid. Vague abdominal distress, flatulence,
constipation or irregularity of the bowel. Mild anorexia, constant fatigue and
lassitude Abdomen lost its elasticity when
picked---up between fingers. On sigmoidoscopy, scattered ulceration
with yellowish and erythematous border. Gangrenous type of stool
Extra intestinal forms• HepaticPain at the upper right
quadrant with tenderness of the liver.
Jaundice Intermittent feverLoss of weight or
anorexiaAbscess may break
through the lungs, patient coughs anchovy-sauce sputum
Diagnostic exam
Stool examBlood examProctoscopy/sigmoidoscopy
Treatment modalities
MetronidazoleTetracyclineAmpicillin, quinolones, sulfadiazineStreptomycinFluid and electrolytes lost should be replaced
Nursing management
1. Isolation, enteric precaution2. Health education Boil water for drinking or use
of purified water Avoid washing food from
open drum or pail Cover leftover food Wash hands after defecation
or before eating Avoid eating raw ground
vegetables (lettuce, carrots, etc.)
Methods of PreventionΘ Health educationΘ Sanitary disposal of fecesΘ Protect, chlorinate and
purify drinking waterΘ Use scrupulous
cleanliness in food preparation, handling, and storage
Θ Detection and treatment of carriers
Θ Fly control
Bacillary Dysentery(shigellosis; bloody flux)
An acute bacterial infection of the intestine characterized by diarrhea, and fever associated with the passing out of bloody-mucoid stools with tenesmus.
Etiologic agent
Four serologic groups
Shigella flesneri Shigella boydii Shigella connie Shigella dysentery The most infectious Habitat is the GIT of man Develop resistance against antibiotics Invade in the blood stream
INCUBATION PERIOD:7 hours to 7 days with the average of 3-5 daysPERIOD OF COMMUNICABILITY: The patient is capable of transmitting the
microorganism during the acute infection until feces is negative for the microorganism. Some patient remain a carrier for a year or two.
MODE OF TRANSMISSION: Ingestion of contaminated food, or drink Transmitted by flies Fecal-oral transmission
Clinical manifestation
• Fever• Tenesmus, nausea,
vomiting and headache• Colicky or cramping
abdominal pain with anorexia and body weakness
• Diarrhea with bloody-muciod stools
• Dehydration and loss of weight
Complications
• Rectal prolapse• Respiratory
complication• Non-suppurative
arthritis and peripheral neuropathy
CYCLE SHIGELLA FLESNERE SHIGELLA BOYDII SHIGELLA CONNEI
SHIGELLA DYSENTERY
HUMAN FACEAL POLLUTION
FECES
FECAL-ORAL
INGESTION OF MICROORGANISM
MAN
Diagnostic procedure
Fecalysis Isolation of the causative
microorganism from rectal swab
Peripheral blood examination
Blood culture Sheets of
polymorphoneuclear leukocytes
Modalities of treatment
Antibiotics IV infusion with NSS Low residue of diet Anti diarrheal drugs
NURSING MANAGEMENT: Maintain fluid and
eletrolyte balance Restrict food until
nausea and vomiting subsides
Isolation Maintain personal
hygiene Proper disposal of
excreta Concurrent and terminal
disinfection
METHODS OF PREVENTION AND CONTROLSanitary disposal of human fecesSanitary supervision of processing, preparation of foodFly controlIsolation of patient