Bacillary Dysentery

Bacillary DysenteryDr. Tjatur Winarsanto SpPD RST CiremaiCirebon

DefinitionBacillary dysentery is a type of dysentery caused by Shigellosis. Bacillary dysentery is associated with species of bacteria from the Enterobacteriaceae family. Shigellosis is caused by one of several types of Shigella bacteria. Three species are associated with bacillary dysentery: Shigella sonnei, Shigella flexneri and Shigella dysenteriae. One study in China indicated that Shigella flexneri was the most common serotype.

contSalmonellosis caused by Salmonella enterica (serovar Typhimurium) has also been described as a cause of bacillary dysentery, though this definition is less common. Bacillary dysentery should not be confused with diarrhea caused by a bacterial infection. One characteristic of bacillary dysentery is blood in stool which is the result of invasion of the mucosa by the pathogen.

4Enterobacteriaceae gastrointestinal diseases Escherichia coli Salmonella Shigella Yersinia entercolitica

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SynonymsShigella Shigella infection Salmonella infection

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6ShigellaS. flexneri, S. boydii, S. sonnei, S. dysenteriaebacillary dysentery shigellosisbloody fecesintestinal painpus

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Morphological Description of Biologic AgentShigella is a genus of gram-negative, non-spore forming rod-shaped bacteria closely related to Escherichia Coli and Salmonella. The causative agent of human shigellosis, Shigella cause disease in primates, but not in other mammals. It is only naturally found in humans and apes. During infection, it typically causes dysentery.

Mode of TransmissionShigella infection is typically via ingestion (fecaloral contamination); depending on age and condition of the host as few as ten bacterial cells can be enough to cause an infection.

9Shigellosisman only "reservoir"mostly young children fecal to oral contactchildren to adultstransmitted by adult food handlersunwashed hands

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PathogenesisNumber of bacteriatoxicityimmunityinvasiveness - attachment - penetration - multiplication

Pathogenesis-commonBacteria

intestine

Normal bacteria florasIg A

Prevent attachingPenetrate mucus

Multiply in epithelia cell & proper lamina

endotoxin

Endogenous pyrogen

feverInflammationvessel contraction

Superficial mucosal in,nec and ulcer

Diarrhea mixed with blood & pus, abdominalache

Pathogenesis-toxicStrong - allergy to endotoxin

Demethyl-adrenaline

Micro-circulatory failure

Shock, DIC, cerebral edema cerebral hernia

Clinical manifestationIncubation period: 1-2 day, (Hrs. To 7 days)Acute dysenterycommon type: onset in sudden, shiver, high feverabdominal paindiarrhea:stool mixed with blood, mucus & pustenesmus, continence

Clinical manifestationAcute dysenterymild type: caused by S. sonneilow fever or no feverAbdominal pain is mildstool mixed with mucus, without blood & pusdiagnosis by isolation bacteria

Clinical manifestationAcute dysentery: Toxic type: Age: 2 to 7 yrs.Abrupt onset, high fever, Trise to 40oCListlessness,lethargy,convulsion,coma.circulatory & respiratory collapsediarrhea mild or absent at beginning shock form: septic shock brain form: respiratory failure mixed form

Clinical manifestationChronic dysentery: > 2 monthsChronic delayed type:diahhrea long-time and repeatedChronic obscure type: acute history in 1 year, no symptoms, stool culture Pos. or sigmoidscopyAcute attack type: same as common acute dysentery

Diagnostics/Lab TestsYour own observation of symptoms.Medical history and physical exam by a doctor.Laboratory stool culture.Blood counts.

Laboratory FindingsBlood picture: total WBC count increase, neutrophils increaseStool examination:direct microscopic exam.: WBC, RBC, pus cellsbacteria culture:Sigmoidoscope: shallow ulcer,scar, polyps

Outcome of DiseaseMost shigella infections are mild and don't require drastic treatment. However, in a severe attack, excessive dehydration can be fatal (especially in infants and young children) if treatment is unsuccessful.

TreatmentFluids and electrolyte replacement if excessive fluid loss through diarrhea or vomiting.Agents are not recommended as they may prolong the course of disease. Treatment is recommended for most symptomatic patients. Use of antibiotics will shorten the period of fecal excretion of the infecting strain and will shorten the clinical course of disease often to a few days. Antibiotics - for adults and children, if the strain is susceptible, are ciprofloxacin or TMP/SMX or azithromycin. Antibiotic resistance frequently develops after treatment.

Control Measures Good personal hygieneToilet hygieneWash soiled clothing and bed linenHandling foodWhile you are suffering from diarrhea you should not go to work/school. Sanitation of food utensils