| ID | 42 |
|---|---|
| Name | BACILLARY DYSENTERY |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. Microscopic examination of stool: shows plenty of pus cells, R.B.C, ingested R.B.C. in the macrophages. 2. Stool culture- positive for shigella in most cases. |
| Management | |
| Introduction | Bacillary dysentery (or shigellosis) is a common disease, caused by shigella, an invasive organism leading to an acute inflammation of the large gut characterised by diarrhoea with blood and mucous in the stools. It is often self-limited and mild but occasionally may develop serious form. Shigellae are gram-negative rods, which are classified into four main groups- s. dysenteriae, s. flexneri, s. boydii and s. sonnei. Most diseases in our country are caused by s. flexneri. Shigella dysentery causes most serious diseases and are often multi-resistant to antibiotics particularly in tropical countries. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Abrupt onset of passage of loose stools for number less time. No faecal matters only blood and mucus, bright red in colour, odourless. 2. Marked tenesmus and lower abdominal cramps. 3. Systemic- fever, chills, anorexia, malaise, headache, lethergy. 4. In more severe cases- thirst, dry tongue, oliguria, intense headache due to meningism and sometimes coma and convulsion. 5. There is tenderness in the abdomen mostly in lower part. 6. Arthritis or iritis may complicate bacillary dysentery (Reiter’s syndrome). |
| Preventions | |
| Treatment | Treatment: 1. Rest in bed. 2. Specific measures: a. Treatment of dehydration & hypotension in severe cases, restoration of circulatory blood volume and renal perfusion (if any)- are life saving measures by oral or i.v fluid as required, b. Antimicrobials-Cotrimoxazole 960mg twice daily for 7-10 days. Or, Ciprofloxacin 500-750mg twice daily or Levofloxacin 500mg once daily for 3 days. Or, Nalidixic acid 500mg to Igm 6 hourly for 7 days. Or, Pivmecillinam 400mg 6 hourly with or immediately after meal for 5-7 days. N.B: Dosages for children should be adjusted accordingly. 3. General measures: a. Loperamide 2-4mg 6-8 hourly for controlling diarrhoea. b. Anti-spasmodic drugs e.g Hyoscine butyl bromide for abdominal cramp or pain. c. Infusion- i.v infusion of cholera saline to combat dehydration, d. Adequate intake of fluid e.g. Dub water and barley, e. Diet should be non-residual e.g. dhai and chera. |
| Complications | |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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