Community Health Nursing

Lyra Lorca and Sushmita Jacutin

Dysentery

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Dysentery is a general term for a group of gastrointestinal disorders characterized by inflammation of the intestines, particularly the colon. WHO- Dysentery is bloody diarrhea, i.e. any diarrheal episode in which the loose or watery stools contain visible red blood. Dysentery is most often caused by Shigella species (bacillary dysentery) or Entamoeba histolytica (amoebic dysentery). American Heritage Dictionary- An inflammatory disorder of the lower intestinal tract, usually caused by a bacterial, parasitic, or protozoan infection and resulting in pain, fever, and severe diarrhea, often accompanied by the passage of blood and mucus. Etymology: Gk, dys + enteron, meaning ill/bad and intestine Types: a.) b.) c.) d.) e.) Bacillary dysentery Amoebic dysentery Balantidiasis, girdiasis, and cryptosporidiosis Viral dysentery Dysentery caused by parasitic worm

Cause: bacterial, parasitic, or protozoan infection, chemical irritation of intestines Effect: pain, fever, and severe diarrhea, often accompanied by the passage of blood and mucus
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Community Health Nursing

Lyra Lorca and Sushmita Jacutin

Mode of Transmission Eating/drinking contaminated food/water Hand to mouth transfer of contaminated materials Via flies Via feces/soiled objects of patient/carrier Anal sex or oral-genital sex Direct contact ie. Swimming in contaminated water Incubation Period: 1 day, less than 4 days Period of Communicability: During acute infection and until microorganism is absent from feces. Individuals can become carriers for 1-2 or more years Susceptibility, Resistance, Occurrence: Common and more severe to children than adults. Developing Countries. Areas with poor sanitation especially in sailing vessels, army camps, areas where large groups of areas. Frequent travelers in developing countries.Children in day care centre, people in nursing homes, and men having sex with other men. Cause: 1. Bacillary dysentery shigellosis: S. sonnei, S. boydii; and S. flexneri. S. flexneri 2. Amebic dysentery intestinal amebiasis or amebic colitis: Entamoeba histolytica, w/c means tissue-dissolving. Releases trophozoite. 3. Balantidiasis, giardiasis, and cryptosporidiosis: protozoa, Balantidium coli, Giardia lamblia, and Cryptosporidium parvum 4. Viral dysentery traveler's diarrhea or viral gastroenteritis: rotaviruses, caliciviruses, astroviruses, noroviruses, and adenoviruses Signs and Symptoms: 5. Dysentery caused by parasitic worm: hipworm (trichuriasis) and flatworm or fluke (schistosomiasis) Signs and Symptoms Diarrhea (bloody, watery) Metastatic amebiasis Severe abdominal cramps/pain High Fever/ Low Fever Chills Pain in rectum Bloating and foul-smelling flatus Nausea Vomitting Headaches Tender Abdomen
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Community Health Nursing

Lyra Lorca and Sushmita Jacutin

Fatigue Painful passing of stools Intermittent constipation Laboratory Tests Stool sample Blood test Imaging Tests CT scan X-rays Ultrasound Medical Treatment 1. Bacillary dysentery: antibiotics a. trimethoprim-sulfamethoxazole (Bactrim, Septra) b. nalidixic acid (NegGram) c. or ciprofloxacin (Cipro, Ciloxan) 2. Amebic dysentery a. diloxanide furoate (Diloxide) b. iodoquinol (Diquinol, Yodoxin) c. metronidazole (Flagyl) d. paromomycin (Humatin) 3. Dysentery caused by other protozoa a. amebic dysentery b. albendazole (Zentel) or furazolidone (Furoxone) 4. Viral dysentery 5. Dysentery caused by parasitic worms a. anthelminthic medications - mebendazole (Vermox) - praziquantel (Biltricide) - metrifonate (Trichlorfon) - oxamniquine 6. Other drugs: tinidazole (Tindamax, Fasigyn) Methods of Prevention and control Sanitary disposal of human feces Construction of sanitary privy Sanitary supervision of processing, preparation, and serving of food (esp raw food) Adequate provision for safe washing facilities Fly control and screening (vs fly contamination) Protection of purified water supplies Control/isolation of infected individual contacts and environment Consistent inspection
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Community Health Nursing

Lyra Lorca and Sushmita Jacutin

Public Health Nursing Responsibilities Assessment/inspection Encourage medical (lab tests) care Health teaching Nursing Care Hospitalization Health teaching/demonstrating of practical procedures to take care of sick family member, proper hygiene, proper sanitation and environmental health safety Assess understanding of family on treatment/procedures Health Teachings Area/Person involved Environment House Behavior Food/water Health Care Delivery System Health Teaching Clean environment (if pests exist: organic pesticides, etc) Maintain cleanliness Proper sanitation of privy/toilets Proper hygiene (hand washing) Safe sex practices Proper preparation, serving and keeping of food/water Consistent inspection of water source and its environment Awareness of local health services (health check-ups/ follow-ups, free medications (vitamins, antibiotics), deworming Personal obligation in maintaining health (reporting immediately to health centre if S/S are present)

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