DISEASE ENTITY with PATHOPHYSIOLOGY Dysentery DEFINITION Dysentery is an inflammation of the intestine characterized by the frequent passage of feces,

usually with blood and mucus. The two most common causes of dysentery are infection with a bacillus of the Shigella group, and infestation by an ameba, Entamoeba histolytica. Both bacillary and amebic dysentery are spread by fecal contamination of food and water and are most common where sanitation is poor. They are primarily diseases of the tropics, but may occur in any climate. Dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the feces. If left untreated, dysentery can be fatal. CAUSES Dysentery is usually caused by a bacterial or protozoan infection or infestation of parasitic worms, but can also be caused by a chemical irritant or viral infection. The most common cause of the disease in developed countries is infection with a bacillus of the Shigella group (causing bacillary dysentery). Infection with the amoeba Entamoeba histolytica, can cause amoebic dysentery. Shigella 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 causes disease in primates, but not in other mammals. It is only naturally found in humans and apes. During infection, it typically causes dysentery. Shigella causes dysentery that result in the destruction of the epithelial cells of the intestinal mucosa in the cecum and rectum. Entamoeba histolytica is an anaerobic parasitic protozoan, part of the genus Entamoeba. Predominantly infecting humans and other primates, E. histolytica is estimated to infect about 50 million people worldwide. When cysts are swallowed they cause infections by excysting (releasing the trophozoite stage) in the digestive tract. The trophozoite stage is readily killed in the environment and cannot survive passage through the acidic stomach to cause infection. E. histolytica was also found to be transmitted through anal-oral sex. The research has shown that HIV-infected gay men were at greater risk of getting infected than healthy population and than seropositive heterosexuals.

Modes of Transmission 1. The disease can be passed from one person to another through fecal-oral transmission. 2. The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and proctogenital sexual activity. 3. Through indirect contact, the disease can infect humans by ingestion of food especially uncooked leafy vegetables or foods contaminated with fecal materials containing E. histolytica cysts. Dysentery is initially managed by maintaining fluid intake using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement.

PATHOPHYSIOLOGY AND MANIFESTATIONS

DIAGNOSTIC TESTS It can be diagnosed by stool samples but it is important to note that certain other species are impossible to distinguish by microscopy alone. Trophozoites may be seen in a fresh fecal smear and cysts in an ordinary stool sample. MEDICATIONS Ciprofloxacin Metronidazole

Dysentery is initially managed by maintaining fluid intake using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. DIETARY MANAGEMENT Diet restriction, to known well-tolerated foods, and the BRAT diet and its extensions, may be used for 1-to-3 days. However, limiting milk to children has no effect on the duration of diarrhea Banana Rice Apple Tea

Nursing Management: 1. Observe isolation and enteric precaution 2. Provide health education and instruct patient to Boil water for drinking or use purified water Avoid washing food from open drum or pail Cover leftover food Wash hands after defecations and before eating Avoid ground vegetables (lettuce, carrots, and the like) Methods of Prevention: 1. Health education 2. Sanitary disposal of feces 3. Protect, chlorinate, and purify drinking water 4. Observe scrupulous cleanliness in food preparation and food handling 5. Detection and treatment of carriers 6. Fly control (they can serve as vector)