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A quick approach to Dysentery
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A quick approach to Dysentery

Topics / Medical / Diarrhea and Electrolytes

Basics

Diarrhea with blood or mucous. It may usually be caused by bacteria (bacillary dysentery) OR amoebas (amoebic dysentery). However, other organisms may also result in dysentery. The EML guidelines state that initially patients with dysentery may be treated as bacillary dysentery, however, if they do not improve after 3 days these patients should be treated for amoebic dysentery.

Very important: Rule out surgical causes. For instance, in children, bloody diarrhea may be due to intussusception so keep that in mind. Other causes may be more local such as hemorrhoids, and anal fissures)

Common Etiologies

  1. Bacteira: Shigella, Salmonella, E.coli, Campylobacter
  2. Amoeba: E. histolytic
  3.  ? Viruses

Investigations

  1. Urea and Electrolytes + Creatinine: Electroyle imbalance, renal function
  2. WCC may be elevated, and inflammatory markers (such as CRP) may also be elevated.
  3. Stool specimen: Stool Microscopy and Culture, ensure you add C.difficile.

Management

1. Bacillary Dysentery

This type of dysentery results due to an acute infection of the bowels by bacteria. There is a characteristic sudden onset of bloody diarrhea, tenesums (feeling of incomplete evacuation) and fever.

Non-pharmacological

  1. Counsel the patient regarding good sanitation
  2. Prevent contamination of food and water
  3. Wash hands before eating, cooking, or handling any food
  4. Washing any soiled items
  5. Promote oral fluid intake

Pharmacological

  1. Fluids:
    1. IF tolerates oral fluids: ORS or Sugar Salt Solution (1/2 teaspoon salt + 8 teaspoons of sugar + 1 L of boiled then cooled water), the amount of fluid depends on the degree of dehydration
    2. If cannot tolerate oral fluids/severely dehydrated: Normal Saline IV
  2. Medications
    • Antibiotics:
      1. Indicated in adults with blood in the stools, and patients who are HIV infected.
      2. Mild (uncomplicated, with no co-morbidity): Ciprofloxacin 500mg PO 12 hourly for 3 days
      3. Moderate (uncomplicated with significant comorbidity e.g. immunocompromised): Ciprofloxacin 500mg PO 12 hourly for 7 days
      4. Severe (signs of sepsis or significant underlying disease): Ceftriaxone 1g IVI daily and continue until it becomes clinically appropriate to switch to the oral regimen (Ciprofloxacin 500mg 12 PO 2 hourly).

2. Amoebic Dysentery

This type of diarrhea is commonly due to E. Histolytica.

Non-pharmacological

  1. Counsel the patient regarding good sanitation
  2. Prevent contamination of food and water
  3. Wash hands before eating, cooking, or handling any food
  4. Washing any soiled items
  5. Promote oral fluid intake

Pharmacological

  1. Fluids: As above
  2. Medications
    • Antibiotics:
      1. Metronidazole PO 800mg 8 hourly for 10 days.

Referral to a higher level of care

  1. No response to treatment
  2. Evidence of abdominal distension
  3. Clinical or radiological signs of intussusception
  4. Acute abdomen
  5. Bloody mucous but no diarrhea
  6. Severe illness
  7. Patient with diarrhea with blood and mucus for longer than 2 weeks
Published on 2 August 2022
Dr. RW Becerra Estevez
Dr. RW Becerra EstevezMBChB (WSU)

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