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What is dysentery disease (shigellosis)?

by Josephine Andrews
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Dysentery (also shigellosis, shigella, bacterial dysentery or bacterial dysentery) is a contagious diarrheal disease caused by an infection with bacteria (shigella). Common symptoms include bloody diarrhea, abdominal cramps, vomiting and fever. Shigellosis can usually be treated well. Only in rare cases is a stay in the hospital necessary. Find out more about causes, symptoms and treatment here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

A03

quick overview

  • Description: Contagious diarrheal disease caused by infection with bacteria (Shigella).
  • Causes: Infection with bacteria that are transmitted directly by sick people through dirty hands or indirectly through contaminated food, drinking and bathing water or objects
  • Symptoms: Diarrhea (watery to bloody), abdominal cramps, fever and vomiting often occur.
  • Diagnosis: Discussion with the doctor, physical examination (e.g. detection of bacteria using a stool sample)
  • Treatment: The doctor usually treats shigellosis with antibiotics. In addition, the supply of liquid and electrolytes (e.g. drinking solutions) is important. Hospitalization is rarely necessary.
  • Course: The symptoms usually appear within a few hours to days and disappear after about a week. The prognosis is good with mild forms and rapid treatment. In severe cases, there are life-threatening complications (e.g. kidney failure).
  • Prevention: Wash your hands regularly, only drink clean drinking water (eg in original sealed bottles), cook or fry food well before eating

What is dysentery disease?

Dysentery disease – also known as shigellosis, shigellae dysentery, bacterial dysentery, bacterial dysentery or shigellae dysentery – is an intestinal disease caused by infection with various bacteria of the Shigella genus. They belong to the intestinal germs, which are medically referred to as enterobacteria.

The infection often causes severe diarrhea and abdominal pain. In Germany, it is mainly travelers and especially those returning from warm countries with poor hygienic conditions who are affected.

Ruhr disease is relatively rare in Germany. An infection with Shigella is highly contagious and must therefore be reported under the Infection Protection Act (e.g. for employees in kitchens and restaurants). This means that the doctor must report a proven infection in his patient to the health department. The most common types of bacteria that cause dysentery include Shigella dysenteriae, Shigella flexneri, Shigella boydii, and Shigella sonnei.

Bacterial dysentery is to be distinguished from amoebic dysentery. The latter is not caused by bacteria but by the parasite Entamoeba histolytica (amoeba).

Where are Shigella found?

Shigella are widespread worldwide. Poor sanitary conditions and a warm climate favor the spread of the disease, which is why it is particularly common in so-called developing countries. According to studies, the cases of shigellosis occurring in Germany come primarily from countries such as Egypt, Morocco, India, China and Turkey.

Typically, bacterial dysentery occurs more frequently in the warm months (summer to early autumn). Children under the age of five and young adults (between the ages of 20 and 39) are most likely to be infected with Shigella.

In Germany, dysentery sometimes occurs in community facilities (e.g. nursing homes or kindergartens) if hygiene measures are not sufficiently observed.

In Germany, dysentery is mostly due to infection abroad.

How does shigellosis develop?

Dysentery is caused by infection with Shigella bacteria. These bacteria begin to produce toxins (endotoxins and exotoxins) in the gut that cause inflammation of the lining of the gut (usually the colon). The most common types of bacteria from the Shigella group include:

  • Shigella sonnei: mainly distributed in western Europe; relatively harmless
  • Shigella flexneri: mainly distributed in eastern countries and the USA; rarer and less dangerous
  • Shigella boydii: mainly distributed in India and North Africa
  • Shigella dysenteriae: mainly distributed in the tropics and subtropics; forms both an endotoxin, which in severe cases leads to colon ulcers, and an exotoxin (Shiga toxin), which leads to severe, bloody diarrhea and circulatory problems

How is the transfer done?

Infection with Shigella occurs via the faecal-oral route. This means that the pathogens are excreted in the stool (faecal) and taken in through the mouth (orally). Infection from person to person usually occurs directly through dirt and smear infection , for example if those affected do not wash their hands or only wash them insufficiently (e.g. after going to the toilet) and shake the hand of another person.

The bacteria are transmitted indirectly via contaminated food, contaminated drinking water and infected objects (e.g. towels) as well as through the shared use of toilets. Transmission through bacteria-contaminated bathing water is also possible.

Infection also occurs through infected individuals who do not show symptoms (asymptomatic carriers or “shedders”). Flies are able to carry bacteria-contaminated stool particles onto objects or food. It is also possible for Shigella to be transmitted through anal sexual contact and occasionally through contaminated medical equipment.

Shigella are highly contagious and cause symptoms even in small amounts (less than 100 germs).

Symptoms of dysentery typically come on suddenly and violently. First, watery diarrhea (“white dysentery”) occurs. Depending on the type of pathogen, there are other symptoms that are more or less pronounced. In severe cases, the diarrhea is mucopurulent or bloody (“red dysentery”). Other symptoms such as fever, ulcers and severe abdominal cramps can also occur.

If the body excretes excessive fluids due to diarrhea, it often loses additional electrolytes, especially sodium and potassium . In severe cases, a lack of fluid and electrolytes leads to a hemolytic uremic symptom (HUS). Small blood clots (thrombi) form throughout the body. These block the blood supply to vital organs (e.g. brain , heart , kidneys). Kidney failure, coma and even circulatory failure are possible consequences.

Symptoms of bacterial dysentery at a glance:

  • Severe, cramping abdominal pain (colic)
  • Vomit
  • Painful urge to defecate
  • Fever
  • Watery to mucous-bloody diarrhea
  • ulcers in the intestines; intestinal bleeding; In severe cases, the intestine expands, ruptures (intestinal perforation) or the peritoneum becomes inflamed (peritonitis)
  • Dehydration ( dehydration ), loss of electrolytes
  • The lack of fluids often causes circulatory problems, impaired consciousness and muscle cramps, including kidney failure and coma.

How does the doctor make a diagnosis?

The first point of contact if you suspect a Shigella infection is your general practitioner. If necessary or for further examinations, the doctor will refer you to a specialist or to a hospital. In order to diagnose shigellosis, the typical symptoms of the disease and a stool examination are usually sufficient.

To diagnose dysentery, the doctor first conducts a detailed discussion (anamnesis) with the person concerned. A physical examination is then carried out.

At the latest, if severe diarrhea lasts longer than three days, is bloody or is accompanied by a fever over 38 degrees Celsius, a doctor’s visit is necessary.

conversation with the doctor

During the conversation, it is important to inform the doctor about recent stays abroad, because bacterial dysentery occurs more frequently in so-called developing countries. Among other things, the doctor asks those affected how often the diarrhea is, what the consistency of the stool is (e.g. soft, mushy or liquid) and what other symptoms occur (e.g. abdominal cramps, fever, nausea).

Physical examination

The doctor then performs a physical exam. For example, he feels the abdomen for hardening or checks it for abnormal bowel noises with a stethoscope.

If there is a suspicion of shigellosis, the doctor makes the diagnosis based on a stool sample from the person concerned. For example, he examines under the microscope whether there is an increased number of white blood cells ( leukocytes ) in the stool.

Shigella can also be detected directly in the laboratory. There it can also be determined whether the type of Shigella bacterium detected has already developed resistance to a specific antibiotic (antibiogram). This tells the doctor whether a particular antibiotic is effective against Shigella or not.

Since Shigella are very sensitive, it is advisable to immediately transport a stool sample that is as fresh as possible to the laboratory in a special transport container.

How is shigellosis treated?

antibiotics

In most cases, the doctor treats an infection with Shigella with antibiotics. These shorten the duration of the disease, reduce the excretion of the pathogens (and thus the risk of infection) and prevent complications. The active ingredients azithromycin or ciprofloxacin in particular have proven to be effective. The doctor administers the antibiotics in the form of tablets or, in severe cases, via an infusion .

Some Shigella are resistant to certain antibiotics and are therefore not sensitive to these drugs. In principle, doctors only recommend treatment with antibiotics after their effectiveness on the respective bacterium has been tested in the laboratory (antibiogram). This ensures that the antibiotic is actually effective against the pathogen.

If you are in good general condition, it is sometimes possible to forego antibiotic treatment. The doctor will assess whether this is possible in your case.

Anticonvulsants

In the case of cramping abdominal pain, the doctor usually prescribes antispasmodic medication (spasmolytics) such as N-butylscopolamine. Drugs against diarrhea, such as loperamide, are not used by doctors in dysentery because they suppress diarrhea and make it more difficult for the pathogen to be excreted from the body.

supply of fluid and electrolytes

It is also important that those affected drink enough to compensate for the loss of fluid caused by diarrhea. If they cannot drink enough themselves, they are given infusions through a vein.

To replace lost minerals and salts (electrolytes) in the body, doctors may also give IV fluids or prescribe electrolyte solutions to drink from the pharmacy. If you don’t have a medical facility or pharmacy nearby while traveling, you can also prepare an electrolyte solution yourself in case of an emergency.

To do this, mix 750 ml of still drinking water with 250 ml of orange juice (as a source of potassium), a tablespoon of lemon juice (as a source of sodium citrate), a level teaspoon of salt and eight level teaspoons of sugar ( dextrose is best). is best ). Mix well until the salt and sugar have dissolved. It is best to take about two liters of the mixture in sips throughout the day.

If you don’t have juice around the house, you can use water or mild tea (like chamomile or rosehip) instead. Especially when you are abroad, make sure that you use clean drinking water!

A homemade electrolyte solution is not intended to treat serious diseases. If your child or baby has diarrhea, if the diarrhea lasts longer than three days or if there is blood in the stool , consult a doctor immediately!

How does dysentery disease progress?

Depending on the type of pathogen, the course of the disease varies. In Germany, infections are mainly caused by Shigella sonnei (about 70 percent of cases) and Shigella flexneri (about 20 percent of those affected). These two types mainly lead to milder illnesses, but they begin very acutely and are usually very contagious.

In some cases, dysentery disease progresses without symptoms. People who are infected and shed the bacteria in their stool without showing any symptoms themselves are called shedders.

Sudden symptoms such as watery diarrhea usually appear between four hours and four days after infection. In some cases, fever, loss of appetite and abdominal pain also occur. In the lighter, harmless forms, the symptoms disappear after about a week.

In rare cases, the bacteria settle permanently in the intestine and continue to be excreted in the stool. People in whom this is the case are referred to as long-term shedders.

If the bacterium Shigella dysenteriae triggers the disease, the shigellosis is usually more severe. This often leads to bloody, mucous diarrhea accompanied by severe abdominal cramps. It is also possible for ulcers to form in the large intestine as the disease progresses, which in extreme cases causes the intestine to widen or break through (intestinal perforation).

How dangerous is dysentery disease?

Dysentery is particularly dangerous for small children, the elderly and those with weakened immune systems. The great loss of fluid and electrolytes represents the greatest danger in bacterial dysentery. Possible consequences are cramps, kidney failure and circulatory collapse up to and including coma.

However, serious and fatal complications are rather rare with bacterial dysentery. In this country, milder courses of the disease predominate, with the infections often starting suddenly and violently and being highly contagious.

How long are you contagious?

Sick people who have recovered and show no symptoms are still contagious for about four to six weeks. That is how long the pathogens can be detected in the stool of those affected.

How to prevent dysentery disease?

The best way to prevent dysentery is to wash your hands regularly and, above all, thoroughly:

  • To do this, hold your hands under running water.
  • Thoroughly rub the hands on all areas (palms and backs of the hands, fingertips, between the fingers and thumbs) with sufficient soap for at least 20 to 30 seconds.
  • Then rinse your hands again under running water.
  • In public restrooms, use a paper towel or your elbow to turn off the faucet.
  • Dry hands carefully. Paper towels are good for public restrooms; at home it is best to use a personal, clean towel.

If you do not have running water and soap, use special disinfectant wipes, gels or sprays from the pharmacy. Make sure your skin is dry and rub all areas thoroughly for about 30 seconds.

Please also note the following measures, especially in warmer countries with poor hygienic conditions:

  • Do not drink tap water, but only water from originally closed drinking bottles.
  • Boil or fry foods before eating them.
  • Do not eat lettuce or unpeeled fruit (e.g. grapes, strawberries). Instead, eat fruit with its skin on (e.g. bananas, oranges) and peel it yourself.
  • Avoid bathing in shallow, warm water.

If you live with a sick person in the same household, you should also pay attention to the following:

  • Wash and disinfect your hands regularly.
  • Wash bed linen and towels at a temperature of at least 60 degrees Celsius.
  • Regularly disinfect all objects that the patient has come into contact with (e.g. remote control, light switch, door handles).

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