Dysentery, an inflammatory disease of the intestine especially of the colon, always end up in severe diarrhea and abdominal pains, fever and feeling of incomplete defecation. Several types of infectious pathogens such as bacteria, viruses and parasites are responsible for this disease. This disease can affect anyone especially children of under five years old and it usually occur in the tropic areas with poor sanitation and personal hygiene promote the spread of the microorganisms.
The issue of dysentery (mostly Shigella and Amoeba infections) remain an important public health problem especially in China; the children and the old people. Bacillary dysentery is an infectious intestinal tract disease caused by Shigella and it spreads by contact with patients or carriers and through food and water contaminated with feces. Increase in temperature has been shown through research to have effect on the incidence of bacillary dysentery and that has gained more concerns recently since it has a direct association with diarrheal disease. For example, temperature, rainfall and relative humidity directly affect the rate of replication of bacterial and protozoan pathogens. Increase in temperature also have an impact on environmental reservoirs. Neglection of multi collinearity among meteorological factors has affected the accuracy of correlation with bacillary dysentery incidence but with an improved method, ridge regression, the accuracy of correlation is far better.
Since the disease involves a microorganism e.g. Shigella, laboratory investigation is very prominent. Cultures of stool samples are examined to identify the strain of the organism causing the dysentery. Blood tests can be involved to measure the abnormalities in the levels of essential minerals and salts since a lot of fluids have been lost from the body. Samples do not only come from the stool or blood but also from poor water bodies in the environment.
In the year 2013, Shigella was known to have caused the death of 34,000 children under the age of five and 40000 deaths in people over five years of age. Amoebiasis dysentery is also known to infect over 50million people each year, of whom 50000 die. The most common form of dysentery, bacillary dysentery usually present itself (signs and symptoms) with mild gut pains, frequent passage of stool. Symptoms normally present themselves after 1 – 3 days, are usually no longer present after a week. The frequency of urge to defecate, the larger volume of liquid ejected, and the presence of blood or mucus depends on the pathogen(s) involved in the disease. In some unpleasant occasions, severe abdominal cramps, fever, shock, and delirium can all be part of the symptoms. Dysentery patients may pass more than one liter of fluid per hour in extreme cases and more often, individuals complain of intense abdominal pains and severe diarrhea with blood or mucus, accompanied by rectal pain and low – grade fever. Rapid weight loss and generalized muscle aches are also seen in dysentery, while nausea and vomiting are rare. In uncommon occasions, the amoebic parasite will invade the body through the bloodstream and spread beyond the intestines. In such cases, it may seriously infect other organs such as brain, lungs and liver (most common). Hospitals serve as the location for most cases of dysentery and individuals who experience dysentery are hospitalized for close monitoring because of the signs and symptoms the disease exhibit and the death that comes with it if not properly managed or late treatment.
Late reporting is one of the limitations of the investigations. As a result of poor information about the disease, they tend to stay at home to cure themselves with their so – called concoctions. Some people also rely on churches, attending many prayer camps all in the name of fighting the dysentery and by the time they realize that it is a hospital problem, the situation would have been worse.
Bacteria of the genus Shigella is known to secrete substance like cytotoxins which kill and damage intestinal tissue on contact. Shigella is thought to cause bleeding due to invasion rather than toxins, because even non – toxogenic strains can cause dysentery. Viruses directly attack the intestinal cells, taking over their metabolic machinery to make copies of themselves which leads to cell death. The pathogens typically reach the large intestines after entering orally, through the ingestion of contaminated food and water, oral contact with contaminated objects or hands.
Amoebic dysentery from amoeba Entamoeba histolytica reach the bowel through improper disposal of feces – then it can contaminate the surroundings such as food and water. If another person then eats or drinks food or water that has been contaminated with feces containing the cyst (from the amoeba grouping together to form a shell), the person will be infected with the amoeba. After entering the person’s body through the mouth, the cyst travels down the stomach. The amoebae inside the cyst are protected from the stomach digestive acid and from the stomach, the cyst travels to the intestines, where it breaks open and releases the amoeba, causing the infection. The amoebae can burrow into the walls of the intestines and cause small abscesses and ulcers to form.
Lack of proper hand washing, poor water supply, poor environmental sanitation are some of the factors that can pave way for one to contract dysentery since these factors facilitate the entry of the microorganism into the body (e.g. poor hand washing) and also can provide favorable conditions for the thriving of the pathogens (e.g. poor sanitation).
Dysentery is managed by maintaining fluids by using oral rehydration therapy. But this therapy is not adequately maintained due to vomiting and diarrhea, hospital admission maybe required for intravenous fluid replacement. If by laboratory works we know the type of microorganism (amoeba or shigella), then we administer either an amoebicidal drugs (with combination of two antimicrobial drugs such as metronidazole and paromomycin or iodoquinol) or antibiotic with which ciprofloxacin or TMP – SMX is used for severe cases. Aside the medications, proper hand washing, avoidance of contact with infections and proper environmental sanitation are very good measure to control the disease, dysentery.
In case of such an epidemic case of dysentery, I will suggest that
Increase Health education: Educative information about dysentery should be propagated to the people in terms of how the disease is transmitted, its incubation period, effects on both individuals and community or society as a whole. Professional health workers, community health workers and the community leaders (like the chiefs, members of Parliament and assembly men) should all be involved in promoting the preventive section of health like how to save a dysentery patient at home with the use of the Oral Rehydrated Salt (ORS) and also how the unaffected ones make contact with affected persons especially a relative so he or she doesn’t come into contact with dysentery through the appropriate platforms (e.g. outreaches, a durbars, door - to - doors). Also to make the people understand that not all diseases are home cured or church cured but sometimes a disease require hospitalization.
Proper Sanitation: To control the transmission of dysentery through water, it is important to improve aggressive house – to – house training with the help of the environmental officer to train volunteers to help others treat their drinking water with chlorine and boiling process. The environmental officer with his team should make sure that all water supplies (which could be mainly from the river) should be disinfected, first with hyperchlorination, then with regular or continuous chlorination or boiled vigorously for some minutes before drinking it or using it to bath. With this, the transmission of the dysentery pathogens will reduce drastically and in effect reduce the case of dysentery. Culturally appropriate toilet facilities should be installed by the help of the community leaders e. g. the chiefs so as to prevent indiscriminate deposits of feces which will otherwise end up in our water bodies which thus contaminate them. Moreover, flying insects such as houseflies feed on the feces and spread it to our foods. That’s why it is so much important to cover our foods and also make sure that we consume hot foods, for cold foods serve as good grounds for the transmission of the pathogens in the feces by the houseflies. Poor environmental sanitation also can provide favorable conditions for the thriving of the pathogens. Thus, we must keep our environment very tidy devoid of any wrong waste deposition and other wrong doings that can predispose us to these pathogens which cause dysentery.
Hand washing: A very well and trusted efficient way of inhibiting the transmission of communicable disease is hand washing. The district health management team and I will visit the schools in the district since it is one of the vulnerable institutions to the dysentery. We will let them know the essence of hand washing and know the necessity of it for conditions in schools can reflect conditions at home. Campaigns about hand washing will be propagated throughout the district from time to time to serve as a warning or a reminder about the essence of hand washing. Hand washing with soap and running water after using the toilet and before eating or handling food can prevent one from contacting the dysentery. As that transition from the toilet straight to the food without hand washing give the pathogens (Shigella and Amoebae) the chance into the body to cause the inflammation to our intestines. Thus, the necessity for hand washing can drastically reduce the case of dysentery.
Dr. Kingsley K. A Pereko
GILBERT ELVIS MINTAH
PHYSICIAN ASSISTANT STUDENT
UNIVERSITY OF CAPE COAST
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