Pharmacotherapy/Treatment Of Dysentery

Dysentery is an intestinal infection. It causes severe diarrhea with blood and sometimes mucus. The intestine gets inflamed from infection. Incubation period can spam 6 days and symptoms can last a period of 3-7 days or in worse cases 4-6 weeks. However, some people become just carriers without symptoms.

There are two methods these organisms cause dysentery. One is by the organism invading the mucosa of the intestine. The other means is the organism releasing poisonous toxins causing cellular damage.

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Symptoms

1. Abdominal cramp or pain

2. Nausea and vomiting

3. Fever (38°c)

4. Dehydration which is life threatening

5. Painful spasm of the intestinal muscles (cramp)

6. Swelling or inflammation of the intestine due to fluid leaking from the capillaries of the intestine (edema)

7. Tissue damage by the body's immune cells and the chemical called cytokines

8. Chronic ulceration of the large intestine

Complications

1. Lactose intolerance

2. Liver, brain or lungs abscess

3. Haemolytic uraemic syndrome (HUS), a type of kidney damage

4. Post infection arthritis

5. Blood stream infection

6. Delirium

7. Convulsion

8. Coma

9. Low potassium

Mode Of Transmission

1. Contaminated food or water. This happens when the food is not properly processed. Fruits need to be washed or peel before eating. Raw food must be cooked.

2. Anal and oral sex in a session with an infected person more common in gay

Types/Causes Of Dysentery

Bacteria: bacteria are the main causes of dysentery. Bacteria accused of causing dysentery is shigella (shigella sonnei, shigella boydii, shigella flexneri and shigella dysenteriae) which is called

shigellosis and most common with 500000 cases yearly in the United States of America, USA. Others are campylobacter, salmonella or enterohemorrhagic (most deadly) and escherichia coli.

There are 120-165 million shigella infections worldwide. About a million fatalities are recorded with 60 percent of that occurring in children under 5 years of age from developing countries.

Parasite: Parasitic amoeba that infests the intestine known as amoebiasis is another common cause of dysentery. It is prevalent in tropic and developing countries. The causative organism is an enteric protozoan that is called entamoeba histolytica and exists in cyst or trophozoite form. It affects about 10 percent of the world population. It causes invasive disease in about 100000 people annually. 90 percent are asymptomatic.  Animal reservoirs are monkeys, dogs and pigs. Homosexual men are commonly infected with nonpathogenic entamoeba dispar.

Parasitic dysentery is more chronic and insidious. The acute cases are caused by trophozoite while the chronic type is caused by cyst which is more common among both.

There are other minor causes that include other types of parasites, chemical or viral.

Pharmacotherapy of dysentery
Dysentery

Diagnosis

1. Microscopic examination of fecal matter for trophozoite or cyst.

2. Blood test for antibodies

Pharmacotherapy/Treatment Of Dysentery

Since most infections resolve on their own, treatment is fluid replacement and rest. Dysentery caused by bacteria that become severe will need to be treated with an antibiotic. Fluoroquinolones e.g ciprofloxacin, ofloxacin and levofloxacin, azithromycin, ceftriaxone and pivmecillinam are the main choice of treatment. The world health organisation (WHO) recommends ciprofloxacin, ceftriaxone and pivmecillinam for children.

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Painkillers like paracetamol and bismuth subsalicylate can be given to ease belly cramps.

Amoeba dysentery is treated with metronidazole, tinidazole, diloxanide furoate, iodoquinol or paromomycin.

Anti motility drugs (loperamide and atropine/diphenoxylate) should be used with extreme caution. There is no vaccine due to lack of interest. Recent strains are becoming resistant to available drugs. If one drug fails, another drug can be tried.

Prevention of dysentery is some hygiene. Also, avoid risky sex behaviour.


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