BACILLARY DYSENTERY

(Shigellosis)

An acute bacterial disease involving the large and small intestine characterised by bloody mucoid diarrhoea.

Bacillary dysentery is a notifiable disease.

Cause

  • Shigella dysenteriae, Shigella flexneri, Shigella sonnei, all spread by faecal-oral route

Clinical features

  • Mucoid bloody diarrhoea
  • Fever
  • Nausea, vomiting, abdominal cramps
  • Tenesmus (sensation of desire to defecate without production of significant amounts of faeces)
  • Toxaemia (sometimes)
  • S. flexneri infection may be complicated with Reiter’s syndrome – urethritis, conjutivitis and arthritis

Differential diagnosis

  • Amoebic dysentery
  • Other causes of bloody diarrhoea

Investigations

  • Stool: For C&S, microscopy

Management

  • Correct any dehydration
  • Ciprofloxacin 1 g single dose
  • Child >3 months: 30 mg/kg twice daily for 3 days

In case of sepsis, toxemia, severe disease or pregnancy

  • Ceftriaxone IV 1 g daily till able to take oral, then switch to oral ciprofloxacin 500 mg every 12
    hours to complete 7 days

Prevention

  • Provide health education to the public about:
    • Washing hands before eating food
    • Proper disposal of faeces
    • Boiling of all drinking water
    • Avoiding eating cold foods & roadside foods