PBL 14 SUPERVISOR : DR SAHAR ZAKARIA DYSENTERY PBL 14 SUPERVISOR : DR SAHAR ZAKARIA

DEFINITION Dysentery is a form of severe diarrhea with mucus and blood in the stools with or without tenesmus. As the result of intestinal inflammation mainly in the colon

CAUSATIVE AGENTS A- INFECTIOUS CAUSES : Bacterial (shigella, salmonella, campylobacter, E-coli, colistredium difficile ) Parasitic (Entamoeba histolytica, Balantedium. coli, Schistosom. mansoni, Plasmodium. falciparum, Leishmania. donovani) Viral (rotavirus, norovirus, adenovirus and CMV ) uncommon cause of dysentery

B. NON INFECTIOUS CAUSES Ulcerative colitis - A chronic inflammatory and ulcerative disease arising in the colonic mucosa Ischemic colitis - Transient reduction in blood flow to the colon Colorectal tumor - Malignancy in the colon

CLINICAL MANIFESTATION

Most common dysentery Bacillary dysentery Amoebic dysentery Causative agents Shigella flexneri, Shigella dyenteriae, Shigella boydi, Shigella sonnei Parasite entamoeba histolytica Frequency of Diarrhea More (up to 20 or 30 watery bowel movements in 1 day)  Less Sign & Symptom High fever Dehydration Bloody + pus stool Loss of appetite Flatulence Painful bowel movement Abdominal pain Nausea & vomiting Mild fever Watery diarrhea, which can contain blood, mucus or pus Intermittent  constipation and diarrhea Painful passing of stools Fatigue Nausea and vomiting Most common Country Western Europe & USA Developing countries

Stool culture Presence of fecal leukocytes on smear stained with methylene blue Presence of E histolytica trophozoites or cysts in faeces with direct saline smear Sigmoidoscopy Diffusely erythematous with numerous small ulcer Shallow skip lesion and flask shaped or ‘collar – stud’ N/E Little- a lot of blood & mucus Bulky- little blood- little mucus M/E Numerous pus cells Gram negative bacilli Macrophages numerous RBC scattered Absent Charcot Leydon Crystal Scanty pus cells E. Histolytica Macrophage very few RBC is rouleaux Present Charcot Leydon Crystal

Bacillary dysentery Amoebic dysentery Complication Dehydration Exudative arthritis Bacteremia Ulcer colonic lesion Reiter’s syndrome Amoeboma Liver abscess Perforation of an amoebic ulcer Strictures of the colon Treatment Rehydration By oral or IV (commonly in children) By oral only Antimicrobial Ciprofloxacin Metronidazole Anti diarrheal Non preferable (can cause aggravating of disease) Preferable

OTHERS INFECTIOUS CAUSES SALMONELLA Common bacterial disease that affects the intestinal tract. Salmonella live in animal and human intestines & shed through feces. Humans become infected most frequently through contaminated water or food.  ROTAVIRUS Most common cause of severe diarrhea among infants and young children The virus is transmitted by the fecal-oral route. It infects and damages the cells that line the small intestine and causes gastroenteritis.

DIAGNOSIS 1. Direct stool inspection to check the presence of blood in the stool 2. Stool culture to find organism that cause gastroenteritis 3. Immunoassay to detect and identify certain bacterial toxin, viral and protozoal antigen in blood 4. Sigmoidoscopy with biopsies to screen for colorectal cancer, rectal bleeding & bowel habits. 5. Colonoscopy and abdominal CT for determine the cause of colorectal problems & to screen for colorectal cancer.

GENERAL TREATMENT Drinking fluids Drinking plenty of fluid to replace the those that have been lost and to avoid dehydration. Oral rehydration solution (ORS) Usually come in sachets that are available without prescription. Help to replace salt, glucose and other minerals that the body losses through dehydration Advise about eating Eat small, light meals and avoid heavy, spicy or heavy food

PREVENTION & CONTROL Environmental sanitation as anti-fly measures, proper sewage disposal and safe water supply. Faeces must not be used as fertilizer. Health education for: washing of green vegetables, fruits before eating. Make sure drink only purified water Wash the hands with antibacterial soap after using bathroom, before preparing and eating food

THANK YOU

PBL-mates Ebrahim Amanina Safwan Syahirah Faisal Najihah Irfan Yasmeen Fatin Eika Munirah