2. Definition—Diarrhoea with visible blood in
the stools
Etiology
Shigella-most important cause in under fives
S. flexneri-responsible for worldwide
epidemics
S. dysenteriae type 1-causes deadly epidemics
S. Sonnei
S. boydii-restricted to Indian subcontinent
3. Other causes
Campylobacter jejuni-especially in infants
Salmonella
Enteroinvasive Escherichia coli-severe
dysentery, infection is uncommon
Entamoeba histolytica---causes dysentery in
older children and adults but rarely in children
under 5 years of age
4. Important cause of morbidity and mortality
associated with diarrhoea
15% of all diarrhoea episodes in children
under 5 years are dysentery
25% of all diarrhoea deaths
5. Dysentery is severe in
Infants and in children who are
undernourished
Those who develop clinically evident
dehydration during their illness
Those who are not breastfed
Occurs with increased frequency and severity
in children who have measles or have had
measles in the preceding month
Diarrhoea episodes that begin with dysentery
are more likely to become persistent
6. The organism invade the large intestine
following the ingestion of contaminated
water or food or oral contact with
contaminated objects or hands.
Shegella secretes cytotoxins which damage
the intestinal tissue on contact, leading to
Inflammatory Immune Response
7. Inflammatory immune response leads to
1. Fever
2. Spams of the intestinal muscles-cramp
3. Water leaks out from the damaged intestine
4. More cytokines release and more tissue
damage.
5. Impaired nutrient absorption
6. Excessive loss of water and minerals
through the stool due to impairment of the
protective mechanisms in the intestine
which reduces fluid loss
8. Excessive loss of water and minerals from the
stool due to impairment of the protective
mechanisms in the intestine which reduces
fluid loss.
In severe cases-entry of pathogenic organism
into the blood stream.
9. Incubation period-2 to 7 days
Clinical diagnosis
Based sorely on the presence of visible blood
in the diarrhoeal stool.
Stool will also contain numerous pus cells
It may contain abundant mucus
Dysentery stools are numerous in frequency
and small in quantity and may not cause
dehydration.
Sometimes the quantity may be much and
result in dehydration
10. Fever
Cramping abdominal pain
Pain in the rectum during defecation or
attempted defecation (tenesmus)
12. Extensive damage to the ileum and colon
Complications of sepsis
Secondary infection-pneumonia
Severe malnutrition
13. Stool culture-to detect pathogenic bacteria-
sometimes impossible. Takes at least 48hrs
Stool microscopy-amoebasis can be
diagnosed if trophozoites of E. histolytica
containing red blood are seen in fresh stool
or in mucus from rectal ulcerations
14. Shigella causes 60% of dysentery. Children
with dysentery should be presumed to have
shigellosis
If stool microscopy show trophozoites of E-
histolytica containing erythrocytes, give
antiamoebic therapy
17. Fluids—evaluate children for dehydration and
treat accordingly—offer water and other
drinks if there is fever
Children should be encouraged to eat so that
nutritional damage can be prevented or
minimized.
18. Continue breast feeding
Give small meals at least 6x a day
Encourage child to eat
Choose energy and nutrient rich foods
Give one extra meal a day for at least 2wks
after diarrhoea stops
19. Follow-up
Children who do not show signs of
improvement within 2 days
Infants
Undernourished
Those not breastfed
Those with dehydration
Those with severe malnutrition should be
admitted
20. Good hand washing with soap and water
The microorganism that causes dysentery are
spread by faecally contaminated hands, food
and water
Number of shigella required to cause
infection is very small---10-100 organisms
21. Definition---diarrhoea episodes that lasts for
14 days or longer
20% of acute diarrhoea episodes become
persistent
It causes nutritional status to deteriorate
Causes 30-50% of all diarrhoea associated
deaths
15% of episodes of persistent diarrhoea
results in to death
22. No single microbial cause
Shigella
Salmonella
Enteroaggregative ecoli
Others
Cryptosporidium-malnurished and
immunocopromised
23. Causes flattening of the villi
Reduced production of disaccharides
enzymes
Reduced absorption of nutrients
24. Malnutrition-delays repair of damaged
intestinal epithelium
Recent introduction of animal milk-lactose
intolerance, hypersensitivity to milk,
bacteria contamination of milk
Young age-most episode occur in children
under 18 months of age
Immunological impairment
Recent diarrhoea-either acute or persistent
25. Persistent diarrhoea is a nutritional disease
Occurs most frequently in malnourished
children
Single episode can last 3-4 weeks causing
significant weight loss
Weight loss during persistent diarrhoea –
reduced absorption of all nutrients especially
fat and lactose in some children
Poor food in take
26. History
Observe whether stool is bloody
Stool culture
Stool microscopy
Stool pH-<5.5 and large amount of reducing
substance in the stool-carbohydrate
malabsorbtion
Fluid and electrolyte replacement
27. Proper feeding-most important therapy
Temporarily reduce the amount of animal
milk or lactose in the diet
Provide a sufficient intake of energy, protein,
vitamins, minerals
Avoid giving foods or drinks that may
aggravate the diarrhoea
Ensure that the child’s food intake is
adequate
28. Children under 6 months of age or with
dehydration should be rehydrated and
referred to the hospital
Older children
Continue breastfeeding
Dilute any animal milk given with equal
amount of water or replace with a fermented
milk product-yoghurt
Ensure a full energy intake
29. Avoid foods that are hyperosmolar
Give food frequently in small meals, at least
6x a day
Provide supplementary vitamins and
minerals-folate, vit B12, vit A, Zinc and iron
30. If diarrhoea has not stopped, refer the child
to hospital for specialized care
If the diarrhoea has stopped
Continue to give same foods for one more
week
Gradually reintroduce the usual animal milk
or formula over several days and shift to a full
strength diet
Give extra meal each day for 1mth
