Definition

inflammatory disorder of the intestine,

especially of the colon

results in severe diarrhea containing mucus
and/or blood in the feces
Fever
abdominal pain
rectal tenesmus
caused by any kind of infection.

Bacillary Dysentery (shigellosis)

Acute infectious disease of intestine caused by dysentery

bacilli
Place of lesion: sigmoid & rectum
Pathological feature: diffuse fibrious exudative
inflammation
Clinical manifestation: fever, abdominal pain, diarrhea,
tenesmus , stool mixed with blood, mucus & pus.
Even companied with marked toxicity and shock toxicencephalopathy.

Etiology
Causative organism:

dysentery bacilli, genus shigella, gram negative, short rod,

non-motile.
4 groups :
- S. Dysenteriae-the most sever
- S. Flexnerii-the epidemic group and easily turn to chronic
- S. Boydii-tropical
- S. sonnei-the most mild
Pathogenicity:

- virulence endotoxin

- invasiveness attach-penetrate-multiply

Transmision
Source of infection:

- patients

- carriers
Route of transmission:

fecal-oral route

Suceptibility of population:

immunity after infection is short and unstead, no cross-immune

Pathogenesis
Number of bacteria
toxicity
immunity
invasiveness

- attachment

- penetration
- multiplication

Pathogenesis

Pathology
Site of lesion:

entire large bowel-colone, sigmoid & rectum

Feature:

acute:
diffuse fibrinous exudative inflammation, hyperemia,
edema, leukocyte infiltration, superficial necrosis
chronic:
edema, polypoid hyperplasis
toxic:
endothelial cell of micro-capillary necrosis

Clinical manifestation

Clinical manifestation
Chronic dysentery: > 2 months
Chronic delayed type:
diahhrea long-time and repeated
Chronic obscure type:

acute history in 1 year, no symptoms, stool

culture Pos. or sigmoidscopy

Acute attack type:

same as common acute dysentery

Laboratory Findings
Blood picture:

WBC count increase, neutrophils increase

Stool examination:

direct microscopic exam.: WBC, RBC, pus cells

bacteria culture
Sigmoidoscope:

ulcer, scar, polyps

Differential diagnosis
Amebic dysentery
Enteritis : E. Coli, salmonella,viral diarrhea
Intussusception: jelly-like stools, abdominal mass and
absence of fever
Rectal & colonic carcinoma: no cure for long-term,drop
of weiht of body
non-specific ulcer colitis: no cure for long-term,culture of
stool is negative, sigmoidoscope: hemorrhage, ulcer

Treatment
Fluids and electrolyte replacement
antibiotics :

shorten the period of fecal excretion

shorten the clinical course of disease
ciprofloxacin or TMP/SMX , or
azithromycin.

Etiology
Entamoeba histolytica
Major

pathogen
Trophozoite & Cyst
Transmision : Oral-faecal

Trophozoite (active form)

Size: 10-40 micrometers

in diameter
Pseudopodium(ectopals
mic protrusion)
Endoplasm: red blood
cells may be found in it.
Nucleus

Cyst (nonmotile)
10-20 mocrometers in

size
spherical in shape
1-2 nuclei (immature
cyst)
4 nuclei (mature cyst)

Clinical classification
Asymptomatic infection (carrier): > 90%

cases
Sympomatic cases : < 10%
8-10% dysentery, colitis
2% invasive amoebiasis
0.1% deaths

Intestinal amoebiasis
dysentery

dysenteric stools (pus and blood without

feces). fever, dehydration, and electrolyte
abnormalities. Tenesmus and abdominal
tenderness.
non-dysenteric colitis
appendicitis
amoeboma

B. Extra-intestinal amoebiasis
Hepatic

- acute non-suppurative
- liver abscess: right upper quadrant pain,
referred to
the right shoulder. tender.
Pulmonary
Brain
Skin, perianal infection

Diagnosis : Stool
examination
trophozoite

cyst

Specimen

feces

feces

Method

direct smear with

normal saline

direct smear with iodine

stain

Disease

amoebic dysentery

chronic intestinal
amoebiasis or carriers

Diagnosis
Serologic studies:

indirect hemagglutination, ELISA and latex

agglutination.
Tissue examination:
sigmoidoscopic biopsy, aspiration

Treatment
Diodoquin-carriers
Metronidazole-dysentery, liver abscess