Dysentery disease

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The dysentery disease (also Shigellosis, Shigella dysentery, bacterial dysentery or bacterial dysentery) is a contagious diarrheal disease that results from an infection with bacteria (Shigella). Common symptoms are bloody diarrhea, abdominal cramps, vomiting, and fever. Shigellosis can usually be treated well. A stay in hospital is only necessary in rare cases. Find out more about causes, symptoms and treatment here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A03

Brief overview

• Description: Contagious diarrheal disease caused by an infection with bacteria (Shigella)
• Causes: Infection with bacteria that are transmitted from sick people directly via dirty hands or indirectly via contaminated food, drinking and bathing water or objects
• Symptoms: Diarrhea (watery to bloody), abdominal cramps, fever and vomiting often occur.
• Diagnosis: conversation with the doctor, physical examination (e.g. detection of bacteria using a stool sample)
• Treatment: The doctor usually treats shigellosis with antibiotics. In addition, the supply of fluids and electrolytes (e.g. drinking solutions) is important. A stay in hospital is rarely necessary.
• Course: The symptoms usually appear within a few hours to days and disappear after about a week. The prognosis is good for mild forms and rapid treatment. In severe cases, life-threatening complications (e.g. kidney failure) occur.
• Prevention: Wash your hands regularly, only consume clean drinking water (e.g. originally sealed bottles), cook food before consumption or fry it well

What is dysentery?

Dysentery disease - also called shigellosis, shigella dysentery, bacterial dysentery, bacterial dysentery or shigella dysentery - is an intestinal disease that results from infection with various bacteria of the Shigella genus. They belong to the intestinal germs that are medically referred to as enterobacteria.

The infection often leads to severe diarrhea and abdominal pain. In Germany, mainly travelers and especially those returning from warm countries with poor hygienic conditions are affected.

Dysentery is relatively rare in Germany. An infection with Shigella is highly contagious and must therefore be reported under the Infection Protection Act (e.g. for employees in kitchens and restaurants). This means that the doctor has to report a proven infection in his patient to the health department. The most common types of bacteria that cause dysentery include Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

The bacterial dysentery is to be distinguished from the amoebic dysentery. The latter is not caused by bacteria, but by the Entamoeba histolytica (amoeba) parasite.

Where do Shigella occur?

Shigella are widespread worldwide. Bad sanitary conditions and a warm climate favor the spread of the disease, which is why it occurs particularly frequently in so-called developing countries. According to studies, the cases of shigellosis occurring in Germany come mainly from countries such as Egypt, Morocco, India, China and Turkey.

Typically, bacterial dysentery occurs more frequently in the warm months (summer to early autumn). Usually children under five years of age and young adults (between 20 and 39 years of age) are infected with Shigella.

In this country, dysentery sometimes occurs in community facilities (e.g. nursing homes or kindergartens) if hygiene measures are not adequately observed.

In Germany, dysentery is mostly due to an infection abroad.

How does shigellosis develop?

Dysentery is caused by an infection with Shigella bacteria. These bacteria begin to produce toxins (endotoxins and exotoxins) in the intestines, which cause inflammation of the intestinal lining (usually the large intestine). The most common types of bacteria from the Shigella group include:

• Shigella sonnei: widespread mainly in Western Europe; relatively harmless
• Shigella flexneri: widespread mainly in eastern countries and the USA; less often and rather harmless
• Shigella boydii: widespread mainly in India and North Africa
• Shigella dysenteriae: widespread mainly in the tropics and subtropics; forms both an endotoxin, which in severe cases leads to large intestinal ulcers, and an exotoxin (Shiga toxin), which leads to severe and bloody diarrhea and circulatory problems

How is the transfer carried out?

Shigella infection occurs via the fecal-oral route. This means that the pathogens are excreted in the stool (faeces) and ingested via the mouth (orally). A person-to-person infection usually occurs directly through dirt and smear infection, for example when those affected do not or only insufficiently wash their hands (e.g. after using the toilet) and shake hands with another person.

The bacteria are indirectly transmitted via contaminated food, contaminated drinking water and infected objects (e.g. towels) as well as through shared use of toilets. Transmission through bacteria-contaminated bathing water is also possible.

Infection also occurs from infected people who do not show any symptoms (asymptomatic carriers or “eliminators”). Flies are able to spread bacteria-contaminated stool particles onto objects or food. It is also possible that Shigella can be transmitted through sexual anal contact and occasionally through contaminated medical equipment.

Shigella are highly contagious and cause symptoms even in small quantities (less than 100 germs).

What are the symptoms of dysentery?

In the case of dysentery, symptoms typically occur, which usually set in suddenly and violently. First of all, watery diarrhea ("white dysentery") occurs. Depending on the type of pathogen, there are other symptoms that are more or less pronounced. In severe cases, the diarrhea is slimy-purulent or bloody ("red dysentery"). Other symptoms such as fever, ulcers and severe abdominal cramps can also occur.

If the body excretes excess fluids through diarrhea, it often loses additional electrolytes, especially sodium and potassium. In severe cases, a lack of fluids and electrolytes later leads to a haemolytic uremic symptom (HUS). This creates small blood clots (thrombi) throughout the body. These block the blood supply to vital organs (e.g. brain, heart, kidneys). Kidney failure, coma and even circulatory failure are possible consequences.

Symptoms of bacterial dysentery at a glance:

• Severe, crampy abdominal pain (colic)
• Vomit
• Painful urge to stool
• fever
• Watery to slimy-bloody diarrhea
• Ulcers in the intestines; Intestinal bleeding; In severe cases, the intestine expands, breaks through (intestinal perforation) or the peritoneum becomes inflamed (peritonitis)
• Lack of fluids (dehydration), loss of electrolytes
• The lack of fluids often causes circulatory problems, impaired consciousness and muscle cramps up to kidney failure and coma.

How does the doctor make a diagnosis?

The first point of contact if you suspect a Shigella infection is your family doctor. If necessary or for further examinations, the doctor will refer you to a specialist or to a hospital. To diagnose shigellosis, the typical symptoms of the disease and a stool examination are usually sufficient.

To diagnose dysentery disease, the doctor first conducts a detailed discussion (anamnesis) with the person affected. This is followed by a physical examination.

At the latest, if severe diarrhea lasts longer than three days, is bloody or is accompanied by a fever of over 38 degrees Celsius, a doctor's visit is necessary.

Talk to the doctor

During the conversation it is important to inform the doctor about recent stays abroad, because the bacterial dysentery occurs more frequently in so-called developing countries. The doctor asks the person affected, among other things, how frequent the diarrhea is, what consistency the stool is (e.g. soft, mushy or liquid) and what other symptoms occur (e.g. abdominal cramps, fever, nausea).

Physical examination

The doctor will then do a physical exam. To do this, he scans the abdomen for induration, for example, or checks it for conspicuous bowel noises with a stethoscope.

If shigellosis is suspected, the doctor makes the diagnosis based on a stool sample from the person concerned. For example, he examines under the microscope whether there are an increased number of white blood cells (leukocytes) in the stool.

Shigella can also be detected directly in the laboratory. There you can also determine whether the detected type of Shigella bacterium has already developed resistance to a certain antibiotic (antibiogram). This tells the doctor whether a certain antibiotic is effective against the Shigella or not.

Since Shigella are very sensitive, it is advisable to immediately transport a stool sample that is as fresh as possible in a special transport container to the laboratory.

How do you treat shigellosis?

Antibiotics

In most cases, the doctor treats an infection with Shigella with antibiotics. These shorten the duration of the disease, reduce the excretion of pathogens (and thus the risk of infection) and prevent complications. The active ingredients azithromycin and ciprofloxacin have proven to be particularly effective. The doctor will give the antibiotics in the form of tablets or, in severe cases, via an infusion.

Some Shigellae are resistant to certain antibiotics and therefore insensitive to these drugs. In principle, doctors recommend treatment with antibiotics only after their effectiveness has been tested for the respective bacterium in the laboratory (antibiogram). This ensures that the antibiotic actually works against the pathogen.

If you are in good general condition, it is possible in some cases to forego antibiotic treatment. The doctor will estimate whether this is possible in your case.

Anticonvulsants

For cramp-like abdominal pain, the doctor usually prescribes antispasmodic medication (spasmolytics) such as N-butylscopolamine. Doctors do not use drugs against diarrhea, such as loperamide, for dysentery because they suppress the diarrhea and make it more difficult for the pathogens to be eliminated from the body.

Supply of fluids and electrolytes

It is also important that those affected drink enough to compensate for the fluid loss caused by the diarrhea. If they cannot drink enough themselves, they will be given an infusion through a vein.

To replace lost minerals and salts (electrolytes) in the body, the doctor may also give infusions or prescribe electrolyte solutions for drinking from the pharmacy. If you do not have medical supplies or a pharmacy in your area while traveling, you can prepare an electrolyte solution yourself in an emergency.

To do this, mix 750 ml of still drinking water with 250 ml of orange juice (as a source of potassium), one tablespoon of lemon juice (as a source of sodium citrate), one level teaspoon of salt and eight level teaspoons of sugar (preferably grape sugar). Stir everything well until the salt and sugar have dissolved. It is best to take around two liters of the mixture in sips throughout the day.

If you don't have juice around the house, you can use water or mild tea (such as chamomile or rose hip) instead. However, especially when abroad, make sure that you use clean drinking water!

A homemade electrolyte solution is not used to treat serious diseases. If your child or baby is affected by diarrhea, if the diarrhea lasts longer than three days or if there is blood in the stool, contact a doctor immediately!

How does dysentery work?

The disease progresses differently depending on the type of pathogen. In Germany there are mainly infections with Shigella sonnei (around 70 percent of cases of the disease) and Shigella flexneri (around 20 percent of those affected). These two types predominantly lead to milder illnesses, but start out very acutely and are usually very contagious.

In some cases, dysentery disease runs without symptoms. People who are infected and excrete the bacteria in their stool without showing symptoms themselves are called excretors.

Usually, sudden symptoms such as watery diarrhea occur between four hours and four days after being infected. In some cases there is also a fever, loss of appetite and abdominal pain. In the lighter, harmless forms, the symptoms go away after about a week.

In rare cases, the bacteria settle permanently in the intestine and continue to be excreted in the stool. People with whom this is the case are called long-term excretors.

If the bacterium Shigella dysenteriae triggers the disease, shigellosis is usually more severe. Often, bloody, slimy diarrhea occurs, which is accompanied by severe abdominal cramps. It is also possible that ulcers may form in the large intestine during the course of the disease, which in extreme cases causes the intestine to expand or break through (intestinal perforation).

How dangerous is dysentery?

Dysentery is particularly dangerous for small children, old people and people with weakened immune systems. The great loss of fluids and electrolytes is the greatest danger in bacterial dysentery. The possible consequences are cramps, kidney failure and circulatory collapse up to a coma.

However, serious and fatal complications are rare in bacterial dysentery. In this country, lighter courses of the disease predominate, whereby the infections often start suddenly and violently and are highly contagious.

How long are you contagious?

Sick people who have recovered and show no symptoms are contagious for about four to six weeks. This is how long the pathogens can be detected in the stool of those affected.

How can you prevent dysentery?

The best method to prevent dysentery is regular and, above all, thorough hand washing:

• To do this, hold your hands under running water.
• Rub your hands thoroughly on all areas (palms and backs of the hands, fingertips, spaces between fingers and thumb) with sufficient soap for at least 20 to 30 seconds.
• Then rinse your hands again under running water.
• In public toilets, use a paper towel or your elbow to turn off the faucet.
• Carefully dry your hands. Paper towels are suitable in public toilets; at home it is best to use a personal, clean towel.

If you do not have running water and soap, use special disinfectant wipes, gels or sprays from the pharmacy. Make sure that your skin is dry and that you rub all areas thoroughly for about 30 seconds.

In addition, especially in warmer countries with poor hygienic conditions, note the following measures:

• Do not drink tap water, only water from originally sealed drinking bottles.
• Boil or fry food before consuming it.
• Do not eat salad or fruit without a peel (e.g. grapes, strawberries). Instead, eat peeled fruit (e.g. bananas, oranges) and peel them yourself.
• Avoid bathing in shallow, warm water.

If you live in the same household with someone who is sick, you should also pay attention to the following:

• Wash and disinfect your hands regularly.
• Wash bed linen and towels at at least 60 degrees Celsius.
• Regularly disinfect all objects with which the sick person has come into contact (e.g. remote control, light switch, door handles).

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