Dysentery resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]


Dysentery is described as blood with stools. It occurs due to inflammatory reaction causing damage to the intestinal tract. The patient also has a fever, abdominal cramping, discomfort, increased bowel movements, fecal urgency, and tenesmus. The underlying cause is mostly an infection due to bacteria. The main aim of the physician is to assess the severity of gastrointestinal symptoms, dehydration, and hypovolemia. In patients with severe symptoms, prompt investigations, and treatment should be carried out to reduce morbidity. This section provides a short and straight to the point overview of the dysentery in adults.


Life-threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

  • Does not include any known cause

Common Causes


Shown below is an algorithm summarizing the diagnosis of dysentery according to the American College of Gastroenterology guidelines.[2][1][3][4]

Characterize the symptoms:
To evaluate cause ask the following questions:
  • Food history
  • Occupational exposure (e.g. daycare center, poultry farm)
  • Exposure to animals (pets, poultry, zoo, turtles)
  • Recent travel to endemic areas
  • Medication history (use of proton pump inhibitor increase susceptibility to infection with Shigella)
Does the patient have any of the following clinical signs or history? abdominal tenderness on palpation, rebound tenderness, abdominal distention, and abdominal rigidity.
Perform the following stool tests:
Does the patient have any of the following:
  • Clinical signs suggestive of inflammatory bowel disease
  • Symptoms present for more than a week despite conservative management
  • The patient is a health care worker or food handler (which can be a potential health hazard)
    Is the fecal leukocytes or lactoferrin test positive?
    * Perform routine stool culture.
    • Specific tests should be performed depending upon the patient’s history.
    No need to perform Stool culture and additional tests.
    Test for Entamoeba histolytica
    Amebic dysentery highly unlikely. Look for other causative agents.


    Shown below is an algorithm summarizing the treatment of dysentery according to the Infectious Diseases Society of America clinical practice guidelines.[1][5][6]

    Characterize the symptoms of the patient:
  • Oral fluid replacement therapy. Give ORS solution for every bowel movement. Approximately 2 liters of ORS solution is given to the patient.
  • Antimicrobial therapy should be initiated on the basis of stool culture results.
  • Bismuth sulphate and loperamide can be given to relieve abdominal symptoms.
  • Reassess hydration status after every 6 hours.
    Assess patient for symptoms of hypovolemia (i.e. altered mental status with lethargy and unconsciousness, weak pulses , and inability to drink)
    Patient has severe hypovolemia.
    • Give parenteral fluid replacement with 5 % dextrose or normal saline solution.
    • Give rapid infusion initially and then slow infusion.
    • The aim is to give 200 ml/kg in 24 hours with 100ml/kg in the first 4 hours of infusion.
    • Reassess hemodynamic and hydration status of the patient after 6 hours.
    Patient has mild hypovolemia.
  • Give oral fluid replacement therapy.
  • 2.2 to 4 liters of ORS is given in the first 4 hours.
  • Reassess hemodynamic and hydration status of the patient after 6 hours.


    • Important clues regarding the etiology of dysentery can be narrowed down while taking history. If the patient has dysentery more than 16 hours after having an outdoor food consider Enterotoxigenic E.coli. There is an increased risk of acquiring the ''Salmonella'' infection in individuals exposed to turtles and poultry. People working in daycare have an increased risk of infection with enteric viruses and ''Shigella''.[1]
    • Physicians can take a rectal swab in patients in whom stool samples cannot be obtained and immediate diagnosis is required.[7] Though the rectal swab has less sensitivity than stool culture in identifying the causative agent.[8]
    • If the clinician is suspecting a particular bacteria, it should be mentioned while ordering the test. Certain bacteria require special culture media to grow and methods to be visualized. ''Campylobacter jejuni'' grows on the specific ‘CAMP’ agar plates at a particular temperature and environmental conditions. If infection with ''Yersinia'' is suspected, it should be specified as it is commonly overlooked.[9]
    • Physicians need to monitor the patients for the complications of the infection with certain bacteria. Bacteremia and reactive arthritis can occur with infection with non- typhoidal ''Salmonella'' and ''Shigella''. The hemolytic-uremic syndrome can occur due to E 0157:H7 or ''Shigella''. A neurological complication Guillain-Barré syndrome can occur with ''Campylobacter'' infection[10].



    1. 1.0 1.1 1.2 1.3 1.4 1.5 Riddle MS, DuPont HL, Connor BA (2016). "ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults". Am J Gastroenterol. 111 (5): 602–22. doi:10.1038/ajg.2016.126. PMID 27068718.
    2. 2.0 2.1 Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K; et al. (2017). "2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea". Clin Infect Dis. 65 (12): e45–e80. doi:10.1093/cid/cix669. PMC 5850553. PMID 29053792.
    3. Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
    4. Kane SV, Sandborn WJ, Rufo PA, Zholudev A, Boone J, Lyerly D; et al. (2003). "Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation". Am J Gastroenterol. 98 (6): 1309–14. doi:10.1111/j.1572-0241.2003.07458.x. PMID 12818275.
    5. Victora CG, Bryce J, Fontaine O, Monasch R (2000). "Reducing deaths from diarrhoea through oral rehydration therapy". Bull World Health Organ. 78 (10): 1246–55. PMC 2560623. PMID 11100619.
    6. Christopher PR, David KV, John SM, Sankarapandian V (2010). "Antibiotic therapy for Shigella dysentery". Cochrane Database Syst Rev (8): CD006784. doi:10.1002/14651858.CD006784.pub4. PMC 6532574 Check |pmc= value (help). PMID 20687081.
    7. Jean S, Yarbrough ML, Anderson NW, Burnham CA (2019). "Culture of Rectal Swab Specimens for Enteric Bacterial Pathogens Decreases Time to Test Result While Preserving Assay Sensitivity Compared to Bulk Fecal Specimens". J Clin Microbiol. 57 (6). doi:10.1128/JCM.02077-18. PMC 6535583 Check |pmc= value (help). PMID 30944186.
    8. Kotar T, Pirš M, Steyer A, Cerar T, Šoba B, Skvarc M; et al. (2019). "Evaluation of rectal swab use for the determination of enteric pathogens: a prospective study of diarrhoea in adults". Clin Microbiol Infect. 25 (6): 733–738. doi:10.1016/j.cmi.2018.09.026. PMID 30315956.
    9. Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am J Med. 78 (6B): 91–8. doi:10.1016/0002-9343(85)90370-5. PMID 4014291.
    10. Rodríguez M, de Diego I, Martínez N, Rosario Rodicio M, Carmen Mendoza M (2006). "Nontyphoidal Salmonella causing focal infections in patients admitted at a Spanish general hospital during an 11-year period (1991-2001)". Int J Med Microbiol. 296 (4–5): 211–22. doi:10.1016/j.ijmm.2006.01.068. PMID 16621698.
    11. Misra NP, Gupta RC (1977). "A comparison of a short course of single daily dosage therapy of tinidazole with metronidazole in intestinal amoebiasis". J Int Med Res. 5 (6): 434–7. doi:10.1177/030006057300100209. PMID 590600.