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* Physicians can take a rectal swab in patients in whom stool samples cannot be obtained and immediate diagnosis is required.<ref name="pmid30944186">{{cite journal| author=Jean S, Yarbrough ML, Anderson NW, Burnham CA| title=Culture of Rectal Swab Specimens for Enteric Bacterial Pathogens Decreases Time to Test Result While Preserving Assay Sensitivity Compared to Bulk Fecal Specimens. | journal=J Clin Microbiol | year= 2019 | volume= 57 | issue= 6 | pages=  | pmid=30944186 | doi=10.1128/JCM.02077-18 | pmc=6535583 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30944186  }} </ref> Though the rectal swab has less sensitivity than [[Human feces|stool]] culture in identifying the causative agent.<ref name="pmid30315956">{{cite journal| author=Kotar T, Pirš M, Steyer A, Cerar T, Šoba B, Skvarc M | display-authors=etal| title=Evaluation of rectal swab use for the determination of enteric pathogens: a prospective study of diarrhoea in adults. | journal=Clin Microbiol Infect | year= 2019 | volume= 25 | issue= 6 | pages= 733-738 | pmid=30315956 | doi=10.1016/j.cmi.2018.09.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30315956  }} </ref>
* Physicians can take a rectal swab in patients in whom stool samples cannot be obtained and immediate diagnosis is required.<ref name="pmid30944186">{{cite journal| author=Jean S, Yarbrough ML, Anderson NW, Burnham CA| title=Culture of Rectal Swab Specimens for Enteric Bacterial Pathogens Decreases Time to Test Result While Preserving Assay Sensitivity Compared to Bulk Fecal Specimens. | journal=J Clin Microbiol | year= 2019 | volume= 57 | issue= 6 | pages=  | pmid=30944186 | doi=10.1128/JCM.02077-18 | pmc=6535583 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30944186  }} </ref> Though the rectal swab has less sensitivity than [[Human feces|stool]] culture in identifying the causative agent.<ref name="pmid30315956">{{cite journal| author=Kotar T, Pirš M, Steyer A, Cerar T, Šoba B, Skvarc M | display-authors=etal| title=Evaluation of rectal swab use for the determination of enteric pathogens: a prospective study of diarrhoea in adults. | journal=Clin Microbiol Infect | year= 2019 | volume= 25 | issue= 6 | pages= 733-738 | pmid=30315956 | doi=10.1016/j.cmi.2018.09.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30315956  }} </ref>
* 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.<ref name="pmid4014291">{{cite journal| author=Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH| title=Evaluation and diagnosis of acute infectious diarrhea. | journal=Am J Med | year= 1985 | volume= 78 | issue= 6B | pages= 91-8 | pmid=4014291 | doi=10.1016/0002-9343(85)90370-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4014291  }} </ref>  
* 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.<ref name="pmid4014291">{{cite journal| author=Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH| title=Evaluation and diagnosis of acute infectious diarrhea. | journal=Am J Med | year= 1985 | volume= 78 | issue= 6B | pages= 91-8 | pmid=4014291 | doi=10.1016/0002-9343(85)90370-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4014291  }} </ref>  
* Physicians need to monitor the patients for the complications of the infection with certain [[bacteria]].  [[Sepsis]] 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.
* 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'']].<ref name="pmid16621698">{{cite journal| author=Rodríguez M, de Diego I, Martínez N, Rosario Rodicio M, Carmen Mendoza M| title=Nontyphoidal Salmonella causing focal infections in patients admitted at a Spanish general hospital during an 11-year period (1991-2001). | journal=Int J Med Microbiol | year= 2006 | volume= 296 | issue= 4-5 | pages= 211-22 | pmid=16621698 | doi=10.1016/j.ijmm.2006.01.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16621698  }} </ref> The [[hemolytic-uremic syndrome]] can occur due to E 0157:H7 or [[''Shigella'']]. A neurological complication [[Guillain-Barré syndrome]] can occur with [[''Campylobacter'']] infection.


==References==
==References==
{{Reflist}}
{{Reflist}}

Revision as of 19:45, 26 August 2020


Associate Editor(s)-in-Chief: Mydah Sajid, MD[1]

Dysentery in adults resident survival guide

Overview

Causes

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

Evaluation

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

Do's

  • 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.[5] Though the rectal swab has less sensitivity than stool culture in identifying the causative agent.[6]
  • 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.[7]
  • 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''.[8] The hemolytic-uremic syndrome can occur due to E 0157:H7 or ''Shigella''. A neurological complication Guillain-Barré syndrome can occur with ''Campylobacter'' infection.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
 
 
 
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.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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?
     
     
     
     
    		Yes
     
    		No
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes
     
    		No
     
    		* 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.
     
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