Sandbox:Mydah

# Dysentery in adults resident survival guide

## Overview
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.

## 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
- Shigellosis
- Shiga toxin-producing E. coli (STEC) (eg, E. coli O157:H7) infection
- Amebic dysentery caused by Entamoeba histolytica
- Salmonella infection
- Campylobacter infection
- Enteric viruses (eg, cytomegalovirus  or adenovirus)
- Inflammatory bowel disease
- Ischemic colitis

## Evaluation
Shown below is an algorithm summarizing the diagnosis of dysentery according to the American College of Gastroenterology guidelines.

## Treatment
Shown below is an algorithm summarizing the treatment of dysentery according to the Infectious Diseases Society of America clinical practice guidelines.

## 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''.
- Physicians can take a rectal swab in patients in whom stool samples cannot be obtained and immediate diagnosis is required. Though the rectal swab has less sensitivity than stool culture in identifying the causative agent.
- 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.
- 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-Barre syndrome can occur with ''Campylobacter'' infection.

## Don'ts
- The empirical antimicrobial treatment for dysentery does not include treatment for E. histolytica.  Metronidazole (500mg thrice daily for 7 to days) should be administered to patients only when trophozoites or cysts are visualized under a microscope in the stool sample.
- A complete metabolic profile is not routinely performed in patients with dysentery. Serum electrolytes and glucose levels should only be measured in patients who present with complications (i.e. altered mental status, seizures, anuria, oliguria, and ileus ).