Dysentery

Abstract

A. Definition
Dysentry is diarrhoeal any episode in the which the loose or watery stools,
contain visible red blood. Dysentry most often caused by two types of
microbes pathogen. They are bacteria (Shigella sp) and protozoa (Entamoeba
hystolytica). Infections caused by bacteria known as bacillary dysentry, while
caused by protozoa known as amoebic dysentry.
1. Amoeboic dysentry
Losch in 1875 have found Entamoeba hystolytica from feces of a
patient with diarrhea in Leningrad, Russia. Entamoeba hystolyticas
trofozoit found in colon. Trofozoit most often found in liquid feces.
Entamoeba histolytica cyst found by Quiche and Roos. In 1903 Entamoba
histolytyca was named by Schaudinn.
The incindence of amoebiasis in Indonesia ranges from 10% to
18%. Feces were examined in hospital in patients with diarrhea form
39,6% caused by amoeba. Amoebiasis is the number two after deaths
from malaria. An estimated 40-50 million cases occur worldwide
amebiasis range between 1,9%-9,1%. Because of more effective methods
of treatment, the mortality rate in extra-intestinal amoebic infection of the
liver range between 1-3%. Deaths due to amebiasis is common due to
severe dehydration.
2. Bacillary dysentry

B. Symptomps
1. Amoeboic dysentry

Clinical symptoms depend on the amebiasis localization and

severity of infection. Entamoeba hystolytica is asymptomatic and life
as commensal organisms. Amoeboic dysentry has known for two
types, intestinal amebiasis (acute and chronic) and extra inttestinal
amebiasis.
In the acute intestinal amebiasis, the symptomps are pain in the low
of abdomen, discomfort stomach and frequent to stool. Feces will soft,
watery, and cotains blood and mucus. It can occur up to 10 times per
day. Some people accompanied symptomps with high fever. Patient
untreated acute amebiasis will recover automatically. This condition
cause patient will be chronic amebiasis. Diarrhoea with blood, lost
their weihgt, and pain in the low of abdomen. Diarrhea amoeba has a
characteristic that the patient feces smell rancid. Asymptomatic patient
of dysentry amoeboic is source of infection as a carrier. Carrier may
produce millions of cysts in one day.
Extra intestinal amoeboic dysentry most often found are in liver
and spread by the bloodstream. Trofozoit enter the bloodstream and
reach the liver resulting abses, though rarely found in the lungs or in
the brain. Feces were negative for the presence of trophozoites and
cysts. A definitive diagnosis is by perform needle aspiraton of the
abcess cavity to be find brown or red material brown.
C. Characteristic
1. Amoboeic dysentry
Entamoeba histolytica in the life cycle have shaped stadium
trophozoit pre cysts cyst meta cysts. Trophozoites diameter is 1060 m, was found in the lower part of the small intestine, but more
often in the colon and rectum are attached to the mucosa. Trophozoites
were found in the feces watery dysentery patients larger than the
trophozoites were found in asymptomatic patients with solid stool. For
patients of dysentery, in the cytoplasm that of the stage can be seen red
blood cells, so this diagnosing Entamoeba histolystica easily. In the
intestine trophozoites divide a-sexual manner, into the colon mucosa.

Inside the walls of the colon is trophozoit carried bloodstream to the

liver, lungs, brain and other organs. The liver is the organ that is often
attacked in addition to the intestine, causing liver damage due trofozoit
parenkhim liver cells eating. Trofozoit in the digestive tract will be
compacting and transformed into a pre-cysts are spherical.
2. Bacillary dysentry
Shigella is a gram-negative bacteria sized 0.5 to 0.7. short rod-shaped,
no spore, no flagella, so it does not move. colony convex-shaped,
round, transparent with smooth edges and a diameter of about 2 mm in
24 hours.
Shigella is a bacteria that lives in an atmosphere of aerobic or
facultative anaerobes. The optimum temperature of this bacterial
growth is 37 C and the optimum pH from 6.4 to 7.8. Shigella
dysentriae not form gas in the fermentation reaction, can ferment
various kinds of carbohydrates except lactose, producing acid without
gas.

D. Treatment
Drug for Amoboeic dysentry are emetin hidrochlorin, quinine,
metronidazole, chloroquin, and dehidroemetin. Drugs used for patients
amoboeic dysentry should have worked as a tissue amoebicide, absorbed
directly into the intestinal mucosa and immediately kill the amoeba, so
effectively kill the cyst and trophozoite.
Emetin hydrochlorin is not recommended for people with heart disease,
pregnant women patients with renal impairment. Drug turned out to be
effevtive when given parenterally because if given oral absorption is not
optimal. But this drug more effectively kills in the form trophozoit than
cysts. Dehidromemetin relatively toxicless compared with emetin and be

given orally. Both of emetin as well as effective for the treatment

dehidroemetin extraintestinal amebiasis (liver abscess).
Patient with accute amebiasis and extra intestinal should be treated
with metronidazole. Metronidazole is the drug of choice because proved
effective at killing Entamoeba histolytica as well in the form of cysts or
trophozoites. Metronidazole side effects mild nausea, vomiting and
dizziness. Treatment by metronidazole with emetin turned out provide
better results with no the discovery of cysts or trophozoites on
examination feces.

E. Advice
Personal hygiene and sanitation conditions the environment is a
major factor prevention amoebic dysentery. In principle the prevention of
the spread of infection amebiasis is breaking of the chain of transmission
of the infection source (feces) to humans. There are two main aspects
namely the prevention of the aspects of personal hygiene and
environmental sanitation. Personal hygiene more focused in terms of
individual behavior in an effort break the chain of transmission. While
sanitation environmental focus of prevention lies in environmental
engineering in isolating the source infection.
1. Prevention of aspects of hygiene individuals are:
a. Wash hands with soap after exit from the restroom and before
touching food.
b. Consuming drink water that has been cooked (boiling). If drinking
water not cooked, in this case drinking water packaging should
check cap of glass which is covered neatly and sealed properly.
c. Dont eat vegetables, fish and meat raw or undercooked. Wash
vegetables thoroughly before cooked.
d. Wash fruit with soap will be consumed.
e. cutting the nails and keep hygiene regularly.

f. Wash tableware (plates, spoons, forks) and drinking tools (glasses,

cups) with soap and dried air. If you use a washcloth, should use
cloth clean and dry.
g. Wash cutlery drink babies / children with soap and soak in water
boil before use.
h. For entrepreneurs food (restaurants, catering) implement strict rules
the acceptance of the candidate handlers food (food handler) that
will work by requiring stool examination to the possibility of the
carrier or asymptomatic patients on the candidates food handlers.
During the handlers these foods work, at least 6 months once
examination of feces.
i. Throw away the trash, dirty water and garbage organic throw
carelessly.
j. Go to a doctor to receive treatment, if increased frequency to stool,
pain abdominal and conditions watery stools and there are blood
and mucus. Before treatment or taking medication, drinking fluids
electrolyte in to prevent dehydration.
2. Prevention of aspects of sanitation environment are:
a. Principle human feces disposal isolated well. No insects (flies,
cockroaches), no pollute water sources and air.
b. Use drinking water from the water source (tap water, the pump
shallow or deep wells, water reservoirs rain).
c. Avoid fertilizing plants with human and animal stool. If using
manure and compost, make sure that the condition of manure or the
compost is completely dry.
d. Keep food and drinks of the possibility for contamination of insects
(flies, cockroaches), rodents (rats), pets (dogs, cats) and dust.