Sandbox:Mydah

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

Dysentery in adults resident survival guide

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 [CMV] or adenovirus)
• Inflammatory bowel disease
• Ischemic colitis

References

Characterize the symptoms: Duration of diarrhea Frequency and consistency of stools Presence of mucus and blood in the stools

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 inhibitors increase susceptibility to infection with Shigella)

Does the patient have any of the following clinical signs or history? Old age (more than 70 years) Presence of co-morbidities (advance cardiac disease, severe immunocompromised state) Fever (>101.3 degrees Fahrenheit) Presence of severe symptoms Need for hospitalization Signs of dehydration (dry mucous membranes, sunken eyes, decreased skin turgor, orthostatic hypotension, oliguria, dark-colored urine, and drowsiness) abdominal tenderness on palpation, rebound tenderness, abdominal distention, and abdominal rigidity.

Yes

No

Perform the following stool tests: Bacterial culture for Salmonella, Shigella, and Campylobacter. Test for Shigella toxin and E. coli O157: H7 Test for fecal leukocytes and lactoferrin.

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.