Common but uncommon bacillary dysentery

Author: Chen Dianjie, Fifth Medical Center, PLA General Hospital

Reviewer: Zhang Xin, Deputy Chief Physician, Fifth Medical Center, PLA General Hospital

Bacillary dysentery is a common gastrointestinal infectious disease in summer. Once a child becomes ill, the disease often consumes the patient's physical and mental strength, which is very painful for both the child and the parents.

There are many differences between bacillary dysentery and common diarrhea in terms of symptoms, risks and treatment. Severe toxic bacillary dysentery can even be life-threatening, so it is important for parents to understand this common infectious disease.

Symptoms and treatment

Bacillary dysentery is an acute intestinal infectious disease caused by Shigella dysenteriae, which can be divided into typical dysentery and atypical dysentery.

(1) Typical dysentery: acute onset, fever, diarrhea, 10 to 30 bowel movements per day, stool with mucus, pus and blood. Nausea, vomiting, paroxysmal abdominal pain, mild abdominal tenderness, and a feeling of tenesmus (manifested as lower abdominal discomfort and a strong desire to defecate, but unable to defecate). Children may also experience general fatigue and decreased appetite, and infants and young children may sometimes have high fever convulsions.

(2) Atypical dysentery: no fever or only a slight fever, mild diarrhea, loose stools, only mucus in the stool without pus or blood, and can only be diagnosed if the stool culture is positive. Because the onset of this type of case is similar to that of general enteritis, it is easy to be ignored and often becomes a spreader of dysentery.

Figure 1 (copyright image from the gallery, unauthorized reproduction)

Compared with children with ordinary diarrhea, children with bacillary dysentery are more likely to have fever, and may have mucus, pus and blood in their stools (the stool is purulent and mucus-like). Routine stool tests may reveal pus cells, and they require anti-infection treatment.

In addition, children with bacillary dysentery should never use antidiarrheal drugs such as phenoxylate that inhibit intestinal motility! If such antidiarrheal drugs are used, it will cause inflammation to accumulate in the intestine and aggravate the infection, or there is a possibility of complications such as sepsis.

Child care

If a child suffers from bacillary dysentery, he or she should seek medical treatment promptly, and proper care and careful attention will help the child recover soon.

(1) Rest: Children should stay in bed during diarrhea and fever. The room should be kept quiet and well-ventilated, and the bed should be flat and clean to facilitate rest. Children can engage in light activities after their condition improves, and gradually increase their activities during the recovery period to enhance their immunity.

(2) Cooling: For patients with a body temperature > 38.5°C, physical cooling can be applied, such as cold compresses on the forehead. If the physical cooling effect is not obvious, antipyretics can be taken under the guidance of a physician. Avoid using medical alcohol baths to cool down.

(3) Pay attention to maintaining buttocks hygiene: wipe the anus and buttocks with a wet tissue after each bowel movement, and then wash with clean water. If the buttocks become red, apply tannic acid ointment around the anus.

(4) Closely observe changes in the condition: If the child is listless, pale, or has cold limbs, it is possible that the disease may progress to toxic bacillary dysentery and a doctor should be consulted immediately.

Toxic bacillary dysentery

Toxic bacterial dysentery is more common in children aged 2 to 7 years with good physical constitution. It has an acute onset and rapid progression. The body temperature quickly rises to 40°C or above, accompanied by severe poisoning symptoms such as chills, shivering, mental depression, and drowsiness. The intestinal inflammatory reaction is extremely mild, and some children do not experience diarrhea at all.

Toxic bacillary dysentery is mainly divided into the following 3 types.

(1) Shock type (circulatory failure type): There are symptoms of infectious shock, such as pale complexion, mottled skin, cold and wet limbs, cyanosis of the lips, decreased blood pressure, decreased urine volume, and impaired consciousness.

(2) Cerebral type (respiratory failure type): There are symptoms of cerebral edema, mainly encephalopathy symptoms, such as irritability, drowsiness, coma, convulsions, unequal pupil sizes, and slow or absent light reflex. This type has a high mortality rate.

(3) Mixed type: Symptoms of both shock and cerebral types appear simultaneously. This is the most severe disease with a high mortality rate.

Children must seek medical treatment immediately if they show symptoms of toxic bacillary dysentery and should avoid taking any medication on their own.

Transmission and prevention

Bacillary dysentery can occur throughout the year. It is most prevalent in my country in summer and autumn, with the highest incidence in July, August and September.

Shigella dysenteriae can contaminate food and water sources, and can also be spread by mosquitoes. After touching contaminated items, children's bad habits such as biting their nails, sucking their fingers, and not washing their hands before meals can all lead to the entry of bacteria and cause illness.

Figure 2 (copyright image from the gallery, unauthorized reproduction)

The large number of Shigella dysenteriae types, great variability and incomplete treatment lead to the easy recurrence of bacillary dysentery. Therefore, regardless of whether you have had bacillary dysentery and recovered, you need to do a good job of preventing the disease.

Shigella dysenteriae can be killed by direct sunlight, and can also be inactivated by boiling at 100°C or 60°C for 10 minutes. Shigella dysenteriae are sensitive to various chemical disinfectants such as benzalkonium bromide, peracetic acid, lime milk and phenol.

Currently there is a vaccine to prevent bacillary dysentery, which can be used for children over 3 years old and adults, with a protection rate of about 80%, but it cannot prevent all Shigella dysenteriae, and the immunity period can only last for 6 to 12 months, and secondary infection may occur later.

Despite these shortcomings, oral dysentery vaccines are an important measure to prevent dysentery during epidemics.