PHARCARE2: PUBLIC HEALTH FINALS

BACILLARY DYSENTERY Tenesmus

- cramping rectal pain
- Acute diarrheal illness characterized - feeling that you need to have a
by odorless, watery stool with bowel movement
blood and mucus Nausea, vomiting, headache
Another name: Shigellosis Cramping abdominal pain
Diarrhea with bloody-mucoid stool
ETIOLOGY Rapid dehydration
Causative agent: EPIDEMIOLOGY
Shigella species Route of Transmission: fecal-oral route
- Gram-negative bacilli from the family
Enterobacteriaceae 1. Direct contact
- Non-motile, facultatively anaerobic - hand to mouth transfer
2. Indirect
4 serologic groups: - food or water contaminated by
A S. Most severe fecal matter
dysenteriae - flies which carry fecal matter; also
(Sd1) other objects contaminated by fecal
B S. flexnerii Epidemic matter
group;
Epidemic features:
Predominant
in SEASON: summer & fall; rainy (increased
developing occurrence of flies)
countries
C S. boydii Tropical AGE: young children (usually less than 5
D S. sonnei Least y.o.)
severe
PLACE: common to tropical and sub-
Mechanism of action in the body: tropical countries
Occurrence:
Invades mainly the large intestine
and a part of the small intestine Most cases are sporadic
Bacteria multiplies and produces a Most common in overcrowded,
potent cytotoxin (Shiga toxin) impoverished areas with poor
o Leads to formation of micro- sanitation, inadequate hygiene
ulcers, inflammatory practices, unsafe water supplies
exudates which causes blood
in stool to appear Endemic to most developing countries,
Incubation period: 1-4 days because of:
(time from moment of exposure to 1. Inadequate sewage disposal
appearance of symptoms) 2. Lack of effectively treated water
Clinical Manifestations (Signs and supplies
Symptoms): 3. Flies may spread the infection;
disease is common at time of year
Fever when fly population is at peak

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Outbreaks: (wag niyo na pansinin to feel ko
di naman lalabas)
1969-1973

Central America
- 500,000 cases
- 20,000 deaths
1994

Rwandan refugees in Zaire

- 20,000 deaths
Kligler Iron Agar (KIA)
1999-2003 Triple Sugar Iron (TSI)

Sierra Leone, Liberia, Guinea, CLINICAL TREATMENT

Senegal, Angola, Central African
Fluid and electrolyte replacement
Republic, Democratic Republic of
- Oral Rehydration Salt/Solution
Congo
(ORS)
DIAGNOSIS - Prevent dehydration in mild cases
(usually resolved in 5-7 days)
Stool culture
- Isolation of shigella; fresh stool
samples must reach lab within 2 hrs
ORS recipe (accdg to WHO):
- Must be processed within 72 hrs
(refrigerated and placed in transport 2.6 g NaCl
medium)
o if patient cannot pass stool: 2.9 g trisodium citrate dihydrate
sterile rectal swab 1.5 g KCl
Stool examination
1. Direct microscopic exam 13.5 g anhydrous glucose
- WBC, RBC, pus cells ----- per 1L of fluid
2. Bacteria culture
Homemade:
Differential Test (Culture):
6 tsp sugar
0.5 tsp salt
1 L water

Glucose serves as transport system

MacConkey Agar: non-lactose of sodim (Sodium Glucose Co-
fermenting Transport System) for absorption
Xylose Lysine Desoxycholate of NaCl; 1 glucose molecule
(XLD) transports 2 Na ions
- Sd1 very tiny compared to other Citrate or bicarbonate needed for
treatment of metabolic acidosis
Biochemical Test:
occurs frequently with dehydration

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 Breastfeeding Health education
Promote
Oral Fluoroquinolones breastfeeding for
infants and young
- Drug of choice: Ciprofloxacin 500 children
mg (15 mg/kg in children) BID for 3
days
- Choice of antibiotic must be based GOVERNMENT PROGRAMS
on antibiotic sensitivity pattern since Focus on prevention of food and
antibiotic resistance is common air/waterborne diseases:
Second line Tx: 1. Emerging and Re-emerging
- Pivmecillinam, ceftriaxone, Infectious Disease Program
azithromycin 2. Food and Waterborne Diseases
Prevention and Control Program
Antimicrobials that SHOULD NOT BE 3. Provision of Potable Water Program
USED: (SALINTUBIG Program Sagana at
Ampicillin, Ligtas na Tubig Para sa Lahat)
Used in the past;
chloramphenicol,
most Shigella are
co-trimoxazole,
now resistant
tetracycline
Drug of choice Questions:
before but now 1. Difference between diarrhea and
Nalidixic acid resistant; may dysentery? How to distinguish
increase resistance
between the two?
to ciprofloxacin
Nitrofurans, Diarrhea Dysentery
aminoglycosides, Penetrate intestinal Odorless, colorless,
1st + 2nd gen mucosa poorly watery stool
cephalosporins, (ineffective) Semi-formed stool
presence of blood
amoxicillin and mucus

No vaccines available for 2. Content of ORS? Purpose of

Shigellosis Glucose and bicarbonate?
- Answer found on page 2 under
PREVENTION
treatment
Preventive measures
Human waste
Hand washing
disposal
Promote Ensure safe
handwashing w/ disposal of human
soap waste
Water supply Food Safety
Increase access to Safe handling and
safe drinking water processing of food
Promote safe Promote individual
transport of water food safety
Promote safe practices
storage practices

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