Shigellosis = Bacillary dysentry Cholera

Definition Bloody mucoid diarrhea with tenesmus (=cramping rectal pain) Severe perfuse excessive watery (secretory) diarrhea leading to dehydration
Causative 1. Shigella dysenteriae 2. Shigella flexneri
Vibrio cholera
agent 3. Shigella boydii 4. Shigella sonnei
IP 1-3 days 1-3 days
MOT Feco-oral, mainly water contaminated with cholera Feco-oral, mainly water contaminated with cholera
1. Ingestion of food contaminated by shigella dysenteriae 1. Ingested
2. Presence of bacteria in the lumen of the colon (causing irritation due to endotoxin secretion) 2. Present in lumen (non-invasive) and secrete:
3. Locally invasion of colon wall & secretion of 3 exotoxins: a. Endotoxin leading to irritation of intestinal mucosa
Pathogenesis a. Cytotoxin: cell death b. Enterotoxin: intestinal damage b. Exotoxin: has 2 subunits (A, B): B subunit facilitate wall invasion by A: Causing
c. Neurotoxin: convulsions in children activation of adenyl cyclase leading to increased ATP and opening of all channels
into lumen leading to loss of K+, Na+, water (20-30 L/day)
1. Vomiting: at first: food remnants, Then rice-water (off white).
1. Constitutional symptoms: fever, malaise, anorexia, nausea, vomiting. 2. Diarrhea: at first: fecal matter, Then rice-water.
2. Specific symptoms: dysentery (=bloody mucoid diarrhea with tenesmus), abdominal pain, 3. Dehydration:
colic. a. Hypotension, tachycardia with weak pulsation
C/P b. Hypothermia
c. Cold dry skin & extremities
d. Rapid shallow breathing leading to acidosis
e. Coma and death
1. Clinical in epidemic area (= Presented with the C\P)
1. Detection of organism in stool: by stool analysis and culture 2. Lab: stool analysis and isolation of organism by stool culture on TCBS (=Thiosulfate citrate
2. Effect: reduced electrolytes as K+ bile salts sucrose agar)
Investigations 3. Effect:
3. PCR, ELISA, Increased ESR
a. Decreased K+ & Na+ & Cl- & HCO3-
b. Increased urea and creatinine due to hypovolemia leading to prerenal failure
All are due to dehydration:
Dysentery, necrosis, ulcer, heal with a membrane (after membrane removing): 1. Corneal ulcer
1. Bleeding per rectum, anemia and hypotension. 2. Chest: pneumonia
Complications 2. Perforation leading to peritonitis and IBD. 3. Cholecystitis
3. Reiter’s syndrome leading to conjunctivitis, urethritis, arthritis. 4. Convulsions and coma
5. In females: Abortion
6. In males: scrotal gangrene
1. Symptomatic treatment Rehydration by: Ringer lactate > saline > ORS
Treatment 2. Antibiotic if complicated by ciprofloxacin 500mg oral twice daily (same as **Saline causes increased Cl- which exchange with H+ leading to acidosis
typhoid) Antibiotic (if needed): Tetracycline & doxycycline (used also for prevention)
>> DD: Anaerobic dysentery caused by entamoeba histolytica which also cause ulcer Vaccination : Koll’s vaccine (killed vaccine)
Note: Hepatic patient presents with renal impairment, how to differentiate between prerenal
and hepatorenal impairment? By: Urea / Creatinine ration:
1. If >100 = prerenal and need rehydration As: urea and creatinine are increased but
Note Typhoid treatment same as shigella treatment, and typhoid is isolated on MacConkey agar
urea is increased more due to its increased affinity of reabsorption.
2. If normal ration = hepatorenal