Sanitation in India has not kept up with the rest of our advances in the 21st century. We lack hygienic toilet facilities and 40 per cent of our population is forced to use open areas. This propagates a self-perpetuating cycle of diarrhoeal infections.
Most of the time, the diarrhoea settles in a day or two, with or without treatment. Sometimes, blood and mucous appear in the stool. This means that the diarrhoea has progressed to dysentery.
Often patients equate dysentery with amoebic infestation and the words ‘diarrhoea’ and ‘amoebic dysentery’ are interchanged. Most of the time they are right and the dysentery is due to the single celled amoeba Entamoeba histolytica. Around four per cent of the Indian population has antibodies to amoebae.
Amoebae have been around a lot longer than humans. They have perfected the art of survival. If exposed to extremes of temperature and medication, they can round themselves off into thick walled hibernating resistant cysts.
Once the cyst is swallowed, amoebic dysentery sets in with an explosive onset of loose bloody stools, cramping abdominal pain and low grade fever. Many people recognise these symptoms, complain of “amoebic dysentery” and self medicate. They use single inadequate suppressant doses of medication. They may eventually become chronic carriers. In some, the amoebae burrow into the intestinal wall, causing perforations, and produce life threatening abscesses in the liver and the brain.
Treatment for amoebic infection is the “azoles” — metronidazole or secnidazole — followed by a second drug like diloxanide furoate. The duration of the treatment is around two weeks.
All dysentery is not caused by amoebae. Infections by other organisms can also produce blood and mucous in the stool. Some bacteria and viruses cause dysentery.
Symptoms of dysentery may occur without any infection at all. In people with diabetes, hypertension or abnormal disordered elevated lipids, the blood vessels supplying the intestine may be partially blocked. The intestine may get damaged in those areas, causing bloody and painful diarrhoea. The person may be diagnosed to have “repeated attacks of dysentery” and given inappropriate antibiotic treatment.
In older people the colon (or the large intestine) can get weakened in certain areas, causing finger-shaped small pouches called diverticula. Food can become trapped and remain in these areas. Inflammation and infection will produce symptoms similar to amoebiasis.
Cells can grow and bulge into the intestine, forming grape-like protrusions called polyps. These can cause recurrent attacks of bleeding from the rectum with or without diarrhoea. Cancers of the intestines can cause intermittent diarrhoea and dysentery.
A number of illnesses, loosely classified as inflammatory bowel diseases (IBD), are characterised by inflammation of various parts of the intestine. One of the common forms is ulcerative colitis that affects the large intestine. It causes intermit attacks of loose stool, with blood and mucous, accompanied by abdominal pain. Although there may be weight loss, many patients remain well between the attacks, giving an initial false impression of repeated attacks of amoebic dysentery. The exact cause of IBD isn’t known. Genes, heredity, environmental factors, stress and autoimmune diseases (where the body attacks its own cells) are all put forward as possible factors.
Milk allergy can cause diarrhoea. If the person is unaware of the condition and overloads the system, severe diarrhoea can result.
Sometimes the cause of the dysentery is obvious. It may follow treatment for cancer with radiation or medication. It can occur after prolonged courses of antibiotics. It may also be due to cancer of the intestines.
A single attack of dysentery may be “amoebiasis”, which can be cured by a complete course of medication. If the symptoms of the dysentery are recurrent, a correct diagnosis is essential. More so if a person over 30 years presents a sudden change in bowel habits or has alternating constipation and diarrhoea. The other danger signals for cancer are blood and mucous in the stool, poor appetite and weight loss.
Diarrhoea needs to be investigated if it lasts longer than two weeks, is recurrent, with blood and mucous in the stool, and there is weight loss.
To prevent infective diarrhoea
• Do not drink water that has not been boiled or purified
• Remember ice cubes in juice may be made from contaminated water
• Do not eat cut raw fruits or vegetables
• Eat food which is piping hot
• Always wash your hands before eating
Sources: The Telegraph (Kolkata, India)
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