Dysentery: Causes, High-Risk Settings, and Prevention

Dysentery = inflammatory diarrhea with blood/mucus, abdominal cramps, tenesmus, fever. Etiologies:

• Bacterial: Shigella (shigellosis), Campylobacter, Salmonella, E. coli (EIEC, EHEC).
• Protozoal: Entamoeba histolytica (amoebic dysentery).
• Viral: Rare; some enteroviruses.

High-Risk Settings

• Low-resource regions with poor sanitation/water.
• Humanitarian crises (refugee camps, natural disasters).
• Institutions (prisons, orphanages, military barracks).
• Travelers to endemic areas.
• MSM (sexual transmission of Shigella, E. histolytica).

Prevention

• Safe water (boil, filter, chlorinate).
• Handwashing with soap (critical after defecation, before food).
• Food safety: cook thoroughly, peel fruits, avoid street food in risk areas.
• Sanitation: proper waste disposal, fly control.
• Vaccines: None for shigellosis/amoebiasis; cholera vaccine for V. cholerae.

Treatment

Oral rehydration; antibiotics for bacterial (azithromycin, ciprofloxacin, ceftriaxone); metronidazole for amoebiasis. Antimotility agents contraindicated in bloody diarrhea.