Acute Bacterial Dysentery: Understanding the Characteristic Lesions and Treatment Options

Acute bacterial dysentery is a severe intestinal infection primarily caused by Shigella species. One of the hallmark pathological features of this disease is the development of pseudomembranous inflammation. This condition affects the colon, especially the sigmoid colon and rectum, where a diffuse fibrinous exudate forms a characteristic pseudomembrane on the mucosal surface.

Transmission and Risk Factors

The primary source of infection includes both symptomatic patients and asymptomatic carriers. The disease spreads mainly through the fecal-oral route, often due to ingestion of food or water contaminated with Shigella bacteria. Crowded living conditions, poor sanitation, and lack of clean drinking water significantly increase the risk of outbreaks.

Pathological Features of the Disease

When Shigella invades the colonic mucosa, it triggers an intense inflammatory response. This leads to the formation of a pseudomembrane composed of fibrin, necrotic debris, mucus, and inflammatory cells. The presence of this membrane is a defining feature of pseudomembranous colitis associated with shigellosis, distinguishing it from other forms of infectious diarrhea.

Clinical Presentation

The onset of acute bacterial dysentery is typically sudden. Common early symptoms include chills, high fever (often reaching 38–39°C), and generalized malaise. As the disease progresses, patients experience severe abdominal cramps, frequent bowel movements (often more than ten times a day), and a strong sense of tenesmus. In severe cases, complications such as septic shock or toxic encephalopathy may develop, particularly in vulnerable populations like children and the elderly.

Management and Treatment Approaches

For mild or self-limiting cases, especially in alert and responsive patients, antibiotic therapy may not be necessary. Supportive care including isolation, rest, and hydration plays a crucial role in recovery. However, in more severe infections, targeted antimicrobial therapy based on susceptibility testing is essential to reduce morbidity and prevent complications.

Recommended Antibiotics

Fluoroquinolones are considered the first-line treatment for adults with acute bacterial dysentery. For special populations such as children and pregnant women, alternative options like ceftriaxone or azithromycin are preferred due to their safety profiles. Additionally, berberine (an alkaloid found in plants like goldenseal) can be used as an adjunct therapy to reduce intestinal secretion and alleviate diarrhea symptoms.

Prevention and Public Health Strategies

Preventive measures include promoting hygiene education, ensuring access to clean water, and improving sanitation infrastructure. In high-risk areas, early diagnosis and prompt treatment can help control the spread of the disease and reduce the burden of illness.