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Dysentery may be simply defined as diarrhoea containing blood. Although
several organisms can cause dysentery, Shigella
are the most important. Shigella dysenteriae type 1 (Sd1), also known as the Shiga
bacillus, is the most virulent of the four serogroups of Shigella. Sd1 is
the only cause of epidemic dysentery. In addition to bloody diarrhoea, the illness caused
by Sd1 often includes abdominal cramps, fever and rectal pain. Less frequent complications
of infection with Sd1 include sepsis, seizures, renal failure and the haemolytic uraemic
syndrome. Approximately 5-15% of Sd1 cases are fatal. Shigellosis is endemic
throughout the world. Worldwide there are approximately 164.7 million cases, of which
163.2 million in developing countries and 1.5 million in industrialized countries. Each
year 1.1 million people are estimated to die from Shigella infection and 580 000 cases of
shigellosis are reported among travellers from industrialized countries. A total of 69% of
all episodes and 61% of all deaths attributable to shigellosis involve children less than
5 years of age. Since the late 1960s pandemic waves of Shigella dysentery (diarrhoea
containing blood) have hit Central America, South and Southeast Asia and sub-Saharan
Africa, often striking areas of political upheaval and natural disaster. During the 1994
genocide in Rwanda between 500 000 and 800 000 Rwandan refugees fled into the North Kivu
region of Zaire. In the first month alone, approximately 20 000 people died from dysentery
caused by a strain of Shigella that was resistant to all commonly used antibiotics. The
combination of Shigella infections and HIV epidemics has had serious consequences, HIV
speeding the spread of Shigella among HIV-positive groups with compromised immunity.
Shigella infection also occurs in industrialized countries, particularly where there is
poor hygiene, and among soldiers and travellers to the developing world. -- WHO
One particularly disturbing feature is the resistance of the bacteria
to the most commonly used antibacterial drugs: sulfonamides, tetracycline, chloramphenicol
and streptomycin. - Rehydration Project
Phage Therapy
Phage Therapy Center
Phage Therapy Center treats antibiotic-resistant infections. [More information...]
Additional Information About Phage Therapy for this Condition
Morton, H. E. and Engely, F. B., 1945 Dysentery
Bacteriophage: Review of the Literature on its Prophylactic and Therapeutic Uses in Man
and in Experimental Infections in Animals. J Am Med Assoc 127: 584-591.
Schade, A. L. and Caroline, L. , 1943 The preparation of a
polyvalent dysentery bacteriophage in a dry and stable form. I. Preliminary Investigations
and general procedures. J Bacteriol 46: 463-473.
Schade, A. L. and Caroline, L. , 1944 The preparation of a
polyvalent dysentery bacteriophage in a dry and stable form. II. Factors affecting the
stabilization of dysentery bacteriophage during lyophilization. J Bacteriol 48: 179-190.
Schade, A. L. and Caroline, L., 1944 The preparation of a
polyvalent dysentery bacteriophagein a dry and stable form. III. Stability of the dried
bacteriophage towards heat humidity age and acididty. J Bacteriol: 243-251.
New York Times
A Stalinist Antibiotic Alternative
Mediscover Infectious Diseases
What
Are Bacteriophages?
Evergreen State College
Phage
Therapy as Antibiotics
Biotechnology and Development Monitor
Bacteriophages:
An alternative to antibiotics?
Annual Reviews, Intelligent Synthesis of the Scientific Literature
Bacteriophage Therapy
Eliava Institute
List of Bacteriophages
Rehydration Project
Dialog on Diarrhoea
During the late 1960s, Shiga's bacillus was responsible for a series of devastating
epidemics of dysentery in Latin America, Asia and Africa. In 1967 it was detected in the
Mexican-Guatemalan border area and spread into much of Central America. An estimated half
million cases, with 20,000 deaths, were reported in the region between 1967 and 1971. In
some villages the case fatality rate was as high as 15 per cent; delayed diagnosis and
incorrect treatment may have been responsible for this high death rate. One particularly
disturbing feature was the resistance of the bacteria to the most
commonly used antibacterial drugs: sulfonamides, tetracycline, chloramphenicol and
streptomycin.
Serious epidemics due to the multiple-drug resistant S. shigae have
occurred recently in Bangladesh, Somalia, South India, Burma, Sri Lanka, Nepal, Bhutan,
Rwanda and Zaire. Each epidemic showed similar features: the disease spread rapidly in
spite of all available public health measures, attacking over 10 per cent of the
population and killing between two and ten per cent even of the hospitalised cases.
West Bengal in India has always been an endemic area for bacillary dysentery. In 1984,
greater numbers of dysentery cases started occurring and spread rapidly throughout the
state. Investigations revealed that attack rates were high, especially among young
children, and that all the shigellae isolated from stool specimens were resistant to the
commonly used drugs.
In response to the outbreak, control measures were initiated, newspapers, radio and
television carried information about the epidemic to raise public awareness; and district
level health personnel were alerted. Reports came in of increasing numbers of dysentery
cases, between two and three thousand new cases, and up to 150 deaths, a day. People began
to panic and doctors were frustrated by the ineffectiveness of conventional treatment .
Rehydration Project
Resistance to antibiotics
The epidemic spread to Calcutta, where stool samples from 382 patients showed Shiga's
bacillus in 35 per cent of cases, and different species of shigella organisms in 52 per
cent. These organisms were sensitive to nalidixic acid (96.7 per cent), gentamicin (83 per
cent), furazolidone (77.7 per cent), and; moderately sensitive to ampicillin (42.2 per
cent), kanamycin (37.4 per cent), neomycin (21.8 per cent) and cotrimoxazole (23.2 per
cent), but were resistant to other commonly available drugs and antibiotics. For most
doctors this was their first experience of coping with an epidemic of severe bacillary
dysentery and there was great confusion over the choie of antibacterial drugs and other
treatment. Nalidixic acid, although found to be most effective, was too expensive for
common use. Oral rehydration, the magic therapy for acute watery diarrhoea, was effective
in only about ten per cent of these cases, since in 90 per cent dehydration was not
serious.
Medical Information
CDC, February 5, 2003
Multidrug-Resistant
Shigella dysenteriae Type 1: Forerunners of a New Epidemic Strain in Eastern India?
Multidrug-resistant Shigella dysenteriae type 1 caused an extensive epidemic of
shigellosis in eastern India in 1984
CDC, October 2, 1987
Nationwide Dissemination of Multiply Resistant Shigella sonnei Following a
Common-Source Outbreak
In early July 1987, an outbreak of multiply resistant Shigella sonnei gastroenteritis
occurred among persons who attended the annual Rainbow Family gathering in North Carolina
(1). Since that time, four clusters of gastroenteritis due to multiply resistant S. sonnei
have been reported among persons who had no apparent contact with gathering attendees.
Association of Medical Microbiologists
Shigella
infections and bacillary dysentery
UTMB Graduate School of Biomedical Sciences
Escherichia,
Klebsiella, Enterobacter,Serratia, Citrobacter, and Proteus |
