A 30 Year Old Man Presents With A Bloody Diarrhea, Fever and Abdominal Pain

A 30 year old man presents to his primary care physician with the complains of severe abdominal pain, high grade fever and a bloody diarrhea that started 2 days ago. Initially the symptoms were mild but now he is feeling very sick and weak. He gives a history of passing more than 5 watery stools mixed with blood today. He has no history of vomiting but his appetite has decreased. He remembers eating at a road side restaurant while he was coming home from work. On examination he looks pale and mildly dehydrated.
Hos fresh stool specimen is collected and examined under the microscope which shows the following picture:

The above picture shows the shigella species under microscope in a stool specimen.

The patient was diagnosed as a case of Bacillary dysentery or Shigellosis



Case Discussion:
Bacillary dysentery also known as Shigellosis is an extremely dangerous and contagious bacterial infection of the colon caused by Shigella bacillus. There are three species of Shigella associated with bacillary dysentery , they are :

• Shigella sonnei
• Shigella flexneri
• Shigella dysenteriae

Transmission of disease is through feco-oral route and even a very small amount of organisms can cause the disease ans the infection. The disease mostly occurs in over populated area and in areas where proper hygiene is not practiced. 

Clinical Features: Patients usually present with:

• Watery diarrhea that later evolves to contain blood or mucus.
• Abdominal pain
• Loss of appetite
• Straining during bowel movements
• Nausea and vomiting
• Fever with chills
• Rapid dehydration. 

Diagnosis: Is usually made through a detailed clinical history and the presence of blood in the stool. 

Stool specimen is taken for culture and examination under microscope to confirm the diagnosis.

Blood test may be done to look for infection and electrolyte abnormalities.

Prevention and Treatment:

1. Hand washing and cooking the food properly helps in prevention of the spread of shigella infection. 

2. Severe cases od dysentry can be treated with antibiotics like Ampicillin, TMP-SMX, and ciprofloxacin.

3. Dehydration should be treated with oral saline or IV fluids as required. 

4. Currently there is no vaccine available for prevention of infection from shigella.