What is dirty hands disease? Dysentery, rubella, dysentery, shigellosis

Bacillary dysentery is a bacterial disease of poorer countries, but it can also occur in developed countries.

It occurs sporadically throughout the year, but its incidence is higher in the hot summer months. The vector is a sick person or a convalescent carrier. It is most often spread in collective facilities with low standards of hygiene.

Bacillary dysentery - dirty hands disease

Bacillary dysentery (dysenteria bacillaris) is a highly infectious bacterial disease caused by bacteria of the genus Shigella. Specifically, it is caused by Shigella sonnei (50%), Shigella flexneri (40%) and less commonly by Shigella boydii (10%).

Shigella are non-mobile, rod-shaped bacteria. They have no capsule and are very sensitive (thermolabile) to the external environment, especially to dryness. They can be killed by common disinfectants.

How does one get infected?

Shigella is a very sensitive bacterium. If it does not have ideal conditions, it will not survive. Therefore, the most common disease occurs in people with low hygiene standards.

Despite Shigella's sensitivity to the external environment, the disease is highly contagious. Why is this so? A very low infectious dose of 10 to 1,000 microbes is enough to get sick.

Since these bacteria are a typical human pathogen (microbe), the source of infection is the sick person who excretes them in the stool. In the same way, one can get sick from a convalescent. This is someone who is recovering from the illness, not outwardly manifesting as sick, but is a carrier of the disease. This happens even weeks after recovery.

What are the pitfalls of summer for our health?

The transmission of the disease is fecal-oral (stool-to-mouth). This means that failure to follow hygiene guidelines, such as washing hands after toileting, and the subsequent contact of dirty hands with the mouth can be the very moment of infection. The disease is then easily spread by direct contact with the sick person (shaking hands), through contaminated objects (money when paying), contaminated food or water. Flies are also a risk factor in the spread of the disease.

What happens in the digestive tract after infection?

When the bacteria enter the mouth, they travel through the digestive tract to the large intestine, where they settle and produce enterotoxin, which enters the mucosa and has a destructive effect on the cells. It causes inflammation of the intestine, small ulcers, even necrotic changes (tissue death) in some cases. The damaged mucosa is sensitive, bleeds and sporadically ruptures (bursts).

Manifestations of dysentery

The incubation period of the disease is 1 to 7 days. Most often the first symptoms start on the second or third day after infection. The disease is characterised initially by fatigue, malaise, loss of appetite, nausea and vomiting. Temperatures rise to around 38 °C to 39 °C, sweating, chills and shivering. Temperatures do not exceed this threshold.

After a few hours from the onset of the first symptoms, crampy abdominal pain appears. The highest intensity of pain is localised over the right groin. Diarrhoea is associated, which is initially mushy. Later in the course of the disease it becomes thinner and less voluminous. The patient experiences frequent and painful urges to pass stools - tenesmus. Stools are frequent, 15 to 30 times a day, with an admixture of blood and mucus.

The patient is sore and exhausted. He loses large amounts of fluid through constant, persistent diarrhoea, which often makes him very weak. Fluid loss and dehydration are particularly dangerous for young children, the elderly or sick people.

Basic manifestations:

1. malaise, fatigue, weakness
2. lack of appetite
3. nausea vomiting
4. high temperatures not exceeding 39 °C
5. sweating, shivering, chills
6. crampy abdominal pain
7. purulent and later watery diarrhoea (15-30 times/day)
8. admixture of blood and mucus in the faeces
9. painful tenesmus (urge to pass stool)
10. sporadic spontaneous leakage of stool (incontinence)

Severe form of dysentery

The severe form of dysentery is rare. It presents with high fever even above 38 °C, intense crampy abdominal pain, frequent painful tenesmus, frequent watery diarrhoea with admixture of blood, mucus, pus and necrotic tissue. The stool is strongly smelly (putrid odour) and leaks - faecal incontinence and rectal prolapse.

The patient is pale, flabby, sweaty. Hiccups, choreatic (writhing) movements, convulsions and sometimes signs of circulatory failure and exsiccation (drying out) occur. These forms end in death in the first few days of the disease.

Dysentery in childhood

In young children, the course of the disease is more severe. Dehydration of the body is more likely to occur, depending on the amount of fluid lost per day rather than the number of stools. Dehydration and often hypoglycaemia (low blood sugar) results in disturbances of consciousness (drowsiness, disorientation, delirium), unconsciousness and death. High temperature is often the cause of febrile convulsions and meningeal symptoms.

Infants have an atypical course of illness. There may be no diarrhoea or intestinal symptoms at all. Nausea, violent, recurrent vomiting, convulsions are prominent. Signs of toxic liver damage and infant death occur.

How to properly treat dysentery

Treatment is possible in the home environment. Only exceptionally difficult conditions require hospitalization in a hospital. It is important to isolate the patient so that the infection does not spread further. He should have bed rest. Proper treatment is aimed at rehydrating the body - that is, replenishing lost fluids.

Important: Since shigella is excreted in the stool, it is important not to administer antidiarrhoeal drugs. This would prevent it from leaving the body and prolong the course of the disease.

Ten rules for treating dysentery

1. isolation of the patient
2. bed rest
3. rehydration with fluids
4. rehydration with infusion therapy
5. diet
6. temperature reduction by cooling
7. lowering the temperature with drugs
8. pain control
9. antiemetics for persistent vomiting
10. disinfection, anti-infective therapy

Interesting fact: In developed countries, dysentery is easily treatable in the home. However, in poor and overpopulated countries with poor sanitation and livelihood problems, it causes up to 600,000 deaths a year.

Preventive measures against dirty hands disease

The downward trend in dysentery can be ensured mainly by improving hygiene standards and by developing preventive measures against its occurrence and that of other diseases.

Basic preventive measures for society

• sanitation and hygienic disposal of faeces
• protection of water sources
• consumption of safe drinking water
• consumption of safe food
• protection against flies
• educating the population
• development of hygiene habits through information

Basic preventive measures for the individual

• Awareness
• good hygiene habits
• educating children about hygiene
• washing hands after each bowel movement
• washing hands before every meal
• sufficient distance from the sick person

People with poor hygiene habits and the socially weak are most at risk of developing dysentery. The disease spreads mainly in collective settings such as schools, kindergartens, children's camps, dormitories, military facilities, and hostels.