The Mysterious Diarrhea and dysentery that crippled the public

health in mountain region of Mid-West Nepal

Dr.Kedar Karki

Since last three months general public are battling their life with
sudden upsurge of diarrhorea and dysentery in the mountain region
district like Jajarkot, Rukum.Although a comprehensive effort had been
initiated to contain the problem the big problem still remain as exact
cause and epidemiology of the disease has not yet being established
.May be due to the this reason even after sky landing the kilos of
medicine and medical expert in the affected area disease is not yet
have come in control rather there are reports of spread of this
syndrome.

Normally dysentery is an infection of the bowel caused either by a

bacterium called Shigella (bacillary dysentery) or, less commonly, by
an amoeba (amoebic dysentery). In its classical form it leads to
symptoms of cramping abdominal pain, diarrhoea, and blood and
mucus in the faeces. Initially the diarrhoea may be copious but it soon
becomes frequent and of small volume; the patient often complains of
painful defaecation. It is sometimes accompanied by other symptoms
such as vomiting and fever. The infection rarely involves other parts of
the body. There are four different species of Shigella: S. dysenteriae,
S. flexneri, S. boydii, and S. sonnei. In general, S. dysenteriae tends
to produce the most severe disease while S. sonnei produces the
mildest.

The organism invades the cells lining the large bowel and multiplies
there, killing the cell; this is the cause of the symptoms produced.
However, it occasionally invades the bowel beyond the surface lining.
S. dysenteriae also produces a toxin similar to that produced by E. coli
O157, which causes additional tissue damage, and may lead to the
haemolytic-uraemic syndrome and kidney failure.

Shigella needs fewer organisms to cause illness than Salmonella and is

thus more easily spread from person to person. Although transmission
via food is much less common than with Salmonella, contamination of
food with human sewage (either directly or via contaminated water)
has led to outbreaks, especially with cold uncooked foods such as
salads. Shigella is often transmitted directly from one person to
another. This can happen if a person with diarrhoea fails to wash their
hands after visiting the lavatory, and then comes into contact with
another person.
In developed countries, most cases are seen in young children. This is
explained by the relatively poor personal hygiene of small children and
their attendance at schools and day nurseries where they come into
close contact with other children. When sanitary facilities are
inadequate, this will contribute to the spread of infection and
contamination of the environment by faeces may also promote the
spread of the organism. In addition, family members frequently
acquire infection from infected people in the same household, so that
infection can spread from children to adults and vice versa.

Many adults probably also acquire Shigella infection but because it is

usually mild most of these cases never come to medical attention.
Outbreaks of infection have been described in other groups of people
in close contact such as in military bases and among cruise ship
passengers. Shigella is an important cause of diarrhorea in travelers to
developing countries. If demographic pattern of the affected area is
taken in mind many peoples of there affected districts usually in winter
travels to different part of India to fetch their livelihood and returns
back home during summer to cultivate their land for summer cropping.
The season and adverse prevailing climatic condition might have
exaggerated the condition.

In developing countries, Shigella is a common infection because of

inadequate sewage disposal and lack of effectively treated water
supplies. It is a cause of severe, potentially fatal, infection in children.
Shigella is of major importance in refugee camps or following natural
disasters, when once again disposal of sewage and the provision of
clean water may be extremely difficult. It has been found that in
developing countries flies may spread the infection from person to
person, as the disease is commonest at the time of year when the fly
population is highest.

Normally Shigella infection is diagnosed by collecting a sample of

faeces from the patient and growing the organism in the laboratory.
But till date there no report about any laboratory report of any kind of
samples from patients of affected has came out in public that might
the cause of poor response to till date’s intervention.

The most important complication of bacterial dysentery is dehydration

due to loss of fluid through diarrhea and vomiting. The mainstay of
treatment is therefore to replace the fluid which has been lost. In most
cases the fluid can be given by mouth but in severely ill patients
intravenous replacement may be required.
The most important preventive measure is the provision of safe water
supplies and effective disposal of sewage. The use of soap when
washing hands is important, but disinfectant solutions are not usually
recommended. In addition, since towels for communal use may
become contaminated with the organism, disposable paper towels are
preferred.

In outbreaks area regular cleaning of toilets and other communal

areas is essential. A strict policy of exclusion from school or work is
recommended until repeat faeces specimens showed that the organism
was no longer being excreted by the patient. Adults are only excluded
from work if they are food handlers or work in health-care premises.
In the case of food handlers, it is recommended that the worker is
excluded until 48 hours after the patient passes a formed motion.