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Chapter 19

SHIGELLOSIS (BACILLARY DYSENTERY)

The history of dysentery is as ancient as the history of medicine itself. Epidemics of dysentery have struck whenever the rules of sanitation have been neglected and especially when large groups have lived in close contact in crowded communities, armies, prisons, or mental institutions. Whether in early or modern civilizations, failure to prevent the spread of the organisms by the sanitary disposal of feces, control of flies, and strict personal hygiene has resulted in epidemics of dysentery.

Its effect on the outcome of wars has been significant. No major conflict from the Peloponnesian War in 431 B.C. to World War II has been waged without dysentery among the troops. These epidemics were often severe, with a high mortality; in many campaigns more soldiers died of dysentery than in battle. In the Gallipoli campaign (1915), it was responsible for most of the 120,000 evacuated medical casualties. There were 9,543 deaths among 34,198 soldiers with epidemic dysentery in the Russo-Turkish War (1828), 38,094 deaths among 155,140 cases in the Sino-Japanese War (1894) and 44,558 deaths among 1,739,135 cases of acute and chronic diarrhea in Federal soldiers during the American Civil War (1861-1865). At the Andersonville prison in South Carolina during the Civil War, there were 4,529 deaths among 16,772 soldiers with dysentery. It was not until sulfonamides and antibiotics became available that dysentery relaxed its hold on warring armies and those in confinement.

Before the antibiotic era, the average mortality from acute bacillary dysentery in this century in untreated individuals was about 5%, although it has been as high as 20% in some recorded epidemics (Dupont, 1979). In 1990, Bennish et al reported an overall fatality rate of 9.1% in a review of 9,780 Shigella-infected patients seen over a period of 15 years in Bangladesh. In the past decade, it has been estimated that there are 250 million cases of shigellosis worldwide annually, with 654,000 deaths (Levine, 1991).

Synonyms

Shigellosis. Bacillary dysentery. Bacillary colitis. Acute or chronic dysentery. Diphtheritic dysentery. Bloody flux. Colitis necroticans, ulcerosa or hemorrhagica. Institutional dysentery. Sp: Disenteria bacilar. Fr: Dysenterie bacillaire. Ger: Bakterienruhr. Bazillenruhr.

Definition

Bacillary dysentery is an acute or chronic infection of the colon (and occasionally the terminal ileum) caused by bacilli of the genus Shigella, the dysentery bacilli.

Geographic Distribution

Epidemics of bacillary dysentery have erupted in virtually every country of the world, but in modern times such epidemics of severe diarrhea are more frequent and significant in those developing nations of the tropics where unsanitary habits and primitive conditions prevail, and are made worse by the wet, humid climate. Shigella dysenteriae, the Shiga bacillus, is responsible for outbreaks in the tropics and subtropics. Shigella of the Flexner and Sonne subgroups are the most common causes of bacillary dysentery in the United States, England, Europe, Egypt, and the Orient. The Boyd subgroup is found in India and Egypt. Strains of any of the four Shigella subtypes can be found in North America.

In the industrialized countries of North America and Europe, bacillary dysentery is most commonly an institutional disease, seen in nursery schools, mental institutions, prisons, and military barracks. Sonne dysentery has been widespread in past winters, especially in children in England, Europe, and America.

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