BAB I

PRELIMINARY

1.1 BACKGROUND
Dysentery is a type of diarrhea that is dangerous and often leads to death
compared to other types of acute diarrhea. The disease can be caused by bacteria
(bacillary dysentery) and amoeba (amoebic dysentery).
In the United States, the incidence of amoebic disease reaches 1-5% whereas
bacillary dysentery is reported to be less than 500,000 cases per year. While the
incidence of amoebic dysentery in Indonesia is still not present, but for basiler
dysentery reported 5% of 3848 people suffering from severe diarrhea suffer from
bacillary dysentery.
In the world at least 200 million cases and 650,000 deaths occur due to
bacillary dysentery in children under the age of 5 years. Most germs that cause
bacillary dysentery are found in developing countries with poor environmental
health. Amoebic dysentery almost spread throughout the world, especially in
developing countries in the tropics. This is due to population density, individual
hygiene, environmental sanitation and socioeconomic and cultural conditions that
support. This disease usually attacks children with age more than 5 years. The
Entamoeba species affects 10% of the world's population. The high prevalence
reaches 50% in Asia, Africa, and South America. Whereas in Shigella in the
United States attacked 150,000 cases and in developing countries Shigella
flexeneri and S. dysentriae caused 600,000 deaths per year.
WHO says that about 15 percent of all diarrheal occurrences in children
under 5 years are dysentery. The results of the evaluation survey in Indonesia in
1989-1990 also showed the same number of events. Dysentery is a major cause of
health and death associated with diarrhea.

1.2 PROBLEM FORMULATION

From the above background can be formulated some problems as follows:
1. What is the meaning of dysentery?
2. How is the spread of dysentery?

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 3. What is the etiology and clinical symptoms of dysentery?
4. How to overcome dysentery?
5. Completion of case study?

1.3 PURPOSE
To find the definition, the etiology of clinical symptoms and how to
overcome the disease of dysentery, And can know the settlement of cases.

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 BAB II
LITERATURE REVIEW

2.1 DEFINITION OF DISENTRI

Dysentery is derived from the Greek word dys (dysfunction) and enteron
(intestine), whIch means intestinal inflammation that causes widespread
symptoms with bowel symptoms with bloody stools, watery diarrhea with little
volume, defecation with mixed stools (mucus) and pain during bowel movements
(tenesmus). Dysentery is an inflammation of the large intestine characterized by
persistent abdominal pain and defecation (diarrhea) mixed with mucus and blood.
Dysentery is an infection that causes wounds that cause limited ulcers in the colon
that are characterized by typical symptoms called dysentery syndrome, namely:
1. Abdominal pain that is often accompanied by tenesmus,
2. Stalking, and
3. The stool contains blood and mucus.
The presence of blood and leucocytes in the stool is a proof that the germs
that cause dysentery penetrate the walls of the colon and nest under it. This
disease often occurs because of cleanliness is not maintained, either because of
personal hygiene or individual and cleanliness of society and the environment.

2.2 CAUSES OF DISEASES

The most common cause of dysentery is not washing hands after using
public toilets or not washing hands before eating. Quite simple indeed for the
cause of dysentery as a classic case, but that's the reality. Broadly speaking the
cause of dysentery is very closely related to environmental hygiene and clean
living habits.
Bacteria that cause dysentery include contact with Shigella bacteria and
some Escherichia coli (E. coli). Other causes of less common bacteria from
bloody diarrhea include Salmonella and Campylobacter infections. For this type
of amoebic dysentery, caused by Entamoeba histolytica parasite
The microorganisms that cause dysentery either in the form of bacteria or
parasites spread from person to person. It is often the case of patients transmitting

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members family to pass it on to the rest of the family. The infection by these
dysenteric microorganisms can persist and spread for about four weeks.
Dysentery can also spread through contaminated food. Poor countries with
inadequate sanitation systems show high rates for dysentery incidence. The
frequency with which each pathogen causes dysentery differs in different regions
of the world. For example, Shigellosis is most common in Latin America while
Campylobacter is the dominant bacteria in Southeast Asia. Dysentery is rarely
caused by chemical irritation or by intestinal worms.
Microorganisms Cause Dysentery Amoeba dysentery (amoebiasis) is caused
by a protozoan parasite known as Entamoeba histolytica. Amoeba can exist for
long periods of time in the colon (colon). In most cases, amoebiasis causes no
symptoms (only about 10% of infected individuals). It is rare except in the
tropical zones of the world, where the disease is very prevalent. People can
become infected after ingestion of debris containing the parasite and then in a
person's excretion.
People at high risk of contracting the parasite through food and water if
contaminated or polluted by waste. Parasites can also enter through the mouth
when the hands are washed in contaminated water. If people neglect to wash
properly before preparing food, food can be contaminated. Fruits and vegetables
can be contaminated if washed in contaminated water or grown on soil that has
been fertilized by human waste.
For microorganisms that cause bacterial dysentery Shigella and
Campylobacter, is the cause of bacilliary dysentery that can be found all over the
world. They penetrate the lining of the intestine, causing swelling, ulceration, and
severe diarrhea containing blood and pus. Both infections are spread by the
consumption of food contaminated with feces and water. If people live or travel in
areas where poverty or density can interfere with hygiene and sanitation, they are
at risk for invasive bacteria. Children (ages 1 to 4) live in poverty most likely to
contact Shigellosis, campylobacteriosis, or salmonellosis.

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2.3 EPIDEMIOLOGY
In the United States, the incidence of the disease is low. Each year less than
500,000 cases are reported to the Centers for Disease Control (CDC). Inside the
Internal Medicine Hospital of Palembang for 3 years (1990-1992) recorded
medical records, from 748 cases treated for diarrhea there are 16 cases caused by
bacillary dysentery. While the results of research conducted in several hospitals in
Indonesia from June 1998 to November 1999, from 3848 people with severe
diarrhea, found 5% shigella. The prevalence of amebiasis varies considerably,
with an estimated 10 percent of the population being infected. The highest
prevalence in the tropics (50-80%). Humans are the main hosts and reservoirs.
Transmission through fecal contamination to food and drink, with fly
intermediates, cockroaches, interpersonal contact, or anal-oral intercourse. Poor
environmental sanitation, dense population and lack of individual sanitation
facilitate transmission.

2.4 ETIOLOGY
The etiology of dysentery is 2, that is:
1. Basiler dysentery, caused by Shigella s p.Shigella is a non motile, gram
negative, enterobacteriaceae family. There are 4 species of Shigella, namely
S.dysentriae, S.flexneri, S.bondii and S.sonnei. There are 43 serotypes O
fromShigella. S.sonnei is the only one that has a single serotype. Because the
body's immunity is serotype-specific, one can be infected several times by a
different type. This genus has the ability to invade intestinal epithelial cells and
cause infection in 102-103 organisms. The disease is sometimes mild and
sometimes severe. An ugly environmental condition will cause easy transmission
of the disease. Clinically has signs of diarrhea, mucus and blood in the stool,
abdominal pain and tenesmus. Shigella sp is the most common cause of invasive
diarrhea (dysentery) compared to other causes. This is illustrated by research
conducted by Taylor et al. in Thailand in 1984.
2. Amoebic dysentery, caused Entamoeba hystolitica.E.histolytica is an intestinal
protozoa, often living as apatogenic commensal microorganisms) in the human
colon. If permitting conditions can be transformed into pathogens by forming

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colonies on the intestinal wall and penetrating the intestinal wall causing
ulceration. Amoeba life cycle there are 2 forms, namely the form of trofozoit that
can move and form cysts.There are 2 kinds of trophozoites, commensal trofozoit
(measuring <10 mm) and pathogenic trofozoit (> 10 mm in size). Commensal
trofozoit can be found in the intestinal lumen without causing symptoms of the
disease. If the patient has diarrhea, the trofozoit will come out with the stool.
While trofozoit pathogens that can be found in the lumen and intestinal wall
(intraintestinal) and outside the intestine (extraintestinal) can lead to symptoms of
dysentery. Its diameter is larger than commensal trofozoit can be up to 50 mm)
and contains some erythrocytes in it. This is because trofozoit pathogens often
swallow erythrocytes (haematophagous trophozoite). This form of trophozoite is
responsible for the occurrence of symptoms of the disease but quickly die when
outside the human body. have signs of diarrhea, mucus and blood in the stool,
stomach aches and tenesmus.
Cyst form there are also 2 kinds, namely young cysts and adult cysts. The
cyst form is found only in the intestinal lumen. Cyst form is responsible for the
occurrence of disease transmission and can live long outside the human body and
resistant to stomach acid and standard chlorine levels in the drinking water
system. Suspected drought due to water absorption along the large intestine causes
the trophozoite to turn into a cyst.

2.5 PATHOGENESIS AND PATHOPHYSIOLOGY

a. Basiler dysentery All Shigella strains of germs cause dysentery, a condition
characterized by diarrhea, with a consistently soft stool consisting of
inflammatory ieksudates containing polymorphonuclear (PMN) leukocytes and
blood. Shigella germs are genetically resistant to low pH, so it can pass through a
stomach acid barrier. It is transmitted orally through water, food, and flies
contaminated by the patient's excreta. After passing through the stomach and
small intestine, these germs invade the colonic mucosal epithelial cells and
multiply therein. Colon is the main place that Shigella attacked but
ileumterminalis can also be attacked. The heaviest disorder is usually in the
sigmoid region, while the ilium is only hyperemic. In acute and fatal conditions

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found hyperemic intestinal mucosa, bruises and thickness, superficial necrosis, but
usually without ulcers. In subacute circumstances, ulcers develop in the lymphoid
follicle region, and in the mucous membrane of the transverse membrane are
found superficial and small ulcers, thickened ulcer edges and infiltrates but not
ulcer form S.dysentriae, S.flexeneri, and S.sonei produce exotoxins such as Shet1
, Shet2,

2.6 CLINICAL SYMPTOMS

Symptoms of dysentery include:
– Stool with bloody stools
– watery diarrhea with little volume
– Stool with mucus mixed stool (mucus)
– Pain during defecation (tenesmus)
– The characteristics of when exposed to dysentery are as follows:
– High heat (39,50 ° C - 40,0 ° C), appear toxic
– Throws up
– Pain in the stomach cramps and pain in the anus during bowel movements
– Sometimes accompanied by similar symptoms encephalitis and sepsis
– Diarrhea with blood and mucus in the stool
– Frequency of bowel is generally less
– Severe abdominal pain (colic)
– Symptoms of Basiler Dysentery
Basiler Dysentery The buds range from 7 hours to 7 days. The mean of
symptoms is 7 days to 4 weeks. In the early phase of the patient complained of
lower abdominal pain, diarrhea accompanied by fever that reached 400C.
Furthermore the diarrhea is reduced but the stool still contains blood and mucus,
tenesmus, and decreased appetite.
Clinical forms can vary from mild, moderate to severe. Abdominal pain,
especially in the left side, feels twisted followed by stool expenditure, causing the
stomach to become concave. The fulminating cases are usually caused by
S.dysentriae.

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 Symptoms arise suddenly and heavy, spreading rapidly, defecating like
water with mucus and blood, vomiting, subnormal body temperature, rapid
dehydration, septic shock and can die if not quickly rescued. As a result arising
thirst, dry and cold skin, skin turgor reduced due to dehydration. It may be bluish
in color, cold extremities and increased blood viscosity (hemoconcentration).
Sometimes the symptoms are not typical, can be like symptoms of cholera or food
poisoning. Death usually occurs due to peripheral circulatory disturbances, anuria
and uremic coma. The mortality rate depends on the circumstances and the course
of treatment.
This number increases in the state of malnutrition and emergencies such as
hunger. The progression of the disease may subsequently improve slowly but it
may take a long healing time. In cases where complaints and symptoms vary,
stools are usually more shaped, may contain less blood / mucus. While in mild
cases, complaints / symptoms mentioned above is lighter. In contrast to a chronic
case, there are attacks like an acute case for a year. This incident is rarely if
received good treatment.
After a short incubation period (1-3 days) suddenly arise stomach pain,
fever, and watery stool. The aqueous stool is associated with exotoxin work in the
small intestine. A day or several days later, because the infection includes ileum
and colon, the amount of stool is increased, the stool is less dilute but often
contains mucus and blood. Each bowel movement is accompanied by "straining"
and tenesmus (rectal spasmus), which causes lower abdominal pain. Fever and
diarrhea resolve spontaneously within 2-5 days in more than half of adult cases.
However, in children and the elderly, loss of water and electrolytes can lead to
dehydration, acidosis, and even death.
Most people on healing secrete dysentery bacteria for a short time, but some
remain chronic gut carriers and may experience repeated disease attacks. In
infectious healing, most people form antibodies to Shigella in their blood, but
these antibodies do not protect against reinfection
Symptoms of Amoebic Dysentery include:
– watery diarrhea, which may include blood, mucus or pus,
– nausea and vomiting,

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 – abdominal pain, and
– fever and chills.
The symptoms of amoebic dysentery usually last from days to weeks.
However, without treatment, even if symptoms disappear, amoeba can continue to
live in the gut for months or even years. Infection can still be transmitted to others
and diarrhea can still return. The dangers of amoebic dysentery can be fatal if
complications occur such as intestinal (intestinal perforation), infection of the
abdominal cavity (peritonitis), abscesses in the liver and brain. And if this
amoebic infection is not treated thoroughly, it can result in death.
a) Carrier (Cyst Passer)
This patient showed no clinical symptoms at all. This is because the
amoeba in the lumen of the large intestine does not involve intestinal wall
covering.
b) mild amoeba dysentery
The onset of disease (onset of disease) slowly. People usually complain of
flatulence, sometimes mild abdominal pain. Can cause diarrhea mild, 4-5 times a
day, with foul-smelling stomach. Sometimes stools are also mixed with blood and
mucus. There is little tenderness in the sigmoid area, rarely pain in the epigastric
region. The situation depends on the location. The general condition of the patient
is usually good, with no or slight mild fever (subfebris). Occasional hepatomega

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 BAB III
CLOSED

3.1 CONCLUSION
Dysentery is an inflammation of the large intestine characterized by
abdominal pain and a watery discharge mixed with mucus and blood. The
etiology of dysentery is 2, namely basiler disenstrients caused by Shigella, sp.
And amoebic dysentery caused by Entamoeba hystolitica

3.2 ADVICE
The author expects for everyone to keep a clean and healthy lifestyle from
small things like diligent hand washing to big things. And for the government
should continue to provide pemahan about healthy lifestyle and clean to every
citizen so that they avoid various diseases and the need for supervision of food
from the government.

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