Dysentery is an infectious gastrointestinal disorder, characterized by inflammation of the intestines, mainly th e colon.

World Health Organization (WHO) defines dysentery as any episode of diarrhea in which there is blood in loose and
watery stool. Dysentery can mainly spread among people through contaminated food and water as well as poor
sanitation. There are several numbers of bacteria that can cause acute dysentery, including Shigella, Salmonella,
Campylobacter, and Escherichia coli (E. coli) (1-3). Dysentery is a major cause of childhood morbidity and mortality,
especially in developing countries in Africa, Asia, and Central and Latin America. Most dysentery cases in tropical areas
are caused by Shigella; but in developed countries, they are usually caused by Salmonella (1,2). Death rates as high
as 6.2% have been reported during epidemics of Shigella dysenteriae type 1 (3). Use of effective antimicrobial
treatments is important, especially for reduction of the prevalence rate of Shigella and other organisms causing
dysentery in children. On the other hand, reduction of the bacterial load excreted by a childs stool also decreases the
probability of fecal-oral transmission to close contacts, such as friends, members of the childs household, and
neighbors (4). Antimicrobial therapy is very important in developing countries, where prolonged and recurrent
episodes of dysentery can diminish the nutritional status and growth in affected children (3-5). Although, it is possible
for some immune-component children to successfully fight against the infection without antibiotics and get a full
recovery. However, WHO recommends that all the dysentery episodes should be treated with antibiotics, especially in
younger children, aged people, and anyone with an immunodeficiency syndrome, because the chances of bacteremia
and sepsis are higher in these groups (6, 7). It is also proposed that the bacteria isolated from the stool sample of a
child with dysentery rarely relapse if the child has received a full-course treatment with one of the effective and
sensitive antibiotics. Emergence of multidrug-resistant (MDR) Shigella spp. (resistance to more than two first-line oral
drugs, such as ampicillin, co-trimoxazole, and ciprofloxacin) is of a growing concern in the world. The drug of choice
for treatment of severe infections with these MDR strains is ceftriaxone (8-10). Meanwhile, the use of azithromycin
rather than ceftriaxone as an empiric antibiotic for cases of severe dysentery prior to culture and sensitivity test
results may be considered in areas where MDR strains are reported to minimize the morbidity associated with the
disease (9, 10). WHO recommends treatment with ciprofloxacin (not for children less than eight years ols) or one of
the three second-line antibiotics, pivmecillinam (pivmecillinam is the pivaloyloxymethyl ester of mecillinam and is only
considered to be active against Gram-negative bacteria), azithromycin, and ceftriaxone (a third-generation
cephalosporin) (8, 9). Therefore, since some bacteria can acquire resistance to antibiotics, drugs should be selected
based on the resistance patterns prevalent in the community. It is estimated that the 99% reduction in diarrhea
mortality is associated with the treatment of dysentery with ciprofloxacin, ceftriaxone or pivmecillinam and it may
even be more important to perform antibiotic susceptibility test before the treatment ( 10-12). Therefore, dehydration
is more likely to occur in children under one year old (particularly those under six months old), in infants who stopped
breastfeeding due to illness, or in children with severe diarrhea and vomiting, and it is recommended to rehydrate
them through oral or intravenous (IV) routes. The child should continue with a normal diet and usual drinks. In
addition, the child should also be encouraged to drink extra fluids. However, fruit juices or fizzy drinks must be
avoided, as they can worsen the diarrhea. For babies aged less than six months who are at increased risk of
dehydration, breast or bottle feeds should be encouraged as normal. Hence, children are more likely to develop
complications and even death. Prompt treatment with an effective antibiotic and rehydration are very important in
children with dysentery.

References

1. Guerin PJ, Brasher C, Baron E, Mic D, Grimont F, Ryan M, et al. Case management of a
multidrug-resistant Shigella dysenteriae serotype 1 outbreak in a crisis context in Sierra Leone, 19992000. Trans R Soc Trop Med Hyg.2004;98(11):635-43. [DOI] [PubMed]

2. Amieva MR. Important bacterial gastrointestinal pathogens in children: a pathogenesis

perspective. Pediatr Clin North Am. 2005;52(3):749-77. vi [DOI] [PubMed]

3. Nath R, Saikia L, Choudhury G, Sharma D. Drug resistant Shigella flexneri in & around
Dibrugarh, north-east India.Indian J Med Res. 2013;137(1):183-6. [PubMed]

4. el Bushra HE, Bin Saeed AA. Intrafamilial person-to-person spread of bacillary dysentery due
to Shigella dysenteriae in southwestern Saudi Arabia. East Afr Med J. 1999;76(5):255-9. [PubMed]

5. Kabir I, Butler T, Khanam A. Comparative efficacies of single intravenous doses of ceftriaxone

and ampicillin for shigellosis in a placebo-controlled trial. Antimicrob Agents
Chemother. 1986;29(4):645-8. [PubMed]

6. Boyce JM, Hughes JM, Alim AR, Khan M, Aziz KM, Wells JG, et al. Patterns of Shigella infection
in families in rural Bangladesh. Am J Trop Med Hyg. 1982;31(5):1015-20. [PubMed]

7. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type
1. Geneva; 2005.

8. Oommen S, Pillai PM, Sushamabai S, Paul PJ. Cefotaximase and AmpC-producing Shigella
flexneri in case of dysentery from southern India. Indian J Med Microbiol. 2013;31(1):77-9. [DOI]
[PubMed]

9. Tajbakhsh M, Garcia Migura L, Rahbar M, Svendsen CA, Mohammadzadeh M, Zali MR, et al.
Antimicrobial-resistant Shigella infections from Iran: an overlooked problem? J Antimicrob
Chemother. 2012;67(5):1128-33. [DOI] [PubMed]

10. Varghese SR, Aggarwal A. Extended spectrum beta-lactamase production in Shigella isolates
- a matter of concern. Indian J Med Microbiol. 2011;29(1):76-8. [DOI] [PubMed]

11. Pivmecillinam. Wikipedia; [updated 2014 ]; Available

from: http://en.wikipedia.org/wiki/P...

12. Das SK, Ahmed S, Ferdous F, Farzana FD, Chisti MJ, Leung DT, et al. Changing emergence of
Shigella sero-groups in Bangladesh: observation from four different diarrheal disease hospitals. PLoS
One. 2013;8(4):ee62029 [DOI] [PubMed]

2.2 Karakteristik Tinja Normal

Melalui absorpsi garam dan air terbentuk masaa tinja yang padat. Dari 500ml bahan
yang masuk ke kolon setiap hari dari usus halus, kolon normalnya menyerap sekitar 350ml,
meninggalkan 150g feses untuk dikeluarkan dari tubuh setiap hari. Bahan feses ini biasanya
terdiri dari 100g air dan 50g bahan padat termasuk selulosa yang tidak tercerna, bilirubin,
bakteri, dan sejumlah kecil garam. Produk sisa utama yang diekskresikan di tinja adalah

bilirubin. Konstituen- konstituen tinja yang lain adalah residu makanan yang tidak terserap
dan bakteri. Normalnya fese terdiri atas tiga perempat air dan seperempat bahan-bahan padat
yang tersusun atas 30 persen bakteri mati, 10 sampai 20 persen lemak, 10 sampai 20 persen
bahan inorganik, 2 sampai 3 persen protein, dan 30 persen serat-serat makanan yang tidak
tercerna dan unsur-unsur kering dari getah pencernaan, seperti pigmen empedu, dan sel-sel
epitel yang terlepas. Warna coklat dari feses disebabkan oleh sterkobilin dan urobilin. Bau
feses terutama disebabkan oleh produk kerja bakteri, produk ini bervariasi dari satu orang ke
orang lainnya bergantung pada flora bakteri kolon masing masing orang dan pada jenis
makanan yang dimakan. Produk yang benar-benar mengeluarkan bau meliputiindol, skatol,
merkaptan dan hidrogen sulfida.
Feces characteristics Normal
Through the absorption of salt and water to form a dense fecal period. 500ml of the
materials that go into the colon every day from the small intestine, colon normally absorbs
about 350ml, 150g leaving feces to be removed from the body each day. Faecal material is
usually composed of 100g of water and 50g of solid materials including cellulose that is not
digested, bilirubin, bacteria, and a small amount of salt. The main waste products are excreted
in the stool is bilirubin. Other constituents of the stool that is not absorbed food residues and
bacteria. Normally fese made up three-fourths water and one-quarter solid materials that
made up 30 percent of the bacteria die, 10 to 20 percent fat, 10 to 20 percent inorganic
material, 2 to 3 percent protein, and 30 percent of the fibers of undigested food and dry
elements of digestive juices, such as bile pigment and epithelial cells were detached. The
brown color of stool caused by sterkobilin and urobilin. The smell of feces was mainly due to
the work product of bacteria, these products vary from one person to another depending on
the colonic bacterial flora of each person and the type of food eaten. Products are really
brought out the smell meliputiindol, skatol, mercaptans and hydrogen sulfide.
1. Suharyono. 2008.
Jakarta

Diare Akut, Klinik dan Laboratorik Cetakan Kedua. Rineka Cipta.