The Mysterious Diarrhea And Dysentery That Crippled The Public Health In Mountain Region Of Mid

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.