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Dysentery: an overview. Still problems to resolve.


 This article reviews the global situation with regard to bacillary dysentery, with particular emphasis on findings from the recent epidemic in West Bengal. Infection is by the fecal-oral route and generally spread by person-to-person transmission. Serious epidemics caused by the multiple-drug-resistant Shigella shigae have occurred recently in Bangladesh, Somalia, South India, Burma, Sri Lanka, Nepal, Bhutan, Rwanda, and Zaire. In each situation, dysentery attacked over 10% of the population and killed 2-10% of hospitalized cases. In 1984, a dysentery epidemic spread rapidly throughout West Bengal, especially among young children, and was resistant to most commonly available drugs and antibiotics. A mass media campaign was initiated which emphasized boiling or chlorination of drinking water, covering feces with soil, protecting food from flies, avoiding exposed raw vegetables and cut fruits, and hand washing. However, these measures were difficult to implement and the epidemic subsided only gradually. Scientific knowledge about the exact mode of transmission of the pathogen, the mechanisms of pathogenicity, and the actual cause of death in dysentery cases could contribute to the development of practical public health interventions and an effective vaccine.
