What is dysentery, and why is it a medical emergency?
Dysentery is a serious intestinal infection characterized by bloody, mucous-containing diarrhea—any diarrhea with blood and mucus should be considered a medical emergency until proven otherwise. It differs fundamentally from ordinary diarrhea and viral gastroenteritis due to the presence of blood and the need for specific medical treatment.
- Bacillary dysentery (shigellosis): caused by Shigella—a highly contagious bacterium (fewer than 10 bacteria are sufficient to cause infection)—incubation period of 1–4 days—bloody diarrhea + fever + cramps—transmitted from person to person and via the fecal-oral route—specific antibiotic treatment required
- Amoebic dysentery (intestinal amoebiasis): caused by Entamoeba histolytica—a parasite—common in tropical and subtropical countries—longer incubation period (1–3 weeks)—mucous diarrhea with red blood—antiparasitic treatment (metronidazole)
- Difference from simple diarrhea: blood and mucus in the stool, fever, and tenesmus (painful, urgent need to defecate)—without treatment, risk of sepsis and colon perforation
- In France: cases imported by travelers (tropical countries, Africa, South Asia)—rare in non-travelers—shigellosis is a reportable disease
- Never take loperamide (an antidiarrheal that slows bowel movements) in cases of bloody diarrhea—risk of toxin retention and worsening of the condition
Symptoms, Diagnosis, and Management
- Characteristic symptoms: mucus-and-blood diarrhea (stools containing mucus and red blood) — fever > 38.5°C — severe abdominal cramps — tenesmus (constant, painful urge to defecate) — nausea, loss of appetite, asthenia
- Diagnosis: stool culture (bacteriological examination of stool) to identify the bacterium or parasite — parasitological stool examination (PSE) for E. histolytica — complete blood count (leukocytosis) and elevated CRP
- Seek urgent medical attention as soon as bloody stools appear — call 15 if: severe dehydration, altered consciousness, fever > 39°C, child < 2 years old, immunocompromised patient, pregnant woman
- Mandatory reporting in France: shigellosis is a notifiable disease (MDO)—report to the ARS for epidemiological surveillance
- Mandatory exclusion from school for children with shigellosis until confirmed bacteriological recovery
Medical treatment and rehydration
- Oral rehydration is the first line of treatment: oral rehydration solutions (ORS)—to replace fluid losses—in cases of severe vomiting or severe dehydration: hospitalization and intravenous rehydration—see our stomach and digestive health product line
- Shigellosis: targeted antibiotics (azithromycin, fluoroquinolones)—antibiogram essential before treatment (increasing resistance)—duration 3–5 days depending on the antibiogram
- Intestinal amoebiasis: metronidazole (Flagyl®) 5–10 days — followed by luminal therapy (tiliquinol-tilbroquinol or paromomycin) to eliminate residual cysts — without complete treatment, there is a risk of hepatic amebiasis (liver abscess)
- Do not self-medicate—never take loperamide or antispasmodics without medical advice in cases of bloody diarrhea
- Post-treatment follow-up: follow-up stool culture at 3–4 weeks to confirm eradication (especially for amoebiasis)
Prevention for travelers and vulnerable populations
- Travelers: bottled or boiled water in high-risk countries — well-cooked foods — avoid raw vegetables, open buffets, ice cubes, and artisanal ice cream — strict hand hygiene (soap, hand sanitizer)
- Children under 5 years of age: the most vulnerable population — 165 million cases of shigellosis per year worldwide, significant mortality in low-income countries — surveillance and early consultation are imperative
- No vaccine available (research on Shigella is ongoing) — prevention relies solely on hygiene and public health measures
- At-risk populations in France: immunocompromised individuals, infants, and elderly people in care facilities — enhanced hygiene and isolation of confirmed cases
- Consult a healthcare provider before traveling to a tropical region: a travel medicine physician or international vaccination center can tailor advice based on your destination — see our food poisoning page for general food safety precautions
