Dysentery is a disease whose principal symptom is the expulsion per anum of large quantities of liquids, typically at the expense of conventional urination. It may also involve uncontrollable vomiting, and the patient will typically be confined to bed.
It is very unpleasant. It is caused either by the bacillus species of bacterium, of which shigella is a common form (in which case it is called 'basilic' or 'bacillary' dysentery); or by amoebae (in which case it is called amoebic dysentery). The symptoms in each case are similar, although blood in the liquid expelled from the anus is more likely with amoebic dysentery; and amoebic dysentery is more chronic than basilic dysentery which is more acute.
Notwithstanding what a lot of textbooks and other things tell you, this author, having had both on several occasions, assures you that it is pretty easy for the patient to tell the difference by the acuteness of the symptoms. Basilic dysentery really takes you out like a shot. Amoebic dysentery degrades you more slowly. Both cause a debilitatingly high temperature. You may also have a distinctive off taste in your mouth, more common with basilic than with amoebic dysentery.
Although the literature will tell you that you can catch dysentery from soil, air and all sorts of other things, in practice the causes of both types of dysentery are very simple: dirty food and water. The principal options are:
Unboiled contaminated water (including water used to wash glasses, cutlery etc)
Uncooked vegetables washed in said water
Fruit eaten without an opportunity to remove its skin
Under-cooked meat kept in unsanitary conditions before being provided as food
Other unsavoury food you may find in the developing world that you shouldn't even be dreaming of eating - e.g. raw lentils, under-cooked rice, etcetera - in short, anything that has been in contact with potentially contaminated unboiled water such as in a paddy field; or pulled straight out of the ground and eaten without being first boiled or peeled
Onset time from consumption of contaminated substance to symptoms is typically 24-36 hours so Midnight Monday evening infection might lead to symptoms starting between Midnight Tuesday evening and lunchtime Wednesday.
You are much more likely to have basilic dysentery than amoebic on any particular occasion. Either way, you'll know it when you have it. You'll be going to the toilet far too frequently, and you will be horrified by what is happening when you do.
Dysentery is very rare in western countries, but relatively common in countries with bad water pipes or tanks, including certain Eastern European countries, the Indian subcontinent, and Latin America, amongst other places. Anywhere with stale water that has a propensity to enter the food supply is a good candidate for dysentery.
Water that has sat in tanks or pipes for days without being flushed through is a really good candidate for dysentery.
The good news is that dysentery is very easy to cure. For basilic dysentery, the treatment is:
Initial dose of 1000mg ciprofloxacin perhaps separated into two doses of 500mg over 4-5 hours, followed by 500mg ciprofloxacin every 24 hours for a few days
Physical rest as may be required
For amoebic dysentery, the treatment is:
2000mg metronidazole single dose
Rehydration as necessary
Physical rest as may be required
Warning: if you drink alcohol at the same time as consuming metronidazole, then you will feel sick. You may even be sick, which you do not want because it may mean that you absorb less metronidazole through your stomach. You may also wish to avoid smoking e-cigarettes, as metronidazole inhibits the liver metabolism of propylene glycol (yes, that really is what you are inhaling into your lungs with an e-cigarette so think again). It is believed that metronidazole can also catalyse serotonin syndrome, a sort of heightened body activity affliction accompanying overdose consumptions of everything from SSRI inhibitors through cocaine and Amphetamine. If you are taking metronidazole, it is probably a good idea to quit the anti-depressants and recreational narcotics for a bit.
In passing we should mention a third disease, giardia lamblia, which appears in many ways to be like amoebic dysentery but it is actually a giant parasitic cell that floats around in your blood making you feel ill. The symptoms are the same as amoebic dysentery although it is less often fatal untreated. It is actually very common throughout the world, with up to 7 per cent of the developed world population and 30 per cent of the developing world population infected but most showing no symptoms. Under a microscope it looks like it has a giant head with a face and tentacles, for example this:
Giardia lamblia is passed through animals' consumption by mouth of faeces. Efficient sewage systems not always being what they might be, this is more common than it sounds. Metronidazole will promptly scotch any strain of giardia lamblia that is showing problematic symptoms. Otherwise avoid eating faeces (and don't let your pet dog do this either).
Both ciprofloxacin and metronidazole are essential components of any tropical medicines or general medicinal first aid kit. They are both exceptional medications and between them will kill virtually any water born disease. Ciprofloxacin is so powerful that it can even be used as an ad hoc treatment for a tooth root infection pending a dentist. It is one of the broadest spectrum antibiotics there is. It is a remarkable medicine and you should never travel without it. Metronidazole is also the most remarkable medicine. Also a sort of antibiotic but more, it kills virtually anything that shouldn't be in your body. Never travel without it.
Both forms of dysentery can be fatal without treatment (giardia rarely so). Shigella alone (there are over 260 varieties of basilic dysentery) is estimated to kill up to half a million people a year worldwide (some estimates suggest even more). But in practice these diseases rarely are fatal to those with access to these medicines. Death is caused by dehydration, and most patients are smart enough to drink lots of (unpolluted) liquids when they see watery substances spraying so rampantly per anum.
Excuse our being so graphic, but this is the key to diagnosing and treating dysentery. As we say, it's so shocking - unlike anything else - that you'll know it when you've got it. It is nothing like 'travelllers' diaerhoea'. It is a serious disease, and you know when you have it.
Countries in Eastern Europe where we know of people who have caught dysentery include:
Ukraine (pre-war, so the risk is no doubt even worse now due to deterioration of water infrastructure)
Intentional poisoning with basilic dysentery is rare; but not unheard of, particularly in some Eastern European countries. Of course you have to be prepared to poison potentially a number of people if you do this, because basically it involves poisoning the water supply, placing possibly a large number of people in mortal danger most of whom will probably not know how to treat it. To repeat: it can be fatal. It is not something to be joked around with.
Russian authorities have had a history of poisoning foreigners that irritate them with basilic dysentery grown in a lab.
Both forms of dysentery clear up remarkably quickly with treatment. Basilic dysentery, which is really very acute (you will suddenly just spray brown liquid from your anus and feel terrible, so it is very clear that you have it) will retreat in its symptoms within an hour or so of the 1000mg ciprofloxacin treatment. Amoebic dysentery is about the same with the metronidazole treatment.
As your body overcomes the disease with medication you can expect a large volume of sweating via your skin pores. You may wake up with the bed drenched in sweat. This is nothing to worry about. But do rehydrate.
None of the above is a replacement for professional medical advice, of course. We don't want to get sued for giving inadequate medical advice. This is a layman's guide when you have no access to a doctor. No liability is accepted for this entirely free ad hoc advice. Incidentally, this author has been misdiagnosed on a number of occasions even in areas where dysentery is common, because the doctor has not wanted to admit that the poor dietary and water conditions locally have led to dysentery. If you receive medical advice that seems not to be working in the face of symptoms consistent with dysentery, then find another doctor.
One other point to be aware of is that these diseases can be contracted through exchange of bodily fluids. While you would be hard pressed to have sex while suffering from dysentery, you might sneeze on someone or share a drinking vessel with them. Do not do this. Isolate yourself sufficiently to avoid such things. It's a good time to pull out that COVID mask.
Dysentery is not the worst thing in the world, but this author has contracted it in some countries where it might seem very unusual to do so (in particular where animals such as birds have got into water tanks and died in there), and you must get it treated with these medicines or it can last a long time and potentially be fatal. It is one of those things where you should trust your own instincts. There is obviously something very seriously wrong when you are spraying brown liquid per anum, and you must get it treated straight away. If you don't have the right medicines with you, go to a hospital immediately. You're not going to get better until you are treated.
Finally, if you take these medications and your condition does not improve, then you do not have dysentery. You may have cancer; bowel irritation; or something else quite different. Rarely do these other conditions cause such immediate and massive expulsion of water. Even cholera cannot be compared to dysentery, although it is harder to treat.
You'll be alright. It's just horrible.