Where There Is No Doctor 2011 145
Typical amebic dysentery consists of:
• diarrhea that comes and goes—sometimes alternating with constipation
• cramps in the belly and a need to have frequent bowel movements, even
when little or nothing—or just mucus—comes out
• many loose (but usually not watery) stools with lots of mucus, sometimes
stained with blood
• in severe cases, much blood; the person may be very weak and ill
• if there is fever, it means there may also be a bacterial infection
Diarrhea with blood may be caused by either amebas or bacteria. However,
bacterial dysentery (Shigella) begins more suddenly, the stools are more watery, and
there is almost always fever (p. 158). As a general rule:
Diarrhea + blood + fever = bacterial infection (Shigella)
Diarrhea + blood + no fever = amebas
Occasionally bloody diarrhea has other causes. To be sure of the cause, a stool
analysis may be necessary.
Sometimes amebas get into the liver and form an abscess or pocket of pus. This
causes tenderness or pain in the right upper belly. Pain may extend into the right
chest and is worse when the person walks. (Compare this with gallbladder pain,
p. 329; hepatitis, p. 172; and cirrhosis, p. 328.) If the person with these signs begins
to cough up a brown liquid, an amebic abscess is draining into his lung.
Treatment:
♦ If possible get medical help and a stool analysis.
♦ Amebic dysentery can be treated with metronidazole, if possible followed
by diloxanide furoate. For dosage, length of treatment, and precautions, see
p. 368.
♦ For amebic abscess, treat as for amebic dysentery. Be sure to take both
metronidazole and diloxanide furoate (p. 368).
Prevention: Make and use latrines, protect the source of drinking water, and follow
the guidelines of cleanliness. Eating well and avoiding fatigue and drunkenness are
also important in preventing amebic dysentery.
Giardia
The giardia, like the ameba, is a microscopic parasite that lives
in the gut and is a common cause of diarrhea, especially in children.
The diarrhea may be chronic or intermittent (may come and go).
A person who has yellow, bad-smelling diarrhea that is frothy
(full of bubbles) but without blood or mucus, probably has giardia.
The belly is swollen with gas and uncomfortable, there are mild
intestinal cramps, and the person farts and burps a lot. The burps
have a bad taste, like sulfur. There is usually no fever.
Giardia as
seen under a
microscope
Giardia infections sometimes clear up by themselves. Good nutrition helps.
Severe cases are best treated with metronidazole (see p. 368). Quinacrine (Atabrine,
p. 369) is cheaper and often works well, but causes worse side effects.