3.

What is the agent infection of this diarrhea with blood

and mucus?
1. Shigella

Shigella is a disease transmitted through food or water. Organism

shigella cause bacillary dysentery and produce an inflammatory
response in the colon through enterotoxin and bacterial invasion.
Classically, shigellosis arise with symptoms of abdominal pain,
fever, defecate bloody and mucoid stool. The initial symptoms
consist of fever, abdominal pain and watery diarrhea
without blood, and bloody stool after 3-5 days later. The average
duration of symptoms in adults is 7 days, in more severe cases
persist for 3-4
Sunday. Shigellosis can mimic chronic ulcerative colitis, and chronic
career status can happen. Shigellosis extraintestinal manifestations
can occur, including respiratory symptoms, neurological symptoms
such as meningismus, and Hemolytic Uremic Syndrome. Arthritis
oligoarticular asymmetric can occur up to 3 weeks from the onset of
dysentery. Smear feces showed polymorphonuclear and red blood
cells. Culture Stool can be used for isolation and identification and
antibiotic sensitivity.
Therapy with adequate rehydration orally or intravenously,
depending on
the severity of the disease. Derivatives opiates should be avoided.
Antimicrobial therapy is given to shorten the course of disease and
the spread of bacteria. Trimetoprimsulfametoksazole or
fluoroquinolones twice a day for 3 days is an antibiotic
recommended.

2. Campylobacter

Campylobacter species found in human C. jejuni and C. fetus,

often
found in immunocompromised patients .. The pathogenesis of the
disease and invasion toxin mucosa. Campylobakter clinical
manifestations of infection vary greatly, from asymptomatic to
dysentery syndrome. The incubation period for 24 -72 hours after
entering the organism. Diarrhea and occurs in 90% of patients, and
abdominal pain and bloody stool up to 50-70%. Other symptoms
that may occur are fever, nausea, vomiting and malaise. Period The
disease course of 7 days. Stool smear showed leukocytes and red
blood cells. Stool cultures can be found presence of Campylobacter.
Campylobacter is sensitive to erythromycin and quinolones, but the
use of antibiotics is controversial. Antibiotics are indicated for
patients with severe or patients who are obviously affected by
dysentery syndrome. If antibiotic therapy is given, erythromycin 500
mg 2 times a day orally for 5 days is quite effective. Like illness

Other diarrhea, fluid and electrolyte replacement is the mainstay of

therapy.

3. EnterohemoragikEColi(Subtipe0157)

EHEC has been known since the outbreak of hemorrhagic

colitis. This happens due to outbreak contaminated food. Most cases
occur 7-10 days after food intake or contaminated water. EHEC can
be a major cause of infectious diarrhea. Subtype 0157: H7 can be
connected with the development of Hemolytic Uremic Syndrome
(HUS). Centers for Disease Control (CDC) has observed that E. coli
0157 is seen as causes acute bloody diarrhea or HUS. EHEC noninvasive but produces shiga toxin,that cause endothelial damage,
microangiopathic hemolysis, and kidney damage.
The beginning of the disease with the symptoms of moderate to
severe diarrhea (up to 10-12 times per day). Early diarrhea is not
bloody but develop into bloody. Abdominal pain common and severe
seizures, nausea and vomiting occur in 2/3 patients. Examination
Abdominal found abdominal distention and tenderness in the right
lower quadrant. Fever occurred in 1/3 patients. Up to 1/3 of patients
requiring hospitalization. Lekositosis often occur. Urinalysis showed
hematuria or proteinuria or the onset of leukocytes. Signs of
microangiopathic hemolytic anemia (hematocrit <30%),
thrombocytopenia (<150
x 109/ L), and renal insufficiency (BUN> 20 mg / dL) is diagnosed
HUS.
HUS occurs in 5-10% of patients at diagnosis and 6 days after
diarrhea. Factor
the risk of HUS, age (especially in children under age 5 years) and
the use of anti
diare. The use of antibiotics also increases the risk. Nearly 60% of
patients with HUS will recover, 3-5% will die, 5% will develop end
stage renal disease and
30% will experience symptoms of residual proteinuria. Platelets can
thrombocytopenic purpura occur but less frequently than in the
HUS.
If the suspected EHEC, to do the stool cultures of E. coli. Serotype
usually
performed in specialized laboratories. Therapy with fluid
replacement and overcome kidney and vascular complications.
Antibiotics are not effective in reducing symptoms or risk of
complications of EHEC infection.
In fact in some of the studies that used antibiotics can increase the
risk
HUS. Antibiotics and anti-diarrhea treatments should be avoided.
Fosfomycin can improve clinical symptoms, however, further studies
are still needed.
Reference : Zein, Umar, Khalid Huda Sagala, Josia Ginting. Diare
Akut Disebabkan Bakteri. Online ( 30 December 2015 ). Available
from URL : http://library.usu.ac.id/download/fk/penydalam-umar5.pdf