Epidemic dysentery caused by the Shiga bacillus in a southern Indian village.

Multi-drug resistant Shigella dysenteriae type 1 caused an epidemic of dysentery in a village in southern India. The epidemic started as a common source outbreak, through the piped water supply of the village with subsequent person-to-person spread. Although the attack rate was high, with nearly 1/2 the children under age 5 being affected, the case fatality rate was only about 1%. Of the 248 patients who attended the field clinic, 89.4% passed small mucoid stools mixed with blood, with the majority complaining of crampy lower abdominal pain and tenesmus. The other 10.6% had a history of diarrhea, only without blood and mucus. Moreover, 126 patients were given appropriate doses of sulphamezathine for 4-7 days. Adequate doses of neomycin were also given as therapeutic agent to infected individuals. The role of early maintenance of hydration and nutrition in the field situation in managing diarrheal epidemics is emphasized. Comparisons with mortality figures in other epidemics support the hypothesis that early and adequate maintenance of hydration and nutrition is a significant factor in reducing mortality.