Long-term Observation of Bacillary Dysentery

II Cases of reinfection and those with long-term bacillary discharge

Abstract

Positive stool Cultures were obtained in 200 male and 172 female cases by serial investigations of dysentery bacilli for 7 years in an asylum with 400 beds. Out of these cases treated all with antibiotics, the reappearance of the same type of bacilli was observed in 9 male and 31 female cases after a period of negative stool culture for over 1month, the majority of them within 3 months and the longest negative period being 19 months.
During the negative period, a number of cases demonstrated slight fever, loose passage or a slight abdominal pain. The negative period ranged up to 3 months in 2 cases of contimued carrier state, less than 3 months in 61% of 18 cases of carrier state induced after the disease, and the period was gradually lengthened up to 8 monthsin the rest of the group, less than 3 months in 31% of 16 relapse cases and the period was more gradually lengthened up to 11 months in the rest of the group.
Reinfection due to the same type of bacilli was infered in 4 cases, based on the 3 criteria as follows: Clinical observations during the period of over 3 months, results of weekly stool cultures and types and sensitivity patterns against antibiotics of isolated bacilli.
The reinfection was observed in the shortest cases in 5 months, in the longest in19 months, where the first infection demonstrated only slight symptoms or a carrier state and the reinfection showed almost always severe symptoms. Cases of reinfection by theother type of bacilli were 16 male and 31 female cases, of which 72%(89% within 1 year) were induced by the strain of the other group and 60% of the cases occurred within 1 year. The reinfection rate by the strain of the other group was 85% within 3 months (67% in the cases with slight or moderate first infection and 90% in the cases with severe first infection). This rate was higher as compared with 50-71% after 3 months. Two rein fection cases by the strain of the same group within 3 months showed only a carrier state though they were slight or showed a carrier state at the first infection. Two other reinfection cases by the strain of the same group within 4-12 months were moderate at the first infection and yet severe or moderate at the second time.
Six cross infection cases between strains of different groups, manifested clinical symptomes except one case among strains of the same group. Nine cases experienced the reinfection over 3 times, two out of them 4 times. Five out of 9 cases were infected all the 3 times by the strain of the other type and one out of them all the 3 times by the strain of the other group.