WEBVTT - Ep 80 Dysentery loves a disaster 0:00:01.600 --> 0:00:03.880 I was called on to visit the Major about the 0:00:03.920 --> 0:00:06.840 middle of May. He was lying in bed and looked 0:00:06.880 --> 0:00:10.559 pale and emaciated. His eyes were sunk, his cheeks hollow, 0:00:10.720 --> 0:00:14.160 and his countenance dejected. He told me he was in 0:00:14.320 --> 0:00:17.840 violent pain which could not be palliated without taking two 0:00:18.000 --> 0:00:21.520 or three grams of opium every three or four hours. 0:00:21.600 --> 0:00:25.200 His bowels were obstinately costive, and he was obliged to 0:00:25.239 --> 0:00:30.000 take some purgative medicine every day. Food was loathsome to him, 0:00:30.400 --> 0:00:33.560 and he had profuse perspirations, for which he was taking 0:00:33.640 --> 0:00:37.319 wine and bark. I endeavored to restore his appetite by 0:00:37.400 --> 0:00:40.800 lessening the quantity of opium and substituting the tincture of 0:00:40.880 --> 0:00:44.680 hops as much as possible. His appetite was frequently coaxed 0:00:44.680 --> 0:00:48.320 by some delicacy, and the sweet oil was frequently alternated 0:00:48.360 --> 0:00:52.960 by magnesia and rhubarb. This treatment was regularly pursued until 0:00:53.000 --> 0:00:55.920 the last of June, and although he suffered much pain 0:00:56.040 --> 0:00:58.960 during that time, he was evidently much better and his 0:00:59.040 --> 0:01:02.720 appetite improved. The pain in his bowels was less frequent 0:01:02.800 --> 0:01:06.800 and not so violent. July fourth, I was sent for 0:01:07.040 --> 0:01:10.039 in great haste to visit him. When I entered his room, 0:01:10.160 --> 0:01:13.880 I was astonished at his altered appearance. His countenance was 0:01:13.920 --> 0:01:16.479 pale and fallen. He was sitting up in his bed, 0:01:16.640 --> 0:01:20.039 struggling for breath. His body was covered with cold and 0:01:20.040 --> 0:01:23.720 clammy sweats, and he had a most anxious and desponding look. 0:01:24.360 --> 0:01:28.360 I immediately gave him large quantities of ether and laudanum. 0:01:28.959 --> 0:01:32.520 These injections brought away from his bowels large quantities of 0:01:32.640 --> 0:01:36.440 dark and hardened feces. They were repeated every day during 0:01:36.480 --> 0:01:39.960 this month with the happiest effect. And it was astonishing 0:01:40.319 --> 0:01:44.080 what masses of these dark and indurated feces were evacuated 0:01:44.200 --> 0:01:49.800 during this time. September, he is much emaciated and exhausted 0:01:49.840 --> 0:01:53.640 by want of sleep. The pain and swelling have pervaded 0:01:53.720 --> 0:01:57.320 all his extremities. Opium can no longer lull his pain, 0:01:57.800 --> 0:02:00.559 and nothing but death now seems to offer him any 0:02:00.600 --> 0:02:06.520 hope of relief. Last entry, he is affected with arispolis 0:02:06.880 --> 0:02:11.280 and is gradually sinking into a state of insensibility. In 0:02:11.320 --> 0:02:14.639 this state he lingered until the thirteenth of September, when 0:02:14.680 --> 0:02:16.480 he expired without a struggle. 0:03:02.160 --> 0:03:09.160 Wow, Yeah, that is brutal. It's horrible. 0:03:09.840 --> 0:03:14.600 So that is an account of dysentery. And it is 0:03:14.800 --> 0:03:19.000 from a book titled Medical Sketches of the Campaigns of 0:03:19.040 --> 0:03:22.880 eighteen twelve, thirteen and fourteen by James Mann and it 0:03:22.919 --> 0:03:28.000 was published in eighteen sixteen. Hi, I'm Aaron Welsh. 0:03:27.520 --> 0:03:29.440 And I'm Aaron Allman Updyke. 0:03:29.639 --> 0:03:31.880 And this is this podcast will Kill You. 0:03:32.680 --> 0:03:38.640 And well, so today we're covering dysentery. We are, But 0:03:38.840 --> 0:03:42.040 that first handy count Aaron, when you read it, like, 0:03:42.120 --> 0:03:43.720 it doesn't really. 0:03:43.440 --> 0:03:44.640 Sound like dysentery. 0:03:45.960 --> 0:03:51.040 Here's my thoughts because I kind of agree, But I 0:03:51.120 --> 0:03:52.960 was like, you know what, Erin, you don't know anything 0:03:52.960 --> 0:03:57.280 about the biology, leave that to Erin. So so like, 0:03:57.520 --> 0:04:01.040 you know, just trust the physician from eighteen thirteen that 0:04:01.200 --> 0:04:03.680 you know that he knew what he was doing. Yeah, 0:04:04.040 --> 0:04:07.320 And the other thought I had is that, yeah, this 0:04:07.360 --> 0:04:10.600 could have been any sort of diarrheal pathogen. But I 0:04:10.680 --> 0:04:13.360 wonder if some of these symptoms were caused by the 0:04:13.400 --> 0:04:16.839 things he was taking, like opium and that lead was 0:04:16.880 --> 0:04:20.880 like a really popular treatment as well mercury. 0:04:21.040 --> 0:04:23.520 So yeah, I don't know absolutely, because it sounds like 0:04:23.560 --> 0:04:27.640 he was having a lot of issues losing weight in 0:04:27.760 --> 0:04:30.120 a lot of pain and then was given a ton 0:04:30.160 --> 0:04:32.960 of opium, which is gonna block you up really good. 0:04:33.520 --> 0:04:34.880 Yeah, so that's why. 0:04:34.640 --> 0:04:38.040 Then his bowels became compacted. 0:04:38.200 --> 0:04:41.200 Is that the word they used? I think what did 0:04:41.279 --> 0:04:47.920 they say? Did they say obstinate? No, yes, obstinately costive? 0:04:48.560 --> 0:04:50.159 Yeah, yeah, that'll do it. 0:04:52.080 --> 0:04:57.960 But in any case, it is horrific. And yeah, but 0:04:58.040 --> 0:05:03.280 also I think that, uh, let's see, the vagueness of 0:05:03.320 --> 0:05:05.720 this first hand account or like the hard to pin 0:05:05.880 --> 0:05:09.440 downness is kind of characteristic of the topic that we're 0:05:09.480 --> 0:05:14.560 covering today. Absolutely, yeah, because dysentery, why do we do 0:05:14.600 --> 0:05:19.200 this to ourselves? Again? Is not caused by one, not two, 0:05:19.279 --> 0:05:24.440 but by several pathogens and parasites. So it's gonna be 0:05:24.480 --> 0:05:25.599 an interesting ride. 0:05:25.839 --> 0:05:30.400 Yeah, as always, as always, as always, Yeah, and as 0:05:30.440 --> 0:05:33.240 always I believe that it's quarantiney time. 0:05:33.640 --> 0:05:36.440 It is. What are we drinking this week? 0:05:36.760 --> 0:05:38.640 We're drinking in flux. 0:05:40.000 --> 0:05:43.920 So flux was the one of the old timy names 0:05:43.960 --> 0:05:46.240 for this disease. I think it actually might still be 0:05:46.279 --> 0:05:50.120 called flux in some places flux or the bloody flux. 0:05:50.760 --> 0:05:54.880 And so you know, since the definition of dysentery has 0:05:55.000 --> 0:05:58.560 kind of been in flux, that's what we're going with. 0:05:59.080 --> 0:06:03.440 But Aaron what infos. 0:06:02.680 --> 0:06:06.679 Well, I thought it would be kind of a nice 0:06:06.720 --> 0:06:10.320 callback to the first hand account to include rhubarb. So 0:06:10.360 --> 0:06:15.520 we're gonna do a rhubarb syrup plus some gin, plus 0:06:15.680 --> 0:06:21.560 some sparkling water, strawberries and lime juice. Yum. And we 0:06:21.600 --> 0:06:25.080 will post the full recipe for this quarantine as well 0:06:25.120 --> 0:06:28.520 as the non alcoholic plus see burrita on our website 0:06:28.520 --> 0:06:30.960 This podcast will kill You dot com, as well as 0:06:31.000 --> 0:06:32.680 on all of our social media channels. 0:06:33.440 --> 0:06:35.640 And speaking of our website, this podcast will kill You 0:06:35.680 --> 0:06:38.160 dot Com. We just keep telling you guys to go there. 0:06:38.160 --> 0:06:40.240 Have you gone there yet? It's really great. We have 0:06:40.560 --> 0:06:44.039 a bookshop dot org link. We have a good Reads link, 0:06:44.080 --> 0:06:47.159 we have links to Bloodmobile, our music, we have links 0:06:47.160 --> 0:06:50.560 to our Patreon, to our merch to transcripts to all 0:06:50.560 --> 0:06:52.440 of the sources from all of our episodes. 0:06:52.600 --> 0:06:53.120 Wow. 0:06:54.000 --> 0:06:56.240 Yeah, it's a It's a gold mine. 0:06:56.040 --> 0:06:59.960 It really is. Yeah. 0:07:00.240 --> 0:07:03.320 Do we have any other business erin I do? 0:07:04.440 --> 0:07:05.400 I have a correction? 0:07:05.600 --> 0:07:08.800 I wanted to point out that somebody emailed us and 0:07:08.839 --> 0:07:12.680 I really appreciate this about One of our recent episodes 0:07:12.760 --> 0:07:14.960 was on Legionnaire's disease and erin. You and I talked 0:07:14.960 --> 0:07:18.360 a lot about atypical versus typical pneumonia. 0:07:18.480 --> 0:07:19.760 I recall that conversation. 0:07:20.160 --> 0:07:22.840 Yeah, and how like poor of a definition it is. 0:07:23.600 --> 0:07:26.520 It's still true. But a listener pointed out, and I 0:07:26.520 --> 0:07:31.040 think this is important, is that today the term atypical 0:07:31.120 --> 0:07:34.680 is mostly used to mean pneumonia that's caused by bacteria 0:07:34.720 --> 0:07:39.160 that don't gram stain very well, rather than previously atypical 0:07:39.400 --> 0:07:43.000 used to be like clinically a little different, or not 0:07:43.080 --> 0:07:46.440 responding to antibiotics, or maybe radiographic differences. But like we 0:07:46.480 --> 0:07:49.760 talked about in the episode, those are not good definitions 0:07:49.760 --> 0:07:54.200 to distinguish different types of pneumonia. So at least the 0:07:54.240 --> 0:07:58.640 way that we use it today is moderately better. Things 0:07:58.680 --> 0:08:01.560 that don't Grant stain well. But again, some things that 0:08:01.640 --> 0:08:05.760 are not considered atypical pneumonia's also don't Graham stain well. 0:08:06.680 --> 0:08:11.480 But that's besides the point. It's still an imprecise term, 0:08:11.520 --> 0:08:13.040 but it's at least a little bit better. 0:08:13.200 --> 0:08:16.520 Okay, So it's more about the pathogen now than it 0:08:16.640 --> 0:08:19.320 is about the symptoms or signs. 0:08:19.280 --> 0:08:23.440 Right, like the clinical picture, gotcha, Okay, that's something. 0:08:23.840 --> 0:08:27.200 Yeah, so thank you again. That's all I got. Should 0:08:27.200 --> 0:08:28.880 we dysenterry it up? 0:08:29.320 --> 0:08:31.720 I think so. She feels like a fast intro, but 0:08:31.960 --> 0:08:33.320 I'm here for it. Let's do it. 0:08:34.960 --> 0:08:36.760 We'll take a quick break and then we'll dive in. 0:09:10.200 --> 0:09:12.319 I'm going to go through this a little bit out 0:09:12.360 --> 0:09:16.320 of order from my usual because, like you said, Aaron, 0:09:16.400 --> 0:09:22.720 this isn't a very typical disease that we cover on 0:09:22.800 --> 0:09:23.480 this podcast. 0:09:23.960 --> 0:09:26.000 So first, what I'm going to do is cover kind. 0:09:25.800 --> 0:09:29.240 Of the symptoms of dysentery. We'll talk about like what 0:09:29.280 --> 0:09:32.440 does dysentery actually mean, and then I'll focus on a 0:09:32.480 --> 0:09:36.040 few of the specific causes, and then Aaron, you can 0:09:36.080 --> 0:09:37.880 ask me a million questions and I probably won't know 0:09:37.920 --> 0:09:38.640 the answers. Cool. 0:09:39.080 --> 0:09:40.640 I am very excited. 0:09:42.280 --> 0:09:42.640 Okay. 0:09:42.760 --> 0:09:48.280 So generally dysentery can be defined as bloody diarrhea. 0:09:49.080 --> 0:09:51.040 Is that cool? Can we all be cool with that definition? 0:09:51.240 --> 0:09:52.160 I mean, that's it, right? 0:09:52.280 --> 0:09:54.080 Like pretty much? Yeah, pretty much? 0:09:54.160 --> 0:09:57.040 Okay. Diarrhea we've talked about kind of a lot on 0:09:57.080 --> 0:10:00.400 this podcast, although not for a while. The the World 0:10:00.400 --> 0:10:05.319 Health Organization definition is three or more loose or liquid 0:10:05.320 --> 0:10:08.559 stools in a twenty four hour period. But even that 0:10:08.600 --> 0:10:11.080 definition is pretty loose. Huh. 0:10:13.160 --> 0:10:15.240 I swear the whole episode's not going to be like this. 0:10:15.880 --> 0:10:17.240 I think it absolutely is. 0:10:18.120 --> 0:10:22.440 Oh, but it is a loose definition because everybody is 0:10:22.480 --> 0:10:25.920 different in terms of their bowel movements, right, right, But 0:10:26.360 --> 0:10:30.000 everyone has had diarrhea at some point, so everyone knows 0:10:30.080 --> 0:10:34.559 what diarrhea feels like and what it means. So dysentery 0:10:34.800 --> 0:10:39.720 is diarrhea with blood, visible blood, and often sometimes mucus 0:10:40.280 --> 0:10:41.080 just for good measure. 0:10:41.559 --> 0:10:46.040 Okay, So question about the blood, Okay, is it bright 0:10:46.120 --> 0:10:47.559 red or is it black? 0:10:48.160 --> 0:10:52.080 Good question? It could be either color. So part of 0:10:52.080 --> 0:10:55.560 what you're asking gets at where is the blood coming 0:10:55.600 --> 0:10:57.280 from in your gi tract? 0:10:57.520 --> 0:10:57.760 Right? 0:10:57.960 --> 0:10:59.880 So, black blood. 0:10:59.679 --> 0:11:02.560 Usually means that the bleeding is coming from further up 0:11:02.720 --> 0:11:05.440 in the digestive tract. So if you have bleeding in 0:11:05.480 --> 0:11:09.640 your stomach, in your small intestine, those will usually be 0:11:09.720 --> 0:11:11.440 black by the time they make it all the way 0:11:11.440 --> 0:11:14.840 to your poop. If you have bleeding in most of 0:11:14.840 --> 0:11:18.240 your colon, then that bleeding is more likely to be 0:11:18.280 --> 0:11:20.720 bright red, although even if you bleed like a ton 0:11:20.920 --> 0:11:23.520 from higher up, it'll end up bright red. It just 0:11:23.559 --> 0:11:25.599 all depends on how long it transits. 0:11:26.080 --> 0:11:27.800 Okay, okay, okay, So. 0:11:27.880 --> 0:11:30.920 In the case of dysentery, it's probably going to be 0:11:31.640 --> 0:11:33.640 I would say, a mixture of two, but more on 0:11:33.679 --> 0:11:36.960 the red spectrum than the black spectrum. And that's because, 0:11:36.960 --> 0:11:41.080 as we'll see, it tends to be a colitis picture, 0:11:41.200 --> 0:11:44.640 and that means inflammation in the colon. So let's talk 0:11:44.640 --> 0:11:47.160 a little more about it. In order to have blood 0:11:47.160 --> 0:11:50.360 in your poop, it means that, in one way or another, 0:11:50.559 --> 0:11:55.000 your gut is very unhappy. Of course, in the case 0:11:55.040 --> 0:11:58.680 of dysentery, what it means is that you have some 0:11:58.800 --> 0:12:04.480 kind of severe inflammation going on, whether it's from a bacteria, 0:12:04.760 --> 0:12:08.680 a virus, a parasite, or even in some cases no 0:12:08.800 --> 0:12:09.959 pathogens whatsoever. 0:12:10.320 --> 0:12:12.320 So you can have a septic. 0:12:11.960 --> 0:12:18.920 Inflammatory bowel disease like Crohn's disease, or ul sort of colitis. Okay, okay, 0:12:19.080 --> 0:12:23.240 So these are autoimmune mediated conditions that cause massive inflammation 0:12:23.400 --> 0:12:27.119 of the colon that lead to bloody diarrhea aka dysentery. 0:12:28.880 --> 0:12:32.040 So any of these different things can cause dysentery. We're 0:12:32.040 --> 0:12:35.920 going to focus today really on just the pathogenic types 0:12:35.960 --> 0:12:38.880 of dysentery, and I'm going to focus even more specifically 0:12:38.920 --> 0:12:42.040 on two major causes of dysentery, but we'll get to 0:12:42.040 --> 0:12:44.400 that in a second. Let's focus on the symptoms, shall we. 0:12:45.880 --> 0:12:49.320 So you can imagine that if you have a very 0:12:49.400 --> 0:12:54.160 inflamed angry gut wall that is so inflamed that it's 0:12:54.480 --> 0:12:57.680 bleeding large enough amounts of blood that it's visible in 0:12:57.720 --> 0:12:59.720 your stools. Because if you just have a little blood 0:12:59.800 --> 0:13:03.160 you you won't notice it. You can imagine that this 0:13:03.240 --> 0:13:07.120 is a very painful process. So dysentery, like a lot 0:13:07.160 --> 0:13:11.640 of other diarrheas, are often accompanied by major abdominal cramping. 0:13:12.920 --> 0:13:17.280 And because today we're focusing on infectious dysentery, it's also 0:13:17.360 --> 0:13:21.160 common to have a fever, which of course causes total 0:13:21.200 --> 0:13:24.760 body pain. So with dysentery, you're often in terrible pain. 0:13:25.600 --> 0:13:28.920 You're pooping like crazy, you have this diarrhea, you have 0:13:29.000 --> 0:13:33.280 abdominal cramps. Often with this type of diarrhea, you have 0:13:33.360 --> 0:13:35.800 a lot of urgency, you know, that feeling like you 0:13:35.920 --> 0:13:38.920 have to go. It's like right this instant, and then 0:13:38.960 --> 0:13:41.000 it's going to be explosive and it's going to be painful. 0:13:41.520 --> 0:13:44.160 And with any type of diarrhea, one of the biggest 0:13:44.200 --> 0:13:49.640 issues is how much fluid you can lose your large intestines. 0:13:49.760 --> 0:13:53.160 One job, really like it's one job, is to absorb 0:13:53.280 --> 0:13:55.280 all of the water back from your stool so that 0:13:55.320 --> 0:14:00.280 we don't get dehydrated. And in massive diarrhea or in dysentery, 0:14:00.320 --> 0:14:03.680 that mechanism is destroyed, so you're just losing water through 0:14:03.679 --> 0:14:06.760 your behind. And so that's one of the major causes 0:14:06.760 --> 0:14:08.359 of death is just from dehydration. 0:14:08.960 --> 0:14:13.240 Okay, so you stated the definition of diarrhea as being 0:14:13.320 --> 0:14:15.800 three loose stools in a period of twenty four hours, 0:14:16.240 --> 0:14:21.520 but four dysentery? Is it three? Is it nine? Is 0:14:21.560 --> 0:14:23.920 it fifteen? Is it fifty? 0:14:24.000 --> 0:14:25.320 Yeah, so there's no number on it. 0:14:25.320 --> 0:14:28.360 It's just if those three loose stools have blood and 0:14:28.520 --> 0:14:31.320 or mucus in them, now you'd call that a dysentery 0:14:31.480 --> 0:14:34.000 rather like a regular old diarrhea. 0:14:34.400 --> 0:14:38.360 Okay, yeah, right, okay, yeah, great question. 0:14:39.800 --> 0:14:44.720 So, yeah, dehydration is one of the biggest concerns and complications, 0:14:45.160 --> 0:14:47.560 but of course it's this podcast, so there are more 0:14:47.560 --> 0:14:51.120 things that can go wrong. Of course, with dysentery and 0:14:51.240 --> 0:14:54.840 other types of diarrhea, like non bloody diarrhea, you also 0:14:54.960 --> 0:14:59.200 lose a ton of electrolytes. You're losing sodium. You're losing chloride, 0:14:59.600 --> 0:15:02.840 and so this can cause problems when your electrolytes then 0:15:02.920 --> 0:15:05.280 get out of whack, So you can end up with 0:15:05.400 --> 0:15:08.960 heart arrhythmias because of problems with your potassium. You can 0:15:09.040 --> 0:15:13.280 end up with neurologic problems because of the lack of sodium. 0:15:13.440 --> 0:15:17.600 And with dysentery, which is different than other forms of diarrhea, you're. 0:15:17.480 --> 0:15:19.680 Losing a lot of blood. So there's a risk of. 0:15:19.720 --> 0:15:23.920 Anemia, especially in the cases of more chronic dysentery, like 0:15:23.960 --> 0:15:26.080 a prolonged diarrhea. 0:15:26.040 --> 0:15:27.480 Right, like the guy on our first hand. 0:15:27.360 --> 0:15:29.880 Account exactly, And so that's how you get, like you 0:15:29.920 --> 0:15:33.560 heard in our first hand account, this kind of muscle wasting, malnutrition, 0:15:34.040 --> 0:15:36.320 and you're just sort of wasting away because you're not 0:15:36.480 --> 0:15:38.200 able to absorb anything. 0:15:38.720 --> 0:15:41.240 Right, how much blood are we talking? 0:15:42.080 --> 0:15:42.880 It's a good question. 0:15:42.920 --> 0:15:45.560 There's no like number or amount on it that would 0:15:45.600 --> 0:15:49.000 qualify something as dysentery versus not. It's really not a 0:15:49.560 --> 0:15:54.840 like strict definition, okay, yeah, And different sources would give 0:15:54.840 --> 0:15:57.840 you like slightly different definitions. I think even so the 0:15:57.880 --> 0:16:00.520 most general would be just to say bloody die diarrhea. 0:16:02.080 --> 0:16:04.840 And then, of course, because today we're going to focus 0:16:04.880 --> 0:16:08.360 on infectious causes of dysentery. There's always a risk of 0:16:08.400 --> 0:16:12.000 this infection spreading beyond the gut itself, so that even 0:16:12.000 --> 0:16:14.920 if it's not the dehydration or the malnutrition that ends 0:16:14.960 --> 0:16:16.800 up killing you, you could end up with a more 0:16:16.840 --> 0:16:22.320 widespread infection. So let's get into these specific bugs. There's 0:16:22.360 --> 0:16:25.920 a lot of different bugs that can cause bloody diarrhea, 0:16:27.000 --> 0:16:31.520 and like I mentioned, even non infectious things. It's possible 0:16:31.520 --> 0:16:34.920 that viruses can cause bloody diarrhea, but it's not super 0:16:34.920 --> 0:16:40.560 common because in general, viruses just cause regular diarrhea, not dysentery. 0:16:40.640 --> 0:16:43.680 It's possible that parasitic worms, like maybe even some we've 0:16:43.680 --> 0:16:47.760 already talked about, like hookworm or maybe tapeworms, These could 0:16:47.760 --> 0:16:52.440 potentially cause bloody diarrhea. But most commonly there's two things 0:16:52.440 --> 0:16:57.000 that cause bloody diarrhea. There's bacteria that cause bloody diarrhea, 0:16:57.280 --> 0:16:59.920 and there's an amoeba that causes dysentery. 0:17:00.320 --> 0:17:02.880 Mm hmm. We've already talked about one. 0:17:02.680 --> 0:17:05.840 Of these bacteria that are a very common cause of dysentery, 0:17:05.880 --> 0:17:09.919 and that is ecoli, right, right, So some forms of 0:17:09.920 --> 0:17:15.680 ecoli are massive causes worldwide of dysentery. There are lots 0:17:15.680 --> 0:17:20.160 of other bacteria, Salmonella we talked about typhoid already, which 0:17:20.200 --> 0:17:24.200 is a form of salmonilla that can definitely cause bloody diarrhea. 0:17:24.280 --> 0:17:28.479 Also Camplobacter, which is another bacteria. There's two that we're 0:17:28.520 --> 0:17:32.080 going to focus on today because they're the leading ladies. 0:17:32.520 --> 0:17:36.760 Well, and I think also like historically these two were 0:17:36.800 --> 0:17:42.440 the ones that caused classic dysentery. Typhoid had its own thing, right, 0:17:43.119 --> 0:17:46.560 had its own name, and so if you were to 0:17:46.680 --> 0:17:51.200 find a treatise on dysentery, it would probably be these 0:17:51.240 --> 0:17:54.520 guys would cause the vast majority, or these leading ladies 0:17:54.560 --> 0:17:58.200 would cause have caused the vast majority of them. 0:17:58.480 --> 0:17:59.639 I think so too. 0:17:59.680 --> 0:18:02.479 It's that's why we're focusing on them today. And that 0:18:02.640 --> 0:18:09.680 is Shigella uh huh and an amiba entamoba histolytica. These 0:18:09.760 --> 0:18:14.359 are the two major causes of bassillary and amobic dysentery. 0:18:15.359 --> 0:18:18.600 All right, I'm excited about this. So let's start with 0:18:18.760 --> 0:18:24.280 amoebic dysentery and then we'll talk about sigalosis or dysentery 0:18:24.280 --> 0:18:26.720 from shigella, and then we'll just like wrap up and 0:18:26.760 --> 0:18:28.879 you can ask me questions I don't know the answer to. 0:18:28.960 --> 0:18:32.720 Okay, okay, uh okay. 0:18:32.800 --> 0:18:36.320 I found this one seminar from the Lancet in two 0:18:36.320 --> 0:18:38.679 thousand and three, so it's a little bit old, but 0:18:38.960 --> 0:18:41.320 I just really liked this quote. I never read quotes. 0:18:41.359 --> 0:18:42.720 I'm going to read you a quote ready. 0:18:42.880 --> 0:18:43.639 Ooh yeah. 0:18:44.400 --> 0:18:49.120 Few pathogens are more aptly named than en amiba histolytica, 0:18:49.480 --> 0:18:54.080 the tissue licing amiba that causes amobic colitis and amobic 0:18:54.200 --> 0:18:58.200 liver abscess. Think of this protozoan parasite as a macrophage 0:18:58.200 --> 0:19:03.600 on steroids with pumped up phagastic, proteolytic and cytolytic capabilities, 0:19:03.920 --> 0:19:08.399 invading human colonic mucosa and occasionally penetrating through to the 0:19:08.440 --> 0:19:12.880 portal circulation, reaching the liver and causing fatal abscesses. 0:19:14.320 --> 0:19:18.680 WHOA, I dig the voice. If you wanted a career 0:19:18.720 --> 0:19:21.560 as a movie voiceover, I think you've got one. 0:19:22.359 --> 0:19:23.119 Thank you, thank you. 0:19:23.359 --> 0:19:26.880 But also I loved that. I love that quote because 0:19:27.200 --> 0:19:32.480 it really aptly describes and tomba histolytica. Plus it does 0:19:32.480 --> 0:19:34.639 the etymology so I don't have to do it. Yeah, 0:19:34.680 --> 0:19:35.320 it's it's. 0:19:35.160 --> 0:19:36.480 The whole thing. I really love it. 0:19:36.520 --> 0:19:42.000 Shout out doctor Samuel Stanley, excellent work. My biology is 0:19:42.000 --> 0:19:45.840 done right. Just kidding because a lot of those words, 0:19:45.880 --> 0:19:50.000 people are probably like, I'm sorry, let's talk about it more. 0:19:49.840 --> 0:19:52.960 Clearly, let's go over it. So this particular. 0:19:52.480 --> 0:19:56.480 Amiba and Tomba histolytica has a simpler life cycle than 0:19:56.640 --> 0:20:00.879 the last amba we talked about. Nagleia faleri. Amoeba exists 0:20:00.920 --> 0:20:04.720 in two forms in the environment as a cyst and 0:20:04.800 --> 0:20:07.360 this is the form that is infectious to humans when 0:20:07.359 --> 0:20:11.160 we ingest it. After we ingest it, it passes through 0:20:11.200 --> 0:20:16.160 our stomach, survives our stomach, acid, travels down our small intestine, 0:20:16.320 --> 0:20:19.440 reaches our terminal ilium or our colon. 0:20:19.720 --> 0:20:21.680 So those are the two places where. 0:20:21.480 --> 0:20:26.320 It exists and becomes a trophozoite like the amoeba shaped 0:20:26.440 --> 0:20:30.359 version of an amiba, and that's where it lives. It 0:20:30.440 --> 0:20:33.879 replicates by binary fission, so it just divides and it 0:20:34.000 --> 0:20:38.720 just lives kindly in our colon, munching on bacteria, which 0:20:38.720 --> 0:20:40.840 our guts are full of. We have plenty of bacteria 0:20:40.880 --> 0:20:42.919 for them to eat. And then it also eats our 0:20:42.960 --> 0:20:47.720 food and it's fine right until it's not. I was 0:20:47.760 --> 0:20:50.520 gonna say, I don't think so yeah, it's fine until 0:20:50.520 --> 0:20:53.840 it's not because it doesn't stop there. It's not satisfied 0:20:53.840 --> 0:20:59.040 with just eating our food remnants and our commensal bacteria. Instead, 0:20:59.119 --> 0:21:02.640 once it's in our gus, it attaches to the epithelium 0:21:02.760 --> 0:21:07.719 of our colon. It immobilizes those cells, and then it 0:21:07.880 --> 0:21:12.360 just kills them. It just lices them open and kills them, 0:21:12.920 --> 0:21:16.399 and then it invades its way, burrows its way through 0:21:16.480 --> 0:21:21.680 our mucosa and into the submucosa of our gutlaw, why. 0:21:21.480 --> 0:21:22.440 Does it do this? Aaron? 0:21:22.800 --> 0:21:26.720 I was just about to ask, I honestly want to 0:21:26.800 --> 0:21:30.560 know from what I read, it's not fully understood, like 0:21:30.680 --> 0:21:34.480 what exactly are the triggers that cause this adherence and invasion? 0:21:35.720 --> 0:21:38.520 Because the thing is only about ten to twenty percent 0:21:38.560 --> 0:21:41.600 of people who get infected with Antamyba hystolytica will end 0:21:41.680 --> 0:21:45.399 up having symptoms. A lot of people are infected and 0:21:45.560 --> 0:21:51.359 entirely asymptomatic. And you're not asymptomatic if it's invading your submucosa. 0:21:51.040 --> 0:21:54.679 Right, okay? And by infected, do you mean that like 0:21:54.800 --> 0:21:56.080 they're shedding. 0:21:56.160 --> 0:21:59.320 They're shedding cysts and you can find trophozoites in their 0:21:59.359 --> 0:22:01.840 poop as well, and that's how it has to complete 0:22:01.840 --> 0:22:04.280 its life cycle, right, it has to go back into 0:22:04.320 --> 0:22:06.680 its cyst form. You have to poop out those cysts 0:22:06.880 --> 0:22:09.680 so they can then travel to find another host via 0:22:09.760 --> 0:22:14.000 water or whatever. So it's a really interesting, like evolutionary question. 0:22:14.040 --> 0:22:16.800 What is the drive to seek out deeper spaces in 0:22:16.840 --> 0:22:19.800 our body and why do they have the capacity to 0:22:19.840 --> 0:22:21.960 do all of this damage to our tissues. 0:22:23.000 --> 0:22:29.000 It's really interesting because like, do people who are symptomatically 0:22:29.040 --> 0:22:34.400 infected shed more amibe than those who are just asymptomatically 0:22:34.440 --> 0:22:35.360 chronically infected. 0:22:35.600 --> 0:22:39.040 That's a good question. I'm not sure. I didn't see 0:22:39.080 --> 0:22:42.120 any papers specifically addressing that, but it's an interesting thought 0:22:42.160 --> 0:22:44.680 because if you have diarrhea, then yeah, you probably are 0:22:44.720 --> 0:22:47.720 shedding a lot more of whatever it is that you're shedding, 0:22:48.560 --> 0:22:51.480 But then if it kills you because of that, then 0:22:51.760 --> 0:22:55.080 you're going to stop shedding, whereas if you're infected chronically. 0:22:55.840 --> 0:22:57.760 So maybe it's a trade off between how long they're 0:22:57.840 --> 0:23:00.600 able to persist in someone before our immunes system shuts 0:23:00.640 --> 0:23:04.360 them down, versus causing massive infection but getting a lot 0:23:04.400 --> 0:23:05.480 out into the environment. 0:23:05.960 --> 0:23:08.080 Yeah, diseases trade offs. 0:23:08.440 --> 0:23:12.360 Yeah, but we can talk about sort of the ramifications 0:23:12.359 --> 0:23:16.399 of what happens when they do this burrowing, because spoiler alert, 0:23:17.080 --> 0:23:17.720 it's not good. 0:23:17.920 --> 0:23:18.600 It's horrible. 0:23:18.840 --> 0:23:21.440 Yeah, And if you thought the bloody diarrhea part was bad, 0:23:21.960 --> 0:23:25.479 it gets a lot worse. There's a vein in our 0:23:25.520 --> 0:23:28.320 bodies called the portal vein that drains blood from your 0:23:28.320 --> 0:23:30.480 small intestine and the right side of your colon are 0:23:30.600 --> 0:23:34.120 large intestine directly to the liver. So as the samiba, 0:23:34.119 --> 0:23:36.600 which we know is in the right side of your 0:23:36.600 --> 0:23:39.720 small intestine or large intestine, as it burrows its way 0:23:39.760 --> 0:23:42.320 through the mucosa and sepucosa, it can end up right 0:23:42.359 --> 0:23:45.560 in these blood vessels, hops straight on that portal vein 0:23:45.680 --> 0:23:49.520 highway and take the first exit to the liver. So 0:23:49.640 --> 0:23:52.199 the liver is the number one site of what we 0:23:52.280 --> 0:23:57.000 call extra intestinal outside of the intestine infection with ntomba histolytica, 0:23:58.359 --> 0:24:01.920 and it can be very severe because in the liver, 0:24:02.119 --> 0:24:04.840 what it does is it kills off chunks of our 0:24:04.880 --> 0:24:07.119 liver cells the same way that it kills off the 0:24:07.160 --> 0:24:11.919 epithelium of our intestine. But then our liver, in trying 0:24:11.960 --> 0:24:17.359 to protect itself, walls off these amoba, essentially forming an abscess. 0:24:17.560 --> 0:24:20.880 Within the liver, and so depending on how many amiba 0:24:20.920 --> 0:24:23.920 you have and how large these abscesses can get, this 0:24:24.000 --> 0:24:27.880 is a common cause of death in people with antomba 0:24:27.920 --> 0:24:31.960 histilitica who progress to liver abscess It can be very serious, 0:24:33.840 --> 0:24:37.960 and it's not limited to just the liver, right This 0:24:38.280 --> 0:24:41.440 amiba can theoretically travel anywhere in our body through any 0:24:41.480 --> 0:24:43.600 blood vessel that it makes it into, So it's not 0:24:43.720 --> 0:24:47.639