An epidemiological study of flexner dysentery in Glasgow

Epidemiology

Hunponu-Wusu, Oladipo Olusegun

University:University of Glasgow

关键词: Epidemiology;   

Others  :  http://theses.gla.ac.uk/73854/1/10662503.pdf

来源: University of Glasgow

【 摘 要 】

Flexner dysentery is world-wide in distribution. In the developing countries the disease is a major cause of morbidity and mortality but in the developed countries, where mortality from it is negligible, morbidity is still significant and there are problems still to be overcome before flexner dysentery can be eradicated or even completely controlled. The objectives of this thesis were to investigate the medico-social aspects in the epidemiology of the disease and to elicit any aetiological factors for its incidence in Glasgow where over the past fifty years it has persisted on a higher level than anywhere else in the United Kingdom. Chapter I reviews the relevant literature on the history of the dysenteries which can be appropriately divided into two periods. The first period culminates in the discovery of Amoeba coli in 1875 and the second period, from 1875 onwards, covers the aetiological differentiation of the various types of bacillary dysentery. The systematic nomenclature and taxonomy of these intestinal pathogens is now undertaken by the Enterobacteriaceae Subcommittee of the International Association of Microbiologists and the various Shigella Centres established throughout the world. In Chapter II the epidemiology of bacillary dysentery is critically appraised. The incidence of sonne dysentery in the United Kingdom by far outnumbers that of flexner and all other types of bacillary dysentery. In consequence the epidemiology of sonne is well documented but specific reference to that of flexner is scanty and thus although there are many factors common to both diseases this deficiency has to be recognised in any attempt to elucidate the epidemiology of flexner dysentery. Bacillary dysentery in the United Kingdom is mainly a disease of children occurring throughout the whole year but especially in winter. It is associated with the lower social classes and wherever there is defective hygiene and sanitation. Transmission is by "anal oral spread". Occasional outbreaks are due to contaminated food, milk and water supplies but its incidence is not related to frequency of fly infestation. From this review however there appears no outstanding epidemiological differences between flexner and sonne dysentery but the severity of illness in flexner infection is usually greater. Chapters III to V which describe accounts of the field work personally undertaken include two series of investigations - a retrospective study and a prospective survey. The retrospective study, Chapter III, involved detailed analysis of the incidence of bacillary dysentery in Glasgow in relation to notifications and bacteriological isolations by serological type and the findings are studied against the background of the incidence in Scotland and in the United Kingdom as a whole. Chapter IV describes the material and methods used in the prospective survey which was preceded by a pilot investigation. The prospective survey consisted of an epidemiological study of 360 patients - 132 with flexner and 228 with sonne dysentery - admitted to the two infectious diseases hospitals, Belvidere and Ruchill, during the period April to November 1968. Patients with flexner dysentery were regarded as the "Cases" and contrasted with those suffering from sonne dysentery - the "Controls'- in an attempt to distinguish any differing epidemiological factors. The results, Chapter V, are considered under the headings, demographic data, housing circumstances, incidence of diarrhoea in households, "Cases" and their contacts, and resistance of organisms to antimicrobial drugs. The majority of patients were children and the housing circumstances of most flexner patients were grossly inadequate in toilet facilities. Such unsatisfactory housing and living conditions are conducive to the existence and spread of flexner dysentery and probably contribute largely to the high incidence in Glasgow.