Bacillary Dysentery and Chronic Ulcerative Colitis in World War II

Abstract

A study of 61 cases of chronic ulcerative colitis occurring in American military personnel of World War II is presented. 50 cases were studied from 5 to 30 months after the onset of diarrhea. In 33 patients the onset of disease was definitely traced to outbreaks. Almost all patients incurred their initial acute bacillary dysentery in known endemic and epidemic areas, chiefly New Guinea, India, the Philippines, and No. Africa. In 5 of the outbreaks Shigella paradysenteriae was isolated. All patients were treated with sulfonamides. The clinical picture in the acute phase was the abrupt onset of abdominal cramps, diarrhea, and fever. The bowel movements were watery, bloody, or mucopurulent. These symptoms subsided in 5-10 days and were followed by the characteristic healing phase of constipation. Recurring episodes of bloody diarrhea followed, and in 8 patients the diagnosis of chronic ulcerative colitis was made. 50 of the 61 patients were subjected to sigmoidoscopic study 5-30 months after the initial infection and all exhibited the hyperemic, granular mucosa or ulceration and purulent cytology of the mucosal exudate. Mural fibrosis and luminal stenosis occurred only in cases of long duration. Five patients showed a concomitant distal ileitis. Of 12 patients receiving fecal cultures during the acute phase, 5 were positive for Bacillus dysenteriae. Of 61 patients examined during the chronic phase, 6 revealed B. dysenteriae by the mucosal crypt aspiration method. One patient exhibited positive cultures during both acute and chronic phases. The evidence presented lends additional support to the contention that chronic ulcerative colitis and ileitis are the result of acute bacillary dysentery.