Dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the feces^[1] with fever, abdominal pain,^[2] and rectal tenesmus. If left untreated, dysentery can be fatal.

Signs and symptoms[link]

In developed countries, dysentery is, in general, a mild illness, causing mild symptoms normally consisting of mild stomach pains and frequent passage of feces. Symptoms normally present themselves after one to three days and are usually no longer present after a week. The frequency of urges to defecate, the volume of feces passed, and the presence of mucus, pus and blood depend on the pathogen that is causing the disease. Temporary lactose intolerance can occur, which, in the most severe cases, can last for years. In some caustic occasions, vomiting of blood, severe abdominal pain, fever, shock, and delirium can all be symptoms.^[3][4][5][6]

Mechanism[link]

Dysentery results from viral, bacterial, or protozoan infections or parasitic infestations. These pathogens typically reach the large intestine after entering orally, through ingestion of contaminated food or water, oral contact with contaminated objects or hands, and so on.

Each specific pathogen has its own mechanism or pathogenesis, but in general the result is damage to the intestinal lining, leading to the inflammatory immune response. This can cause elevated temperature, painful spasms of the intestinal muscles (cramping), swelling due to water leaking from capillaries of the intestine (edema), and further tissue damage by the body's immune cells and the chemicals, called cytokines, they release to fight the infection. The result can be impaired nutrient absorption, excessive water and mineral loss through the stools due to breakdown of the control mechanisms in the intestinal tissue that normally remove water from the stools, and in severe cases the entry of pathogenic organisms into the bloodstream.

Some microorganisms – for example, bacteria of the genus Shigella – secrete substances known as cytotoxins, which kill and damage intestinal tissue on contact. Viruses directly attack the intestinal cells, taking over their metabolic machinery to make copies of themselves, which leads to cell death.

Definitions of dysentery can vary by region and by medical specialty. The U. S. Centers for Disease Control and Prevention (CDC) limits its definition to "diarrhea with visible blood."^[7] Others define the term more broadly.^[8]> These differences in definition must be taken into account when defining mechanisms. For example, using the CDC definition requires that intestinal tissue be so severely damaged that blood vessels have ruptured, allowing visible quantities of blood to be lost with defecation. Other definitions require less specific damage.

Amoebic dysentery[link]

Dysentery may be caused by amoebiasis, an infection by the amoeba Entamoeba histolytica,^[9] and is then known as amoebic dysentery.^[10] Proper treatment of the underlying infection of amoebic dysentery is important; insufficiently treated amoebiasis can lie dormant for years and then lead to severe, potentially fatal, complications. Amoebic dysentery (amoebiasis) is caused by an amoeba (a single-celled parasite) called Entamoeba histolytica. It is mainly found in tropical areas. When the amoebas inside the bowel of an infected person are ready to leave the body, they group together and form a shell that surrounds and protects them. This group of amoebas is known as a cyst. The cyst passes out of the person's body in their feces and is able to survive outside the body. If hygiene standards are poor; for example, if the person does not dispose of their feces hygienically, it can contaminate the surroundings, such as nearby food and water. If another person then eats or drinks food or water that has been contaminated with feces containing the cyst, they will also become infected with the amoeba. Amoebic dysentery is particularly common in parts of the world where human feces are used as fertilizer. After entering the person's body through their mouth, the cyst will travel down into their stomach. The amoebas inside the cyst are protected from the stomach's digestive acid. From the stomach, the cyst will travel to the intestines where it will break open and release the amoebas, causing the infection. The amoebas are able to burrow into the walls of the intestines and cause small abscesses and ulcers to form. The cycle then begins again. The amoebas that cause dysentery can also be sexually transmitted during mouth-to-anus contact.

Bacillary dysentery[link]

Severe dysentery may also be caused by shigellosis, an infection by bacteria of the genus Shigella,^[11] and is then known as bacillary dysentery (or Marlow Syndrome).

Diagnosis[link]

A clinical diagnosis may be made by taking a history and doing a brief examination. Treatment is usually started without or before confirmation by laboratory analysis.

Medical history[link]

Exposed individuals may experience either mild, severe, or even no symptoms at all. In extreme cases dysentery patients may pass over a litre of fluid an hour. More often, individuals will complain of nausea, abdominal pain, and frequent watery and usually foul-smelling diarrhea accompanied by mucus and blood, rectal pain, and fever. Vomiting, rapid weight loss, and generalized muscle aches sometimes also accompany dysentery. On rare occasions, the amebic parasite will invade the body through the bloodstream and spread beyond the intestines. In such cases, it may more seriously infect other organs such as the brain, lungs, and the liver.^[12]

Physical exam[link]

The mouth, skin, and lips may appear dry due to dehydration. Lower abdominal tenderness may also be present.^[12]

Stool and blood tests[link]

Cultures of stool samples are examined in order to identify the organism causing dysentery. Usually, several samples must be obtained due to the changing number of amoeba, which changes daily.^[12]

Blood tests can be used to measure abnormalities in the levels of essential minerals and salts.^[12]

Prevention[link]

To reduce the risk of contracting dysentery the following precautions are suggested:^[13]

• Washing one's hands after using the toilet, after contact with an infected person, and regularly throughout the day.
• Washing one's hands before handling, cooking and eating food, handling babies, and feeding young or elderly people.
• Keeping contact with someone known to have dysentery to a minimum.
• Washing laundry on the hottest setting possible.
• Avoiding sharing items such as towels and face cloths.

Vaccines currently in development may eventually become a critical part of the strategy to reduce the incidence and severity of diarrhea, particularly among children in low-resource settings. For example, Shigella is a longstanding World Health Organization (WHO) target for vaccine development, and sharp declines in age-specific diarrhea/dysentery attack rates for this pathogen indicate that natural immunity does develop following exposure; thus, vaccination to prevent this disease should be feasible. Currently, no licensed vaccine targeting Shigella exists. The development of vaccines against these types of infection has been hampered by technical constraints, insufficient support for coordination, and a lack of market forces for research and development. Most vaccine development efforts are taking place in the public sector or as research programs within biotechnology companies. Several vaccine candidates are currently in various phases of research and development, including a number of ongoing clinical trials.^[14]

Treatment[link]

Dysentery is initially managed by maintaining fluid intake using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. In ideal situations, no antimicrobial therapy should be administered until microbiological microscopy and culture studies have established the specific infection involved. When laboratory services are not available, it may be necessary to administer a combination of drugs, including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection.

If shigella is suspected and it is not too severe, the doctor may recommend letting it run its course — usually less than a week. The patient will be advised to replace fluids lost through diarrhea. If the shigella is severe, the doctor may prescribe antibiotics, such as ciprofloxacin or TMP-SMX (Bactrim). However, many strains of shigella are becoming resistant to common antibiotics, and effective medications are often in short supply in developing countries. If necessary, a doctor may have to reserve antibiotics for those at highest risk for death, including young children, people over 50, and anyone suffering from dehydration or malnutrition.

Amoebic dysentery usually calls for a two-pronged attack. Treatment should start with a 10-day course of the antimicrobial drug metronidazole (Flagyl). To finish off the parasite, the doctor will sometimes prescribe a course of diloxanide furoate (available only through the Centers for Disease Control and Prevention), paromomycin (Humatin), or iodoquinol (Yodoxin).

The seed, leaves, and bark of the kapok tree have been used in traditional medicine by indigenous peoples of the rain forest regions in the Americas, West-Central Africa, and South East Asia to treat this disease.^[15][16][17]

Prognosis[link]

With correct treatment, most cases of amoebic and bacterial dysentery subside within 10 days, and most individuals will achieve a full recovery within 2 to 4 weeks after beginning proper treatment. If the disease is left untreated, the prognosis varies with the immune status of the individual patient and the severity of disease. Extreme dehydration can prolong recovery and significantly raises the risk for serious complications.^[18]

Epidemiology[link]

Insufficient data exist, but conservative estimates from the WHO suggest that 90 million cases of Shigellosis are contracted annually, with at least 100,000 of these resulting in death.^[19] Amebiasis is infecting over 50 million people each year, killing about 50,000.^[20]

History[link]

• 1216 – King John of England died of dysentery at Newark Castle on 18 October 1216.^[21]
• 19th century – As late as the nineteenth century, the 'bloody flux,' it is estimated, killed more soldiers and sailors than did combat.^[8] Typhus and dysentery decimated Napoleon's Grande Armée in Russia. More than 80,000 Union troops died of dysentery during the American Civil War.^[22]
• 1896 – Phan Dinh Phung, a Vietnamese revolutionary who led rebel armies against French colonial forces in Vietnam, died of dysentery as the French surrounded his forces on January 21, 1896.^[23]
• 1930 – The French explorer and writer, Michel Vieuchange, died of dysentery in Agadir on 30 November 1930, on his return from the "forbidden city" of Smara. He was nursed by his brother, Doctor Jean Vieuchange, who was unable to save him. The notebooks and photographs, edited by Jean Vieuchange, went on to become bestsellers.^[24][25]
• 1942 – The Selarang Barracks Incident in the summer of 1942 during the Second World War involved the forced crowding of 17,000 Anglo-Australian prisoners-of-war (POWs) in the areas around the barracks square for nearly five days with little water and no sanitation after the Selarang Barracks POWs refused to sign a pledge not to escape. The incident ended with the capitulation of the Australian commanders due to the spreading of dysentry among their men.^[26]

References[link]

Benicio del Toro
Benicio del Toro at Cannes 2008
Born	Benicio Monserrate Rafael del Toro Sánchez (1967-02-19) February 19, 1967 (age 45) Santurce, San Juan, Puerto Rico
Occupation	Actor, producer
Years active	1987–present

Benicio Monserrate Rafael del Toro Sánchez (born February 19, 1967) is a Puerto Rican actor and film producer. He won an Academy Award, a Golden Globe Award, a Screen Actors Guild Award, and a BAFTA Award for his role as Javier Rodríguez in Traffic (2000). He is also known for his roles as Fred Fenster in The Usual Suspects (1995), Dr. Gonzo in Fear and Loathing in Las Vegas (1998), Franky Four Fingers in Snatch (2000), Jackie Boy in Sin City (2005), and Che Guevara in Che (2008). He is the third Puerto Rican to win an Academy Award.

Early life[link]

Benicio del Toro was born in San German, on the southwest side of the island of Puerto Rico, and grew up in Santurce, a district of San Juan. He is the son of Gustavo Adolfo del Toro Bermúdez and Fausta Genoveva Sánchez Rivera, who were both lawyers, and deeply respected and beloved in Puerto Rico for their commitment to their community. Gustavo Del Toro was affectionately called the "lawyer of the poor". Many of Del Toro's relatives are involved in the island's legal system. ^[1] He has an older brother, Gustavo, who was a pediatric oncologist at the Mount Sinai Medical Center in New York City.^[2][3] He is of Spanish descent through a Catalan paternal great-grandfather and a Basque maternal great-grandmother,^[4] he has Italian and Amerindian ancestry as well.^[5] The surname del Toro (Touro) is of Sephardic origin. Benicio del Toro is related to Puerto Rican basketball player Carlos Arroyo, his father Gustavo is a cousin of Arroyo's mother, Gloria Bermudez. Del Toro is also related to Spanish Euro-pop singer Rebeca Pous Del Toro, whose grandfather is Puerto Rican, and Puerto Rican singer Eliseo del Toro.

Del Toro, whose childhood nicknames were "Skinny Benny" and "Beno", was raised a Roman Catholic^[6][7] and he attended Academia del Perpetuo Socorro (The Academy of Our Lady of Perpetual Help), a Roman Catholic school in Miramar, Puerto Rico.^[8][9] When del Toro was nine years old, his mother died of hepatitis.^[2] At age 12, he moved with his father and brother to Mercersburg, Pennsylvania, where he was enrolled at the Mercersburg Academy. He spent his adolescence and attended high school there.^[10] After graduation, del Toro followed the advice of his father and pursued a degree in business at the University of California, San Diego.^[10] Success in an elective drama course encouraged him to drop out of college and study with noted acting teachers Stella Adler and Arthur Mendoza, in Los Angeles, as well as at the Circle in the Square Theatre School, in New York City.^[10]

Career[link]

Del Toro began to surface in small television parts during the late 1980s, playing mostly thugs and drug dealers on programs such as Miami Vice and the NBC miniseries Drug Wars: The Camarena Story. He had a cameo in Madonna's 1987 music video clip "La Isla Bonita" as a background character (the kid sitting on the car). Work in films followed, beginning with his debut in Big Top Pee-wee and in the 007 film Licence to Kill,^[10] in which 21-year-old del Toro held the distinction of being the youngest actor ever to play a Bond henchman. Del Toro continued to appear in movies including The Indian Runner (1991), China Moon (1994), Christopher Columbus: The Discovery (1992), Money for Nothing (1993), Fearless (1993) and Swimming with Sharks (1994).

His career gained momentum in 1995 with his breakout performance in The Usual Suspects, where he played the mumbling, wisecracking Fred Fenster.^[10] The role won him an Independent Spirit Award for Best Supporting Actor and established him as a character actor. This led to more strong roles in independent and major studio films, including playing Gaspare in Abel Ferrara's The Funeral (1996) and winning a second consecutive Best Supporting Actor Independent Spirit Award for his work as Benny Dalmau in Basquiat (1996), directed by his friend, artist Julian Schnabel. Del Toro also shared the screen with Robert De Niro in the big budget thriller The Fan, in which he played Juan Primo, a charismatic Puerto Rican baseball star.

For Fear and Loathing in Las Vegas, the 1998 film adaptation of Hunter S. Thompson's famous book, he gained more than 40 lbs. (about 18 kg) to play Dr. Gonzo (a.k.a. Oscar Zeta Acosta), Thompson's lawyer and drug-fiend cohort.^[10] The surrealistic film, directed by Terry Gilliam, has earned a cult following over the years. Returning from a two-year hiatus after Fear and Loathing, del Toro would gain a mainstream audience in 2000 with a string of performances in four high-profile films. First up was The Way of the Gun, a crime yarn that reunited him with The Usual Suspects screenwriter Christopher McQuarrie, making his directorial debut. A few months later, he stood out among a first-rate ensemble cast in Steven Soderbergh's Traffic, a complex dissection of the North American drug wars. As Javier Rodriguez —a Mexican border cop struggling to remain honest amid the corruption and deception of illegal drug trafficking —del Toro, who spoke most of his lines in Spanish, gave a performance that dominated the film.^[10]

His performance swept all of the major critics awards in 2001. Del Toro won an Academy Award for Best Supporting Actor, becoming the fourth living Oscar winner whose winning role was a character who speaks predominantly in a foreign language. Del Toro is also the third Puerto Rican actor to win an Oscar, after Jose Ferrer and Rita Moreno.^[10] The night he won his Oscar marked first time that two actors born in Puerto Rico were nominated in the same category (the other actor was Joaquin Phoenix). In his acceptance speech, del Toro thanked the people of both Nogales, Arizona and Nogales, Sonora and dedicated his award to them. In addition to the Oscar, he also won the Golden Globe Award and the Screen Actors Guild award for Best Actor. Traffic was also a success at the box office, bringing to del Toro real Hollywood clout for the first time in his career. While Traffic was still playing in theaters, two other del Toro films were released in late 2000/early 2001. He had a brief role as the diamond thief Franky Four Fingers in Guy Ritchie's hip caper comedy Snatch, and played a mentally-challenged Native American man in The Pledge, directed by his old friend Sean Penn.^[10]

In 2003, del Toro appeared in two films: The Hunted, co-starring Tommy Lee Jones, and the drama 21 Grams, co-starring Sean Penn and Naomi Watts. He went on to garner another Best Supporting Actor Oscar nomination for his work in the latter. He then appeared in the film adaptation of Frank Miller's graphic novel Sin City, directed by Robert Rodriguez, and Things We Lost in the Fire, the English language debut of celebrated Danish director Susanne Bier. Things We Lost in the Fire co-starred Halle Berry, Alison Lohman, and John Carroll Lynch.

In 2008, del Toro was awarded the Prix d'interpretation masculine (or Best Actor Award) at the Cannes Film Festival for his characterization of Che Guevara in the biographical films The Argentine and Guerrilla (together known as Che).^[11] During his acceptance speech del Toro dedicated his award "to the man himself, Che Guevara" along with director Steven Soderbergh.^[12] Del Toro was also awarded a 2009 Goya Award as the Best Actor for his depiction of Che.^[13] Actor Sean Penn, who won an Oscar for his role in Milk, remarked that he was surprised and disappointed that Che and del Toro were not also up for any Academy Award nominations. During his acceptance speech for the Best Actor's trophy at the Screen Actors Guild Awards Penn expressed his dismay stating, "The fact that there aren't crowns on Soderbergh's and Del Toro's heads right now, I don't understand ... that is such a sensational movie, Che."^[14] For the final portions of the film (shown here), del Toro shed 35 pounds to show how ill Guevara had become near the end of his life in the jungles of Bolivia.^[15]

In 2010, del Toro starred in and produced the remake of Lon Chaney, Jr.'s classic cult film The Wolf Man.^[16]

He was chosen to be the face of the 2011 Campari calendar, becoming the first male model to be featured in the Italian liquor company's calendar.^[17][18]

Personal life[link]

Benicio is not related to Oscar-nominated director Guillermo del Toro; this is a popular misconception.

While promoting his film The Wolfman in 2010, he described his romantic life as "in limbo." When asked if he had thoughts of settling down, he responded, "Why? Everyone says, 'Why isn’t he married?' But it’s like, Fuck! Why do I have to get married? Just so I can get divorced?" In an interview with The Times he mentioned that he didn't want his West Hollywood apartment, which he described as his "cave," to be "invaded" by a wife and children.^[19]

Benicio del Toro has been linked to various women through the years, including actresses Valeria Golino, Claire Forlani, Alicia Silverstone, Chiara Mastroianni, Heather Graham, and Sara Foster.

On April 11, 2011, del Toro's publicist announced that del Toro and Kimberly Stewart (daughter of Rod Stewart) were expecting their first child, although they were not in a relationship.^[20] Stewart gave birth to a daughter, Delilah,^[21] on August 21, 2011.^[20]

In November 2011, he acquired Spanish citizenship. The request was granted by the Spanish government due to his artistic talents and his Spanish roots (he has family in Barcelona).^[22]

In March 2012, he was granted a honorific degree by the Inter-American University of Puerto Rico for his impact on the cinema enterprise, during the celebration of the institution centenary.^[23]

Filmography[link]

Films[link]

Short films[link]

Television series[link]

Selected awards[link]

See also[link]

	Puerto Rico portal
	Academy Award portal
	Biography portal
	Film portal

• List of Best Supporting Actor nominees
• List of Puerto Ricans

References[link]