GRAND ROUNDS AND TEACHING FILES

A 3 year old girl with chronic diarrhea

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Clinical Problem:

Ira Shah
Consultant Pediatric Infectious Diseases, Nanavati Hospital, Mumbai

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056

A 3 year old girl born of non-consanguineous marriage presented with watery diarrhea since 1 month. The diarrhea initially was blood stained and then foul smelling, greasy with a frequency of 12-15 times, day. There was a weight loss of 2 kg in last one month. She had history of right-sided otorhoea 1½ year back. There was no history of similar complaints in the past, no contact with tuberculosis and similar history in the family. She was treated for same with oral antibiotics but there was no response. On examination, she was malnourished {Weight = 8 kg, Less than 5th centile, Height = 87 cm { Less than 5th centile}} with no significant examination finding. Her investigations showed:
_? Stool examination – fat globules
_? Urine examination – Normal
_? Mantoux test – Negative
_? HIV ELISA – Normal
_? S. electrolytes, blood gases – Normal
_? Hemoglobin = 8.2 gm, dl
_? WBC count = 21,600, cumm {59 percent neutrophils, 40 percent lymphocytes}
_? ESR = 6 mm at end of 1 hour
_? Stool for cryptosporidia – multiple oocysts seen

She was treated with Nitazoxanide to which she responded.