Diagnostic Dilemma

Diarrhea with blood in stools

An eight year old girl presented with diarrhea and blood in stools for 3 days associated with tenesmus and fever. Stools were watery associated with mucus 8-10 times/day. There was no history of vomiting, oliguria.

It is bacterial dysentery or amoebic dysentery?
Expert Opinion :
Amoebic diarrhea is usually large bowel diarrhea. (Entamoeba histolytica affects colon). As a result, stools are semi-loose and small in quantity. Amoebic diarrhea is classically associated with pain in the abdomen that is relieved on defecation. Bacillary dysentery is predominantly small bowel diarrhea. (Most of the pathogenic bacteria affect the small intestine. Only ETEC affects large intestine but it does not need any treatment with antibiotics). Small bowel diarrhea is associated with watery, large quantity stools. Thus, in this child, the dysentery is due to small bowel affection suggestive of bacterial diarrhea. This child was treated with Ofloxacin following which diarrhea subsided. Other conditions with large bowel diarrhea and blood in stools are ulcerative colitis and Crohn's disease but they lead predominantly to blood in stools and less often loose stools.
In a child with large bowel dysentery unresponsive to treatment, inflammatory bowel disease should be considered.
Answer Discussion :
shyamini adikaram
4 years ago
Bacterial Dysentry - Shigellosis
4 years ago

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