DYSENTRY IN CHILDREN
[Link] SAHITHI
ASSISSTANT PROFESSOR
DEPARTMENT OF PAEDIATRICS
OBJECTIVES
DEFINITIONS
ETIOLOGY
CLINICAL FEATURES
INVESTIGATIONS
COMPLICATIONS
MANAGEMENT
ASSESSMENT
DEFINITIONS
DIARRHEA: Diarrhea is defined as an increase in frequency and change in
consistency of stools to liquid or watery in nature and generally at least
≥ 3 times in a day.
Acute diarrhea is when the episode lasts less than 14 days.
Persistent diarrhea starts as an acute episode of infection, continues for
14 days and above.
Chronic diarrhea lasts 4 weeks or more, usually due to non-infective
causes.
Dysentery is a condition where the diarrhea is accompanied with blood
and mucus, associated with abdominal pain, high fever and tenesmus and
it is usually of bacterial etiology.
Dysentery is visible blood in the stools in a child presenting with loose
stools.
ETIOLOGY
Bacterial causes:
Shigella species: S. dysenteriae, S. flexneri, S. sonnei
E. coli types: enteroinvasive, enterohemorrhagic
Salmonella species
Campylobacter jejuni
Amoebic causes:
Protozoa, mainly Entamoeba histolytica
Spread: contaminated food and water ,
poor sanitation conditions.
CLINICAL FEATURES
Most common symptoms: fever and diarrhea
Diarrhea starts watery, then contains mucus and blood
Diarrhea frequency increases within 1-2 days
Abdominal discomfort progresses to severe colicky pain
Tenesmus: persistent spasms with ineffective
defecation,
suprapubic discomfort, and straining.
INVESTIGATIONS
CBC, RFT with serum electrolytes
Stool microscopy
Bacterial dysentery: The stool will also contain numerous pus cells
(polymorphonuclear leukocytes) which are visible with a microscope and sheets of RBC
Amoebic dysentery: Trophozoites of E. histolytica containing red blood cells are seen
in fresh stools or in mucus from rectal ulcerations .
COMPLICATIONS
Intestinal perforation
Toxic megacolon (dilated colon)
Rectal prolapse, convulsions (with or without a high fever)
Septicemia
Haemolytic-uremic syndrome
Prolonged hyponatraemia
Weight loss and
Rapid worsening of nutritional status.
MANAGEMENT
Four key components of the treatment of dysentery are:
Antibiotics
Fluids
Feeding
Follow-up
MANAGEMENT-ANTIBIOTIC therapy
Early treatment of shigellosis with an appropriate antibiotic shortens
the duration of the illness and reduces the risk of serious
complications and death
First line drugs include oral ciprofloxacin 15mg/kg in two divided
days for 3-5 days. If there is no improvement in 2 days, oral cefixime
is the next choice.
Intravenous ceftriaxone 50-100mg/kg for 2-5 days – Serious infection
Amoebic dysentery - metronidazole
MANAGEMENT- fluids and feeding
Children with dysentery should be evaluated for signs of dehydration
and treated accordingly
Breast feeding should be continued in infants along
with complimentary feeding.
Older children should be encouraged to have
frequent small meals at least six times a day with
energy and nutrient-rich foods.
Administer oral rehydration salts (ORS)
Provide zinc supplementation
Follow up
Monitoring the general well-being of the child and ensuring intake
of nutritious diet and gradual weight gain are the main objectives
during follow-up.
One extra meal a day using the same foods for at least two weeks
should be given after control of dysentery for optimal catch-up
growth.
Health Education :
Personal hygiene
Environmental hygiene
Good sanitation and water purification
Careful food handling
ASSESSMENT
Case:1
A 2-year-old male child is brought to the clinic with a 2-day
history of loose stools. The mother reports that the stools are
frequent (6–7 times/day) and contain blood and mucus. The
child also has fever (38.5°C), is irritable, and refuses to eat or
drink. He has reduced urine output.
Question:
What is the most likely diagnosis?
What are the key clinical features that support your diagnosis?
What are possible causative organisms?
ASSESSMENT
Answer:
Most likely diagnosis: Acute bacterial dysentery, likely shigellosis.
Key clinical features:
Bloody, mucous-containing stools
Fever
Signs of dehydration (reduced oral intake, decreased urine output)
Irritability
Common causative organisms:
Shigella spp. (most common)
Entamoeba histolytica (less likely in young children)
Salmonella, Campylobacter, EHEC (E. coli)
ASSESSMENT
Case:2
A 3-year-old male child with a 3-day history of bloody diarrhea and
high-grade fever is brought to the emergency department with a
generalized tonic-clonic seizure lasting 3 minutes. On
examination, he is febrile (39.5°C), drowsy, and mildly
dehydrated. Stool microscopy shows numerous RBCs and pus
cells.
Question:
What is the most likely diagnosis and complication?
What is the pathophysiology of this complication?
How would you manage this child?
ASSESSMENT
Answer:
Diagnosis: Shigella dysentery with febrile seizure (possible shigellosis-
associated encephalopathy in severe cases)
Pathophysiology:
Shigella produces neurotoxins (e.g., Shiga toxin) which may cause CNS irritation and
seizures.
Fever can also precipitate febrile seizures in young children.
Management:
Stabilize airway, breathing, circulation
Control seizure if ongoing (e.g., IV Lorazepam)
Treat fever (paracetamol)
Start appropriate antibiotics (e.g., Azithromycin or Ceftriaxone)
Rehydrate with ORS or IV fluids depending on severity
Monitor for signs of encephalopathy.
ASSESSMENT
Case:3
A 6-year-old child presents with intermittent bloody diarrhea
for 10 days. The child has mild abdominal cramps but is
afebrile and otherwise well. Stool microscopy shows few
RBCs and trophozoites with ingested RBCs.
Question:
What is the likely diagnosis?
How can you differentiate bacterial from amoebic dysentery
clinically and on investigations?
What is the treatment of choice?
ASSESSMENT
DIFFERENTITATION
Feature Bacterial Dysentery Amoebic Dysentery
Older children and
Age group Common in <5 years
adults
Onset Acute Subacute or insidious
Fever Common Rare or low-grade
Colicky, lower
Abdominal pain Cramping, diffuse
abdomen
Trophozoites,
Stool microscopy Pus cells, RBCs
ingested RBCs
Response to
Good No response
antibiotics
Response to anti-
No response Rapid improvement
protozoals
Answer:
Diagnosis: Amoebic dysentery due to Entamoeba
histolytica
Treatment of choice:
Metronidazole 30–50 mg/kg/day in 3 divided doses for 7–
10 days
Follow with luminal agent (e.g., Diloxanide furoate) to
eradicate cysts
THANK YOU
