CASE PRESENTATION

1 yr old child weight 10kg admitted with complains of: Blood in stool since 1 wk Vomitting since one day

HOPC
According to the patients mother the child was in his usual state of health when 1 week back she had loose stools which contained fresh red blood. Stools were watery in consistency and occurred 5-6 times a day, Mother also complained that the child had vomitting for 1 day which was non projectile, and contained food particles.it occurred 6 times a day.

 Past history: not significant. Immunization: complete but card was unavailable. Developmental history: walks with hand held, calls out baba, amma, drinks from cup, points to desired objects. Nutritional history: breastfed for 6 mths, weaning started at 6 mths with dalia, khichdi banana and cerelac. Birhth history: NVD no complications.

G.P.E: sick looking child lying on bed pulse: 103/min Temp: A/f R/R: 30/min CVS:s1+s2+0 CNS: intact RESP: normal vesicular breathing no added sounds. Abdomen: soft non tender.

D/D
Dysentry Intussuception.

INVESTIGATIONS
CBC Hb: 11.7 pcv: 34 Mcv: 75 MCH: 26 MCHC: 34 TLC: 8.2 Plt: 433 N:63 L: 24 M: 12 E: 1

CONTD..

Electrolytes: Na: 140 K: 4.8 Cl: 100 HCO3: 18

CONTD..

Stool DR: Colour: yellowish Consistency: soft pH: 6.0 Mucous: +2 Pus cells: 4 Stool c/s: shigella isolated.

CONTD

Urine DR: pH: 6.0 Sp gr: 1.025 Leucocytes: 2 Epithelial cells: occ

TREATMENT
Inj 1/5th d/saline 1000cc in 24 hrs @ 40ml/hr Inj Rocephin 750mg i/v od Syp gravinate 2.5cc po TDS Ors cup after each loose stool

DYSENTRY

DEFINITION
Acute diarrhea associated with blood, mucous and pus cells in the stool is called dysentry.

EPIDEMIOLOGY
Shigellosis is a common disease occuring primarily in children between 1 to 10 years of age. Mode of transmission = feco-oral route. Infection in the first 6 months of age is rare especially in breast fed babies. Humans are the major resorvoir of infection. Contaminated food and water supplies are common source of spread. Incubation period = 1 to 7 days.

PATHOGENESIS
Shigella destroys the superficial epithelial cells producing inflammation, edema, microabscesses and ulceration with bleeding.

CLINICAL FEATURES
Child may have crampy abdominal pain, urgency, tenesmus, malaise and non localized lower abdominal tenderness. Temperature is usually upto 104 F lasting for 1 to 3 days. Stools are watery,mucoid and contain blood. Shigellosis may present like CNS disease such as meningitis, particularly when high grade fever is associated with seizures, lethargy, and neck rigidity. Seizures are more common if the temp rises upto 104 F

DIAGNOSIS
Stool examination reveal leukocytes, pus cells, and red blood cells. CBC may show leukocytosis In children who appear to be toxic, blood culture may be positive. Diagnosis is confirmed by isolating shigella by stool culture.

COMPLICATIONS
Dehydration Acidosis Shock Renal failure Bacteremia Febrile seizures Rectal prolapse

D/D

Other organisms causing dysentry are: E- coli E. histolytica Campylobacter jejuni Yersinia enterocolitica Salmonella Other conditions mimicking shigellosis are: IBD intussuception

TREATMENT
Fluid and electrolyte replacement by using ORS. Effective antibiotics are: ampicillin, trimethoprim sulfamethoxazole, nalidixic acid, ceftriaxone, cefixime, ciprofloxacin.

PREVENTION
Encourage prolonged breast feeding. Hand washing especially after defecation and before food preparation and consumption. Proper water and sewage treatment.

PROGNOSIS
Prognosis is excellent if dehydration is treated adequately by fluid therapy. The mortality rate is high in very young, malnourished, infants who do not receive fluid and electrolyte therapy. Antibiotic therapy produces a bacteriologic cure in 80% of cases after 48hrs of treatment.

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