Dysentery in Children: Model Clinical Case and Viva Q&A
Clinical Case of Dysentery in Children
A 4-year-old boy is brought to the emergency department by his parents with a 3-day history of frequent, loose, bloody stools. The child has had 8-10 episodes of diarrhea per day, each time passing small amounts of stool mixed with blood and mucus. The parents report that the child has been complaining of abdominal pain and has a low-grade fever.
On examination, the child appears lethargic and mildly dehydrated. His temperature is 38.5°C (101.3°F), heart rate is 110 beats/minute, and respiratory rate is 28 breaths/minute. The abdomen is tender, especially in the left lower quadrant. There are no signs of peritonitis.
Laboratory tests reveal:
- WBC count: 15,000/μL with a left shift
- Hemoglobin: 11.2 g/dL
- Stool examination: Numerous leukocytes and erythrocytes
- Stool culture: Positive for Shigella flexneri
The child is diagnosed with bacillary dysentery caused by Shigella flexneri. Treatment is initiated with oral rehydration therapy and appropriate antibiotics. The patient's condition improves over the next 48 hours, with a reduction in the frequency of stools and resolution of fever.
Clinical Presentations of Dysentery in Children
-
Acute Watery Diarrhea with Blood
The child presents with sudden onset of watery diarrhea that progresses to contain visible blood and mucus. Stools are frequent (10-30 times per day) and small in volume. Abdominal cramps and tenesmus are common.
-
Febrile Illness with Bloody Diarrhea
High fever (39-40°C or 102.2-104°F) accompanies bloody diarrhea. The child may appear toxic, with signs of systemic involvement such as lethargy, poor feeding, and decreased urine output.
-
Severe Dehydration and Electrolyte Imbalance
Rapid onset of severe dehydration characterized by sunken eyes, dry mucous membranes, reduced skin turgor, and lethargy or irritability. Electrolyte disturbances, particularly hyponatremia and hypokalemia, may be present.
-
Abdominal Pain Mimicking Appendicitis
Severe abdominal pain, particularly in the right lower quadrant, may mimic acute appendicitis. This presentation is more common in older children and can lead to diagnostic confusion.
-
Chronic or Persistent Diarrhea
Some children, particularly those with malnutrition or immunodeficiency, may develop a prolonged course of dysentery lasting more than 14 days. This can lead to significant weight loss and failure to thrive.
-
Seizures and Altered Mental Status
In severe cases, especially those caused by Shigella, children may present with seizures, altered mental status, or even coma. This can be due to severe electrolyte imbalances, toxic encephalopathy, or rarely, central nervous system invasion.
-
Hemolytic Uremic Syndrome (HUS)
A rare but serious complication, particularly associated with Shiga toxin-producing E. coli. The child may develop acute kidney injury, thrombocytopenia, and microangiopathic hemolytic anemia following a bout of bloody diarrhea.
-
Rectal Prolapse
Prolonged and severe straining during defecation can lead to rectal prolapse, especially in young children or those with malnutrition.
Knowledge Check: Question and Answers for Medical Students & Professionals
This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
