Dysentery In Children

Dysentery is diarrhoea containing visible blood, usually from invasive colonic infection. Shigella is a major cause in children, although Campylobacter, Salmonella, Entamoeba histolytica and Shiga toxin producing Escherichia coli are important alternatives.

Bloody diarrhoea with severe abdominal cramps and little or no fever should raise concern for Shiga toxin producing E. coli because antibiotics may increase the risk of haemolytic uraemic syndrome.

• Frequent small volume stools containing blood and mucus
• Fever
• Lower abdominal cramps
• Tenesmus
• Vomiting
• Dehydration

Severe Shigella infection can cause:

• Seizures
• Toxic megacolon
• Sepsis
• Rectal prolapse
• Haemolytic uraemic syndrome

• Send stool culture and susceptibility where available before antibiotics.

• Stool PCR can rapidly identify invasive pathogens and Shiga toxin.

• Check FBC, renal function, electrolytes and urinalysis if HUS is suspected.

• Amoebiasis should be considered where diarrhoea is prolonged or epidemiology supports it, but stool microscopy alone cannot reliably distinguish pathogenic E. histolytica from nonpathogenic species.

• Correct dehydration using ORS or IV fluids according to severity.

• Give zinc for 10 to 14 days.

• For suspected or confirmed shigellosis, ciprofloxacin 15 mg/kg PO every 12 hours for 3 days, maximum 500 mg per dose, is an effective regimen where local susceptibility supports it.

• Azithromycin is an alternative where resistance or local policy favours it.

• Do not give antimotility agents.

• Avoid empirical antibiotics if Shiga toxin producing E. coli is strongly suspected until the diagnosis is clarified.