Acute Bloody Dysentery

Introduction

This is a clinical diagnosis based on frequent near-liquid diarrhea flecked with blood, mucus or pus.

Causes

• ·         Shigella
• ·         Campylobacter  jejuni
• ·         Escherichia coli
• ·          Non-typhoid Salmonella
• ·         Entamoeba histolytica
• ·         Non-infectious causes- Ulcerative colitis, clostridium deficile associated diarrhoea (CDAD)

Clinical feature

·         Fever, chill

·         Nausea

·         Body aches, fatigue

·         Abdominal pain or cramping, bloating

·         Fecal incontinence

·         Feeling of incomplete emptying

·         Urgent need to pass stool

·         Vomiting

o    Life threatening feature

·         Confusion and disorientation

·         Difficulty breathing

·         High fever (higher than 101° F)

·         Rapid pulse /  Hypotension

·         Rigid, board-like abdomen

·         Severe abdominal pain

Complication

             Anemia
Dehydration
Hemolytic uremic syndrome or other type of kidney failure
Severe blood loss
Shock

Investigations

·         Stool R/M/E

o    Polymorphoneuclear leucocytosis

o    Trophozoites or cysts of E. histolytica

·         Stool C/S

·         CBC

o    Neutrophilic leucocytosis

·         Blood urea

·         Serum electrolytes

Management

·         General management

o    Rehydration- ORS, if severely dehydrated or vomiting- IV fluid

o    Anti pyretic if required

o    Anti spasmodic if required

o    Don’t use loperamide as this may develop toxic mega colon

·         Specific management

o    Ciprofloxacin 500 mg bid for 3-5 days

o    Metronidazol 400 mg tds for 5 days in case of amoebic dysentery

·         Re-evaluate after 48 hours, if following features appear then refer the patient

o    No improvement

o    Deterioration of patient

Development of complication