PE23.5 | Dysentery — Summary & Reflection

KEY TAKEAWAYS

Dysentery is bloody diarrhoea with mucus — a marker of mucosal invasion. Shigella dysenteriae is the commonest cause in Indian children. Key points: (1) Bacillary dysentery presents with fever, tenesmus, and numerous pus cells on stool microscopy; amoebic dysentery is more insidious with trophozoites (containing RBCs) on fresh stool examination. (2) EHEC (O157:H7) causes AFEBRILE bloody diarrhoea and carries risk of haemolytic uraemic syndrome — antibiotics are ABSOLUTELY CONTRAINDICATED. (3) Rehydration with reduced-osmolarity ORS and zinc supplementation form the foundation of management. (4) For Shigella, ciprofloxacin (15 mg/kg/day oral, 3 days) is first-line in India; IV ceftriaxone for severe/parenteral cases. (5) For amoeba, metronidazole followed by diloxanide furoate. (6) HUS triad = haemolytic anaemia + thrombocytopaenia + AKI — supportive management only. Dehydration assessment using IMNCI criteria and nutritional support through illness are essential components of management.

REFLECT

Think about a child you have seen (or will see) with diarrhoea. The temptation in clinical practice is to prescribe an antibiotic for any episode of bloody diarrhoea 'to cover everything.' Reflect on why this approach is dangerous in EHEC infection. How would you approach discussing with a parent the decision NOT to prescribe antibiotics for their child's bloody diarrhoea? What signs would you warn them to watch for (pallor, decreased urination) that should prompt immediate return? This tension between 'doing something' and the principle of harm avoidance is central to good clinical reasoning in infectious disease.