Paediatric Dysentery
Lesson Objectives
By the end of this module, the learner should be able to:
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Define dysentery and differentiate between amoebic and bacillary dysentery.
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Describe the clinical presentation in paediatric patients.
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Identify appropriate investigations for confirming the diagnosis.
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Outline evidence-based supportive and pharmacological treatment according to Zambian protocols.
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Provide correct dosing for ciprofloxacin, ceftriaxone, metronidazole, and tinidazole in children.
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Emphasize prevention and appropriate follow-up care.
Description
Dysentery is an intestinal disorder caused by microorganisms—bacteria, amoebas, or viruses—transmitted through contaminated food and water. It is characterized by diarrhoea containing pus and blood.
There are two major types:
| Type | Causative Agents |
|---|---|
| Bacillary dysentery | Shigella (≈50% of cases), Salmonella, Campylobacter, E. coli |
| Amoebic dysentery | Entamoeba histolytica |
Clinical Features
| Signs & Symptoms |
|---|
| Abdominal pain and cramps |
| Fever |
| Tenesmus |
| Nausea |
| Vomiting |
| Bloody diarrhoea |
Investigations
| Investigation | Purpose |
|---|---|
| Stool microscopy and culture | Detect causative organisms (bacteria or amoeba) |
| FBC/DC | Evaluate infection and hydration status; detect leukocytosis |
| Serum Electrolytes | Assess dehydration and electrolyte imbalance |
Treatment
Supportive Care
| Intervention | Notes |
|---|---|
| Adequate rehydration | ORS or IV fluids as clinically indicated |
| Pain control | Age-appropriate analgesia |
| Adequate nutrition | Continue feeding, avoid prolonged fasting |
| Zinc supplementation | Reduces duration and severity of diarrhoea |
Pharmacological Treatment
Bacillary Dysentery
| Drug | Dose | Duration | Max Dose |
|---|---|---|---|
| Ciprofloxacin | 7.5 mg/kg/day | 7–10 days | 500 mg per dose |
| Ceftriaxone | 50 mg/kg/day | 7–10 days | 2 g |
Amoebic Dysentery
| Drug | Dose | Frequency/Duration | Max Dose |
|---|---|---|---|
| Metronidazole | 7.5 mg/kg/day | Orally every 8 hrs × 5 days | — |
| Tinidazole | 50 mg/kg once daily | 3 days | 2 g/day |
Summary
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Dysentery is caused by bacterial or amoebic pathogens, commonly transmitted through contaminated food and water.
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Shigella accounts for approximately half of bacillary dysentery cases.
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Children typically present with abdominal pain, fever, tenesmus, vomiting, and bloody diarrhoea.
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Diagnosis relies on stool microscopy/culture and supportive laboratory tests.
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Treatment includes rehydration, nutrition, zinc supplementation, and targeted antimicrobial therapy.
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Ciprofloxacin/ceftriaxone treat bacillary dysentery; metronidazole/tinidazole treat amoebic dysentery.