Dysentery
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A03.9 DESCRIPTION Passage of blood and mucus in the stools. Shigella infection is the most common serious cause in children in South Africa. Complications include: dehydration, convulsions, shock, toxic megacolon, acidosis, rectal prolapse, renal failure, haemolytic uraemic syndrome. DIA
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: A03.9
DESCRIPTION
Passage of blood and mucus in the stools.
Shigella infection is the most common serious cause in children in South Africa.
Complications include:
- dehydration,
- convulsions,
- shock,
- toxic megacolon,
- acidosis,
- rectal prolapse,
- renal failure,
- haemolytic uraemic syndrome.
DIAGNOSTIC CRITERIA
Clinical
- Sudden onset.
- Abdominal cramps, peritonism, urgency, fever and diarrhoea with blood and mucus in the stools.
- Meningismus and convulsions may occur.
- Exclude intussusception. Evidence of intussusception includes:
- pain or abdominal tenderness,
- bile-stained vomitus,
- red currant jelly-like mucus in stool,
- appearance of the intussusceptum through the anus.
Investigations
- Stool culture to confirm diagnosis of Shigellosis.
- Polymorphs and blood on stool microscopy.
- Immediate microscopy of warm stool to diagnose amoebic dysentery.
GENERAL AND SUPPORTIVE MEASURES
- Monitor fluid and electrolyte balance.
- Ensure adequate nutrition and hydration.
MEDICINE TREATMENT
Fluid and electrolyte replacement
See: Diarrhoea, acute.
Antibiotic therapy
Treat as Shigella during an epidemic of Shigellosis, or if the child is febrile, “toxic”-looking, has seizures or if Shigella is cultured from the stool and the child is still ill.
- Ciprofloxacin, oral, 15 mg/kg/dose 12 hourly for 3 days.
Where oral medication cannot be used:
- Cefotaxime, IV, 100 mg/kg/dose 8 hourly for 5 days.
For Entamoeba histolytica (only if demonstrated on stool microscopy, or strongly suspected):
- Metronidazole, oral, 15 mg/kg/dose 8 hourly for 7 days.
REFERRAL
- Dysentery with complications, e.g. persistent shock, haemolytic uraemic syndrome and toxic megacolon.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 2: Alimentary Tract, 2.2 Gastrointestinal Disorders, 2.2.7 Dysentery