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Intestinal manifestations of invasive diarrheas and their diagnosis
1Wellcome Research Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Insights
Shigellosis in children often presents with bloody diarrhea, abdominal pain, and fever. Early clinical judgment can guide antibiotic treatment before lab confirmation, improving patient outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Diagnostics
Background:
- Shigellosis is a significant cause of childhood diarrhea globally.
- Accurate and timely diagnosis is crucial for effective management and preventing outbreaks.
- Distinguishing shigellosis from other diarrheal diseases based on clinical signs can be challenging.
Purpose of the Study:
- To identify a diagnostic clinical profile for shigellosis in children.
- To evaluate the utility of clinical judgment in early shigellosis diagnosis and treatment initiation.
Main Methods:
- Analysis of data from 916 children with diarrhea, including 122 with confirmed shigellosis.
- Inclusion of data from a Shigella dysenteriae type I epidemic.
- Comparison of clinical symptoms between shigellosis patients and those with other diarrheal illnesses.
Main Results:
- Key symptoms more frequent in shigellosis included blood/mucus in stool, increased stool frequency, abdominal pain, rectal tenesmus, and fever.
- Isolation of Shigella remains the gold standard for diagnostic confirmation.
- Clinical presentation shows a recognizable pattern suggestive of shigellosis.
Conclusions:
- A distinct clinical profile aids in suspecting shigellosis in children.
- Early antibiotic therapy for suspected shigellosis can be initiated based on clinical assessment.
- Clinical judgment, informed by local epidemiology of dysentery, is valuable for prompt treatment.
Abstract:
Data from studies of 916 children with diarrhea, including 122 from whom shigellae were isolated, and data on patients affected in an epidemic due to Shigella dysenteriae type I were analyzed to determine whether a diagnostic clinical profile of shigellosis could be identified. Blood and/or mucus in stool, increased frequency of stool, abdominal pain, rectal tenesmus, and fever were noted more frequently in patients with shigellosis. The diagnostic confirmation of shigellosis depends on the isolation of the organism, but in the clinical situation early initiation of appropriate antibiotic therapy can be based on clinical judgment that utilizes local perceptions regarding dysentery.