Question

Case-2:

Complaint:

Five children from the same school presented with abdominal pain and diarrhea (streaked with blood) over a period of 3 days. Upon investigation it was found that those children had recently been in birthday party. Fecal specimen was collected and sent to microbiology lab. Lab report showed presence of pus cells on direct microscopy and non motile bacteria on motility test.

Clinical History: The children are usually healthy. They take no regular medications

a. What is the possible clinical diagnosis?

b. What is the etiological agent and its natural reservoir?

c. How could these infected children be treated?

d. Identify parasitic organism could resemble the same clinical feature of this infection and what laboratory test is used to diagnose it?

e. Identify a virus cause diarrhea with possibility of developing flaccid paralysis? What are the best samples for diagnosis of this virus? What immunological test can be used to confirm this viral infection? Is any prophylaxis available for this virus? If so, explain!

Answer 1

Answers : Case 2

a) The children are suffering from Shigellosis dysentery.

b) The etiological agent most likely involved is Shigella spp.
It is a food and water borne pathogen spread by contaminated food and water. Humans are the only known reservoirs of this pathogen and is shed by infected individuals suffering from the dysentery or convalescent carriers. It spreads by feco-oral route.

c) The infected children should be put in hospital with immediate replacement of water and electrolytes by ORAL or by IV rehydration. The antibiotics of choice could be informed by microbiology laboratory after performing culture and sensitivity tests from stool samples. The best known antibiotics for children with shigellosis are Azithromycin and Ciprofloxacin in appropriate doses as calculated for their body weight and age. Other alternative antibiotics will include - Ampicillin / Ceftriaxone / trimethoprim with sulfamethoxazole.

d) A similar dysentery may be caused by Entamoeba histolytica. The stools can be checked for positive visual confirmation by observing this protozoans' amoebic and cystic forms. It is part of routine laboratory check up. However, pus cells will be noticeably less or absent in amoebic dysentery.

e) The Polio virus is pathogen that will cause diarrhoea and possibly flaccid paralysis. Polio is a food and water born disease.
Doctors usually will recognize polio from clinical symptoms rather than from investigations, but if needed the virus could be looked for in throat secretions / stool, samples or in CSF of the suspected patient.

Immunological test available for diagnosis
- detection of polio virus antigen
- detection of polio virus specific IgM antibodies in the serum
- detection of polio virus specific IgA antibodies in the mucosal specimen
antibody tests can also help in checking for the efficacy of polio vaccination.

Prophylaxis for polio virus does exist. Oral Polio Vaccine (OPV) is the best method for combating this debilitating disease. All children should be vaccinated and dose repeated to ensure long time immunity. Any visitors to a country where polio is endemic, should take this vaccine 2-3 weeks before visiting the country. Polio vaccination drives across the 3rd world countries / developing nations has reduced its incidents considerably. In certain developed and developing nations polio has been already eradicated.