Tropical Travel Trouble 004 Bloody Diarrhoea
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 004
A medical student who has just returned from their elective in Nepal presents with 1 week of bloody diarrhoea. He has been in the lowlands and stayed with a family in the local village he was helping at. It started three days before he left and he decided to get home on the plane in the hope it would settle. He is now opening his bowels 10x a day with associated cramps, fevers and has started feeling dizzy.
Questions:
Q1. What is dysentery and what is your differential?
Answer and interpretation
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Dysentery is simply diarrhoea with blood – it is usually associated with fever but this is not always the case.
Sir William Osler described dysentery as “One of the four great epidemic diseases of the world”. He further stated “In the tropics it destroys more life than cholera, and it has been more fatal to armies than powder and shot.”
Differentials include:
Bacterial
Gram positive – Clostridium Difficile
Gram negative – Shigellosis, Enterohaemorrhagic E.coli, Salmonella, Yersinia enterocolitica
Protozoa – Entamoeba histolytica, Balantidium coli
Helminths – Schistoma (S. mansion or S. japonicum), Ascariasis, Trichuriasis
Non-infectious – inflammat...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine amoebic dysentery bacillary dysentery e.histolytica entamoeba histolytica shigellosis Source Type: blogs
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