World Health Organization : Year 1994 ; World Health Organization, Programme for the Control of Diarrhoeal Diseases, No. 94.49: The Management of Bloody Diarrhea in Young Children

By World Health Organization

Book Id: WPLBN0000032786
Format Type: PDF eBook
File Size: 0.7 MB
Reproduction Date: 2005

Title:	World Health Organization : Year 1994 ; World Health Organization, Programme for the Control of Diarrhoeal Diseases, No. 94.49: The Management of Bloody Diarrhea in Young Children
Author:	World Health Organization
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Organization, W. H. (n.d.). World Health Organization : Year 1994 ; World Health Organization, Programme for the Control of Diarrhoeal Diseases, No. 94.49. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
INTRODUCTION Bloody diarrhoea in young children is usually a sign of invasive enteric infection that carries a substantial risk of serious morbidity and death. This is especiafly true in the developing countries, where the problem occurs most frequently. Non-infectious causes account for a very small proportion of episodes of bloody diarrhoea. About 10% of diarrhoea1 episodes in children under 5 years of age have visible blood in the stool, and these account for about 15% of diarrhoea-associated deaths in this .age group worldwide (1). Compared with watery diarrhoea, bloody diarrhoea generally lasts longer, is associated with more complications, is more likely to adversely affect a child's growth, and has a higher case fatality rate (2-4). Studies in communities and health facilities have shown that the management of patients with bloody diarrhoea is frequently irrational. Many medications prescribed are ineffective or dangerous, and when an effective medication is advised the amount given is often too little, the duration of treatment too short, or both (5-7). Oral rehydration salts (ORS) solution is recommended in only a smaU proportion of cases and the amount taken is often insufficient to prevent dehydration (5). Food also may be withheld or given in reduced amounts. The correct treatment of bloody diarrhoea requires that mothers recognize the problem and seek medical care promptly, and that health workers dispense an appropriate antibiotic, give ORS solution or other fluids to prevent or treat dehydration, advise on appropriate feeding and provide follow-up, especially for children at increased risk of serious morbidity or death. When correct treatment is given promptly, most episodes of bloody diarrhoea resolve rapidly and many serious consequences are avoided.

Table of Contents
TABLE OF CONTENTS 1 . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 . DEFINXnONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2.1 Bloody diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2.2Dysentery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2.3 lnvasive diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 . CAUSES OF BLOODY DIARRHOEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3.1 Xnvasive bacteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3.1.1 Shigella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3.1.2 Other invasive. bacteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3.2 Entamoeba hirtolytica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3.2.1 Invasive amoebiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3.2.2 Luminal amoebiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3.3 Non-infectious causes of bloody diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4 . NATURAL HISTORY OF BLOODY DIARRHOEA AND ITS RESPONSE TO TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.1Shigellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.2 Bloody diarrhoea caused by other invasive bacteria . . . . . . . . . . . . . . . . . . . . 5 4.3 Intestinal amoebiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5 . DETERMINING THE ETIOLOGY OF BLOODY DIARRHOEA . . . . . . . . . . . . . . 6 5.1 Based on clinical features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5.2 Based on microscopic examination of stool . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5.3 Based on stool culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6 . PRINCIPAL STEPS IN THE MANAGEMENT OF CHILDREN WITH BLOODY DIARRHOEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7 . DETAILED ASPECTS OF CASE MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . 7 7.1 Detection of bloody diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7.2 Antimicrobial therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 7.2.1 Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 7.2.2 Antibiotics for Shigella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 7.2.3 Antimicrobials for bloody diarrhoea caused by other invasive bacteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 7.2.4 Antimicrobials for invasive amoebiasis . . . . . . . . . . . . . . . . . . . . . . 9 7.2.5 Misuse of metronidazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 7.3Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 7.4Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 7.5 Follow-up and referral to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 8. OTHER MEASURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .