E-DRUG: Rx of shigellosis/amoebiasis?
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Amoebiasis is common in my area so I feel that I should give treatment for
both shigellosis and Amoebiasis. When I treat child with dysentery just to be
sure to cover both problems. I have heard that it is incorrect. Can anybody
explain? There is no Laboratory for investigation in my place.
Peter arbogast Ruzangi
MSD-MTWARA
P.O. Box 646
Tel: 023 2333316
Fax: 023 2333316
MTWARA
TANZANIA
msd-mtwara <msd-mtwara@twiga.com>
[moderator comment: In the absence of a laboratory the differential diagnosis at
PHC level is indeed difficult. Without a laboratory to confirm a Shigellosis and/or
amoebiasis, one depends on good clinical diagnosis. The natural history of both
diseases is different: shigellosis starts sudden and acute; amoebiasis can be acute
but is more often chronic. A good interview with the mother/father is essential. How did
it start? How long is it going on? Shigellosis is more epidemic: are there other cases?
Shigellosis has high fever; amoebiasis normally not.
Then a good clinical investigation is needed, as the biggest danger to the child is
dehydration which requires Oral Rehydration. That should be the 1st treatment.
Then we should look at the stools! Both can have blood and/or mucus in stools, but
experienced clinicians could "see" a difference. Shigellosis always comes with acute
diarrhoea, but amoebiasis might only show occasional loose stools.
After treating the dehydration, and with a seriously ill child, empirical treatment
of suspected shigellosis (amoxycillin in South Africa; but this depends on local
sensitivity patterns!) might be more important than treatment of amoebiasis (metronidazole).
But most acute diarrhoea is viral and thus self limiting.
Referral could be considered if the child is seriously ill.
Bottomline: good clinical skills and locally adapted treatment protocols are as essential
as the essential drugs themselves!
Any other clinical suggestions for the differential diagnosis?
Wilbert Bannenberg, co-moderator and MD (but not a practising clinical physician any more!)
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