A 30-year-old woman from a remote village in Punjab presents with frequent bowel movements, tenesmus, and low-grade fever for past two days. Upon examination, blood and mucus are present in her stool. Which of the following is the most likely diagnosis?
A. Ulcerative colitis
B. Bacillary dysentery
C. Carcinoma of the rectum
D. Irritable bowel syndrome
E. Malabsorption syndrome
Correct Answer: B. Bacillary dysentery
Explanation:
The most likely diagnosis in this case is bacillary dysentery caused by Shigella infection. The patient’s presentation aligns with the classic symptoms of dysentery, particularly in an area where Shigella infections are common.
Key Features Supporting Bacillary Dysentery:
- Acute Onset of Gastrointestinal Symptoms:
- The patient’s frequent bowel movements and tenesmus (feeling of incomplete evacuation) are typical of dysentery, where the infection leads to colonic inflammation.
- The presence of blood and mucus in the stool is characteristic of Shigella dysentery, an infection that results in ulceration of the colonic mucosa.
- Geographical Context:
- The patient’s origin from a remote village in Punjab, an area where infectious diseases like Shigellosis are prevalent, makes bacillary dysentery a leading consideration.
- Fever and Systemic Symptoms:
- Low-grade fever commonly accompanies infections like Shigella due to the systemic inflammatory response. This is not typically seen in chronic conditions like ulcerative colitis or irritable bowel syndrome.
Why Other Options Are Incorrect:
A. Ulcerative colitis (UC):
- UC typically presents with chronic diarrhea, not acute symptoms. It is also less likely to present with acute fever and is more associated with long-standing symptoms like rectal bleeding, rather than mucus and blood in the stool.
- Additionally, UC usually involves continuous colonic involvement, starting from the rectum, while the acute onset and mucus in the stool point to an infectious etiology.
C. Carcinoma of the rectum:
- Rectal cancer may cause bloody stool but is usually a slow-developing condition. The patient’s age (30 years old) and acute symptoms (fever, frequent stools) make malignancy unlikely at this stage.
- Rectal cancer does not typically cause tenesmus and fever as early symptoms.
D. Irritable bowel syndrome (IBS):
- IBS generally causes chronic abdominal discomfort, bloating, and alternating diarrhea and constipation, but does not typically cause blood and mucus in the stool.
- The fever is also uncommon in IBS, as it is a functional disorder rather than an infectious one.
E. Malabsorption syndrome:
- Malabsorption syndromes typically cause chronic diarrhea and steatorrhea (fatty stools) rather than blood and mucus. They also tend to cause nutritional deficiencies over time, not the acute symptoms seen in this patient.
- Fever is not a typical feature of malabsorption syndromes.
Next Steps in Diagnosis and Treatment:
- Stool Culture and Sensitivity:
- This is the key test to identify Shigella or other potential pathogens and confirm the diagnosis of bacillary dysentery.
- Oral Rehydration Therapy (ORT):
- Patients with dysentery are at high risk for dehydration due to diarrhea. Oral rehydration is critical in restoring fluid and electrolyte balance.
- Antibiotic Therapy:
- Once Shigella is confirmed, antibiotics like ciprofloxacin, azithromycin, or ceftriaxone are recommended, especially for severe cases, to reduce the duration of symptoms and transmission.
- Antipyretic and Antidiarrheal Drugs:
- Paracetamol for fever management, but antidiarrheal drugs (such as loperamide) should be avoided in infectious diarrhea, as they can slow the elimination of the pathogen.
Conclusion:
The combination of fever, frequent bowel movements, tenesmus, and blood and mucus in the stool strongly points to bacillary dysentery as the most likely diagnosis. Early diagnosis and treatment with antibiotics and oral rehydration are key to managing the infection, preventing complications, and reducing transmission in the community.