ACUTE VIRAL GASTROENTERITIS VERSUS DYSENTARY VERSUS TYPHOID VERSUS BRUCIELLOSIS

Diarrhea, vomiting and GI symptoms overwhelm me overseas in developing countries. In the US I know the most common is acute viral gastroenteritis and we never really have to worry about anything else. People’s farm animals don’t live in their homes in the US. Raw eggs and milk are pasteurized. Meat is well cooked for the most part. Drinking water is clean for the most part. But abroad, nearly-half of the children complain of diarrhea, vomiting, bloody stools or abdominal pain. I freeze u inside unsure of what to do. This month has been good for me and I highly recommend the book “handbook of Medicine in Developing Countries” for those trying to make the transition to resource limited situations and hospitals. Shortly after arriving in Kenya I was on call and admitted a 4 year old girl with 3 days of bloody, mucous stool, vomiting, and fevers. No urine output since earlier that day. Very lethargic and ill appearing dysentery. Dysentery is a bacterial infection and unique to it is a couple day history of blood/mucous in the stools. Antibiotics are indicated for moderate to severe cases. Pretty much anyone who is admitted to the hospital is in the moderate to severe category. She was pretty severely dehydrated (as noted by the lethargy), so we treated with antibiotics and lots of IV fluids. That night I admitted another 4 year old with one day history of multiple watery stools. NO blood. And fever. He was ill appearing but not lethargic or as dry looking as the first girl - Acute viral gastroenteritis: identified based on the watery stool and no blood. I treated him with IV fluids as well, but no antibiotics were needed and he improved. Earlier that day I’d rounded on a 10 year boy who had been admitted from Out patient department with severe low back pain and constipation for a month. He was now unable to walk. I asked Aaron to review the case with me, because I was stumped. The clinical officer (i.e. the Kenyan version of a PA) admitted him was concerned for Potts Dz. But Aaron ordered a test looking for Bruciolosis (a bacteria from raw milk or under cooked poultry). The test ended up being positive, so we sent him home with 6 weeks of appropriate antibiotics Bruciolosis is suspected based on fever without source, +/- diarrhea or constipation. About 20% of cases have joint pain or low back pain. Typhoid is the other GI illness seen a lot here. It’s suspected with more than 2 weeks of diarrhea +/- fever. In Niger we’d see it all the time after it was too late and the bacteria had already caused perforations in the bowel walls. The test they had in Niger wasn’t very helpful, so they nearly never tested. I never saw a typhoid perforation while at Kapsowar. They used that same test at Kapsowar, so they probably prevented perforation by over treating falsely positive Widel tests.