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V., 33 years old, engineer, came to the clinic with complaints of fever up to 37.2°C, weakness, headache, cramps in the lower abdomen, loose stools. She got sick acutely, last night. During the night, the stool three times, mushy, with mucus, twice in the morning. On examination, the skin is of normal color. Pulse 82 in min. BP120/80 mmHg. The tongue is wet. The abdomen is soft, painful on palpation in both iliac regions. She cannot associate his disease with anything. She lives in a two-room apartment together with her husband. She is healthy. You are a district doctor. Justify the preliminary diagnosis. Determine the tactics for this patient.

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Quick answer

Preliminary diagnosis: acute intestinal infection, most consistent with acute shigellosis (bacillary dysentery), mild colitic form.
Justification
  • Acute onset with low-grade fever, weakness and headache, suggesting an infectious process.
  • Frequent small-volume stools with mucus, rather than profuse watery diarrhea.
  • Cramping lower abdominal pain and tenderness in both iliac regions, reflecting predominant colonic involvement, especially distal colon.
  • No signs of dehydration, shock, or severe intoxication: moist tongue, normal pulse and blood pressure, normal skin color.
  • The main differential is another invasive bacterial enterocolitis, including Campylobacter, Salmonella, enteroinvasive E. coli, or amoebic colitis. Etiology must be confirmed microbiologically.
Tactics of the district doctor
  1. Manage at home initially, provided she can be isolated, reliably followed up, and has no high-risk occupation involving food, childcare, or healthcare. Her presentation is mild and she has no dehydration or severe systemic illness.
  2. Investigations before antimicrobial therapy where possible
    • Stool testing for enteric bacterial pathogens, including Shigella, with culture and antimicrobial susceptibility testing.
    • Consider multiplex stool PCR if available.
    • CBC, electrolytes and renal function if symptoms persist, worsen, or dehydration is suspected.
  3. Treatment
    • Oral rehydration solution in frequent small amounts, with replacement of ongoing losses.
    • Light diet as tolerated.
    • Antipyretic such as paracetamol if fever or headache is troublesome.
    • Do not use loperamide or other antimotility drugs when invasive diarrhea or dysentery is suspected.
    • Antibiotics should be considered if Shigella is confirmed or strongly suspected with persistent or more severe dysentery, taking local resistance patterns and stool susceptibility into account. Empiric choice should follow local infectious-disease guidance.
  4. Anti-epidemic measures
    • Notify public-health/sanitary-epidemiologic services according to local reporting rules for suspected shigellosis.
    • Explain strict hand hygiene, separate towels and utensils, safe food handling, and routine disinfection of toilet and frequently touched bathroom surfaces.
    • Assess the husband for symptoms and arrange observation of household contacts during the incubation period, commonly up to 7 days.
  5. Review and escalation
    • Reassess within 24-48 hours, earlier if needed.
    • Refer for hospital assessment/admission if fever rises, stool frequency or bloody diarrhea increases, vomiting prevents oral intake, dehydration develops, severe abdominal pain/peritoneal signs occur, altered mental status develops, or there is failure to improve.
The diagnosis is presumptive until stool testing identifies the organism.
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