Diarrhea and dysentery are two common clinical presentations especially in pediatric practice. In pediatric wards, in some countries, there is a separate section for children with diarrhea to admit. This section has expanded latrine facilities and purposefully separated from the other patients due to the high risk of spread. Although both conditions present with bowel symptoms, there are many fundamental difference between the two conditions.
Diarrhea is the passage of watery stools. Diarrhea is very common among children because they play in the dirt and get soiled often. It is more dangerous in children because the distribution of body water is different from that of an adult. There is more extra-cellular water in children, and this compartment can get depleted rapidly with prolonged diarrhea. Therefore, diarrhea in children needs hospital admission and proper fluid management.
Diarrhea is most commonly due to viruses. E Coli can also cause watery diarrhea (entero-toxigenic type). Due to viral infection, there is bowel inflammation and loss of water absorption capability. This holds water in the bowel lumen, and the stools become watery. When a child presents with watery diarrhea the level of dehydration is assessed to guide the fluid therapy. According to the level of dehydration, oral rehydration solutions or intravenous fluid therapy may be used. Regular monitoring of urine output, serum electrolytes, heart rate and blood pressure are important when managing watery diarrhea.
Dysentery is the passage of stools with blood and mucus. This is most commonly due to a bacterial infection. E – Coli (entero-hemorrhagic and entero-invasive types), Shigella, and Salmonella are the most common causative organisms. These organisms enter the bowel with spoiled meat products. After a short incubation period, patients present with blood and mucus diarrhea, a.k.a. dysentery. Upon admission to hospital, dehydration level, pallor, and fever are assessed. These examination findings guide the fluid therapy just like in watery diarrhea.
Investigations done in the case of blood and mucus diarrhea include stool culture full report, full blood count, serum electrolytes, random blood sugar, and urine full report. Dysentery needs antibiotic treatment. According to the clinical condition of the patient, route of antibiotic administration may be decided. Intravenous antibiotics may be needed in severely ill children while oral antibiotics may suffice in not so ill children. Full regimen of antibiotics should be administered without fail to prevent the spread. Normal food hygiene is adequate to ensure there are no recurrences.
What is the difference between Diarrhea and Dysentery?
• Diarrhea is the passage of watery stools while dysentery is blood and mucus stools.
• Diarrhea is mostly viral while dysentery is mostly bacterial.
• Assessment is similar in both conditions, but stool culture is not indicated in watery diarrhea unless there are extraordinary circumstances.
• Watery diarrhea does not need antibiotics while dysentery almost always requires antibiotic treatment.