Features of disease onset and temperature curve
To make a correct diagnosis, it is extremely important to evaluate the onset of clinical manifestations. Acute shigellosis (its colitis variant) manifests acutely with a very short initial period. This rapid development of symptoms somewhat resembles foodborne toxic infection (FTI), which is characterized by a stormy onset. In contrast to infectious processes, ulcerative colitis (UC) develops gradually or subacutely (an acute course is much less common). Colon cancer also has a gradual onset.
When evaluating fever, it should be noted that in shigellosis it is short-lived, can reach high numbers, or remain subfebrile. In FTI, the temperature elevation is also short-lived or absent altogether. Chronic and neoplastic processes behave differently: in UC, the fever is prolonged, remittent, or subfebrile (may be absent at the very beginning), whereas in colon cancer it is prolonged and subfebrile (less commonly absent).
Intoxication and pain syndrome
The severity of intoxication is an important diagnostic criterion. In shigellosis and FTI, it is pronounced but short-lived. In UC, the intoxication syndrome varies in severity and gradually increases, while in colon cancer it is mild or completely absent. Pay attention to signs of wasting: they are absent in infectious diarrheas, mild or absent in oncology (at the stages under consideration), whereas in progressive UC, wasting is clearly pronounced.
Characteristics of abdominal pain:
- Acute shigellosis: cramping pain, localized predominantly in the lower half of the abdomen.
- FTI: pain of varying intensity, concentrated in the upper half of the abdomen and around the umbilicus.
- UC: moderate, aching pain, which in some cases may be completely absent.
- Colon cancer: nature and localization depend on the tumor site; acute pain occurs predominantly when intestinal obstruction develops.
Additionally, specific symptoms from the lower GI tract (tenesmus/urgency) should be noted. In shigellosis, they are frequent. In FTI, they are absent. In UC, they occur only in severe forms, and in oncology, exclusively when the tumor is localized in the rectum.
Liver changes and stool characteristics
During physical examination, assessing the state of the liver provides valuable information. Acute shigellosis and FTI proceed without changes in this organ. In UC, the liver may be moderately enlarged and tender on palpation. In colon cancer, liver enlargement indicates metastasis, while palpation remains painless.
The key marker is visual assessment of stool:
- In acute shigellosis, the stool is loose and scanty (low fecal mass). The presence of pathological impurities is characteristic: mucus and streaks of blood.
- In FTI, the stool is copious, fecal, greenish, and foul-smelling. Pathological impurities are completely absent.
- In UC, the stool is mushy (less commonly loose). Pus, mucus, and bright red blood are clearly detectable.
- In cancer, the stool is usually formed or semi-formed (loose is rare), and blood is located on top of the stool rather than mixed with it.
Laboratory profile (CBC)
A complete blood count (CBC) completes the differential diagnosis picture.
- Acute shigellosis: proceeds without significant changes in the test results. Leukocytosis and neutrophilia are registered only in severe forms.
- FTI: leukocytosis and neutrophilia with a band neutrophil shift to the left are typical. The erythrocyte sedimentation rate (ESR) is slightly elevated.
- UC: pronounced inflammatory process (leukocytosis, band shift, elevated ESR). Signs of anemia of varying severity are frequently observed.
- Colon cancer: the picture may be without significant changes, or a band shift and relative neutrophilia may be detected. ESR is elevated (sometimes significantly), and signs of anemia may be present.
Briefly: answers to topical questions
What are the absolute indications for hospitalizing children with acute shigellosis?
Age in children is indicated in sources as an indication for hospitalization in shigellosis. Hospitalization is performed strictly according to clinical and epidemiological indications to prevent the further spread of infection.
Indications confirmed by sources include:
- Age factor — children.
- Clinical indications — for example, moderate form of the disease.
- Epidemiological indications — the source provides an example: 3rd day of the disease.
What drugs are used for etiotropic therapy of shigellosis in children?
For etiotropic therapy of acute shigellosis, sources explicitly indicate antibacterial therapy.
Confirmed example of a drug:
- Ciprolet 0.5 g twice daily, course for 5–7 days — indicated for moderate-to-severe colitic variant.
Antibiotics are prescribed strictly after collecting material for bacteriological examination.
In mild forms of shigellosis, probiotics/eubiotics can be prescribed as the main treatment method without antibiotics: Biosporin, Lactobacterin, Bifikol, Bifidumbacterin-forte, Probifor.
To remember the stool pattern in shigellosis, use the rule "Scanty, but with streaks": the stool is scanty (low fecal mass) but contains characteristic inclusions — mucus and blood streaks.
Class and exam questions
How to distinguish stool in shigellosis from stool in foodborne toxic infection?
In shigellosis, the stool is loose and scanty, containing mucus and blood streaks. In FTI, the stool is copious, greenish, foul-smelling, with pathological impurities (blood, pus) absent.
Where is pain localized in the colitic variant of shigellosis?
Cramping pain located in the lower half of the abdomen is typical for this disease.
Are there any changes in the complete blood count during the typical course of shigellosis?
In most cases, the disease proceeds without significant changes in the blood test. Leukocytosis and neutrophilia occur only in severe forms of the infection.
What does blood in the stool look like in colon cancer compared to shigellosis?
In cancer, blood is located on top of formed or semi-formed stool, whereas in shigellosis it is present as streaks in scanty loose stool.
What else to study on this topic
- Pathogenesis of impurity formation in stool during lower gastrointestinal tract involvement
- Features of temperature curves in acute intestinal infections and autoimmune pathologies
- Relationship between pain syndrome and the localization of an inflammatory or tumor process in the GI tract
- Mechanisms of changes in laboratory parameters (leukogram and ESR) in colitis of various etiologies
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