Published: 2022-10-29

Causes, clinical assessment and management of paediatric bloody diarrhoea

Attia Abdrabalnabi Alshaikh, Saeed Mohammad Alshehri, Ibrahim Abdu Alsubaihi, Mohammad Ahmed Boeisa, Bassam Khalid Kiki, Ahmed Ali Asiri, Ahmed Maddi Asiri, Shahad Ali Aloufi, Ayat Mohammad Azhari, Afraa Faisal Saklou, Batool Abed Mansoor


Despite being easily preventable and treatable, diarrhoea continues to be a serious public health problem in impoverished and emerging countries. It is a typical sign of gastrointestinal issues brought on by numerous pathogens, including bacteria, viruses, and protozoa. Particularly in developing nations it is of great concern as it is associated with considerable mortality and morbidity in children. Despite the decline in mortality rate, it is still the second leading cause of mortality among children under five years of age. Bloody diarrhoea is characterized by intestinal inflammation, particularly of the colon, stomach pain, and severe diarrhoea with blood or mucus in the faeces. It is also referred as dysentery. Among the bacteria and parasites that cause dysentery include Entamoeba histolytica, Shigella, Campylobacter, Salmonella, Schistosoma mansoni, and Campylobacter. The most common cause of this disease is Shigella. The purpose of this research is to review the available information about causes, clinical assessment and management of paediatric bloody diarrhoea. Stool culture is a standard diagnostic measure. Digestive issues and nutritional inadequacies are more frequent in children with bloody diarrhoea. Bloody diarrhoea often lasts longer and is more problematic than watery diarrhoea. It has a high percentage of case fatalities and adversely impacts a child's growth. Rehydration therapy shall be started immediately to prevent dehydration associated complications and fatalities. Treatment with fluoroquinolones as first-line medications, beta-lactams and cephalosporins as second-line medications is recommended. Further clinical research is however needed to define the clinical efficacy of available treatment and management strategies.


Bloody, Diarrhoea, Children, Treatment

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Bawankule R, Shetye S, Singh A, Singh A, Kumar K. Epidemiological investigation and management of bloody diarrhea among children in India. PloS One. 2019;14(9):e0222208.

Al-Kubaisy W, Al Badre A, Al-Naggar RA, NI NS. Epidemiological study of bloody diarrhoea among children in Baghdad, Iraq. Int Arch Med. 2015;8.

Ferdous F, Ahmed S, Das SK. Aetiology and clinical features of dysentery in children aged <5 years in rural Bangladesh. Epidemiol Infect. 2014;142(1):90-98.

Holtz LR, Neill MA, Tarr PI. Acute bloody diarrhea: a medical emergency for patients of all ages. Gastroenterology. 2009;136(6):1887-98.

Gu B, Cao Y, Pan S. Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe-America and Asia-Africa from 1998 to 2009. Int J Antimicrobial Agents. 2012;40(1):9-17.

Von Seidlein L, Kim DR, Ali M. A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology. PLoS Med. 2006;3(9):e353.

Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM. Shigellosis. Lancet. 2018;391(10122):801-812.

Eliason BC, Lewan RB. Gastroenteritis in children: principles of diagnosis and treatment. Am Family Physician. 1998;58(8):1769-76.

Murphy MS. Management of bloody diarrhoea in children in primary care. BMJ. 2008;336(7651):1010-15.

Thomas DW. Bloody diarrhea in children. Gastroenterol Nurs. 1989;12(2):100-3.

Turgeon DK, Fritsche TR. Laboratory approaches to infectious diarrhea. Gastroenterol Clin N Am. 2001;30(3):693-707.

Humphries RM, Linscott AJ. Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Bacterial Gastroenteritis. Clin Microbiol Rev. 2015;28(1):3-31.

Ardissino G, Vignati C, Masia C. Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network. J Pediatr. 2021;237:34-40.

McKee RS, Tarr PI, Dietzen DJ, Chawla R, Schnadower D. Clinical and Laboratory Predictors of Shiga Toxin-Producing Escherichia coli Infection in Children With Bloody Diarrhea. J Pediatr Infect Dise Society. 2018;7(3):e116-22.

Hoxha TF, Azemi M, Avdiu M, Ismaili-Jaha V, Grajqevci V, Petrela E. The usefulness of clinical and laboratory parameters for predicting severity of dehydration in children with acute gastroenteritis. Med Arch (Sarajevo, Bosnia and Herzegovina). 2014;68(5):304-7.

Da Cruz Gouveia MA, Lins MTC, da Silva GAP. Acute diarrhea with blood: diagnosis and drug treatment. J Pediatr. 2020;96(1):20-8.

Bruzzese E, Giannattasio A, Guarino A. Antibiotic treatment of acute gastroenteritis in children. F1000Res. 2018;7:193.

Dejkam A, Hatam-Nahavandi K. Dysentery in Children. Iran J Public Health. 2021;50(9):1930-31.

Traa BS, Walker CL, Munos M, Black RE. Antibiotics for the treatment of dysentery in children. Int J Epidemiol. 2010;39(1):i70-74.

Tickell KD, Brander RL, Atlas HE, Pernica JM, Walson JL, Pavlinac PB. Identification and management of Shigella infection in children with diarrhoea: a systematic review and meta-analysis. Lancet Global Health. 2017;5(12):e1235-48.

Williams PCM, Berkley JA. Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence. Paediatr Inte Child Health. 2018;38(1):S50-65.