HEAD OF CHAIR: TEACHER: CASE REPORT PATIENT (NAME, SURNAME): KUDINOVA ANASTASIA SERGIEVNA AGE: 3 YEARS 2 MONTH CLINICAL

DIAGNOSIS MAIN DISEASE: Acute shigellosis ( Shigella Sonnei) Collitis syndrome -severe form COMPLICATIONS: ACCOMPANIED DISEASE: -

STUDENT: Dzameshie Benjamin GROUP: 507 I) PASSPORT DATA Name: KUDINOVA ANASTASIA SERGIEVNA Age: 3 years 2 months Sex: Female Address; Simferopol Nationality: Ukrainian Date of admission: 22 march 2013 II) INQUIRY (INTERROGATIO) COMPLAINTS Chief complaints: 1. Abdominal pain .

2. 3. 4.

Diarrhea- frequent but little stool, with mucous Vomiting . Temperature was -39.6 deg.

HISTORY CASE (ANAMNESIS MORBI) On 22 march, night around 9pm patient started having fever with body temperature 39.6c.her mum gave her medication ( aspirin) but it didnt help her. At midnite she started vomiting and her rectal temperature was 39.6 c.Thee same night she was brought to the doctor and she was diagnosed as intoxication. She was prescribed dimedrol and panangin. But the following morning around 6am she started having diarrhea with mucous stool.She was then brought to the Children Infectious Disease Hospital in Marino on 15th October. Patient was admitted here. LIFE HISTORY (ANAMNESIS VITAE) Patient is not going to school yet. She only used to play outside tha house. She loves to eat sweet stuffs. Her father is a company director and her mother is a housewife. Parents has no history of hereditary disease and never involved in any epidemic or pandemic infectious disease. They have no history of intestine disease as well. Patient is the 2 nd child of the family.Patient has no food allergy .she never had any other infectious disease before. Epidemiology : a week prior to her illness she had her normal daily routine, only ate her mums cooking and drank boiled water .she didnt have any contact with anyone other than her mum and sister at home.She also didnt have any contact with any animals(pet). PHYSICAL EXAMINATION Patients general state is good. Her consciousness is clear. She is in active position. Body constitution is normostenic. Character of her nourishment is satisfactory. Her gait is active. She is 90cm tall and weight 15kg. Vital signs: Body temperature: 37.2`C. Pulse: 68/min Breathing rate: 16/min Systems Review Skin-is pale-pinkish, clean and turgor is usual. Skin is dry and no rashes is spoted. Lip is pinkish. Visible mucosa is pinkish and moist. Inspection of conjunctiva, upper and lower eyelids reveals pale off white coloration. Sclera is of pinkish coloration Growth of hair on skin is normal. Hair covering is female type. Pigmentation of skin is usual. Subcutaneous fat tissue developed moderately. Thickness of her skin fold measured under her scapula is 1.5cm., on back-3cm. Edema is not present on his foot. Nails shape is usual n color of it is pinkish whitish. Lymph nodes palpation was carried out in the region of submental, submandibular, anterior cervical, posterior cervical, supraclavicular, anterior parotid and popliteal groups. In all of these groups, their sizes varies from 0.5-1.5 cm in diameter, round form with smooth surface, elastic consistence, mobile, not adhered to the skin. Skin over them is not changed. Painless on palpation. Head is round and symmetry. Facial part and membranous part is proportionate. Hair covering is usual, thin type and clean. Face-is symmetry. No swelling is observed. Facial expression is impressive. Eyes- width of eyes is moderate with usual shape. Lacrimation discharged is usual. Positive reaction of pupil in response to light. Nose- sharp nose shape with no external discharge. Bleeding is not observed.

Throat- tonsils is present with usual size, about 1.5-2cm. Voice is low pitch. Ear- bilateral position with soft characteristic of pinna. Hearing is moderate. Neck-is mobile, able to support the head. Thyroid gland is not palpable. Isthmus is painless. Muscles, bones and joints-general development of muscle is good. Tone and muscle force of both upper and lower extremity is good and identical on both sides. Tenderness of the extremities muscle during palpation is marked. Parts of the skeleton are proportional. Palpation and tapping of the bone are painless. Spine deformity is absent. Movements of joints is not limited. On other parts, joints are of regular shape, painless during palpation and movement. Thorax and its organs Form of chest is regular and symmetric. Normostenic constitution. Supraclavicular fossa is normally pronounced. Respiration type is thoracic. Breathing is rhythmic, deep. Respiration rate is 16/min. Inspiration and exspiration are equal. Vocal fermitus is of moderate intensity in all the symmetrical points in front, on lateral sides and on back. Palpation of ribs is painless with no displacement detected. Space between each rib is regular on both sides. On palpation of scapula, symmetrical position of scapula angle is noted at the 7th thoracic vertebra. Painless. Topographical percussion of lung; Upper border of lung apices is 3.5cm above clavicle on both sides. Upper border of lung apices from the back is on the level of spinous process of the 7th vertebra. Lower border of lungs are as follows: Topographic line Parasternal line Midclavicular line Anterior axillar line Mid axillar line Posterior axilar line Scapula line Paraspinal line Right lung 5th intercostals space 6th intercostals space 7th intercostals space 8th intercostals space 9th intercostals space 10th intercostals space 11th intercostals space Left lung 7th intercostals space 8th intercostals space 9th intercostals space 10th intercostals space 11th intercostals space

On comparative percussion on the lungs, clear lung sound is heard over symmetrical points. Traubes space gives tympani.

Excursion of the lower border of lung is as follows: Topographic line Midclavicular Midaxilar Scapular Right lung 5cm 7cm 5cm Left lung 7cm 5cm

On auscultation of lungs, bronchial breathing is heard over larynx, trachea, point of trachea bifurcation, in the lower lateral parts of the chest and under scapula to the right. Both inspiration and expiration can be heard, but expiration sounds becomes louder, harsh and longer. No pathological sound is heard during auscultation. In vesicular breathing, during inspiration, it gives a long soft(blowing) noise, and on expiration, vesicular breathing is heard only during 1/3 of this phase. No pathological sound is heard during auscultation. Cardiovascular Apex beat is palpated in the 5th intercostals space, 1-2 medially of left midclavicular line. It is restricted.

Percussion on the heart. On percussion of the heart, right border of relative cardiac dullness is situated medially from right parasternal line. The upper border of relative cardiac dullness is on the left 2nd intercostals space, whereas the left border of relative cardiac dullness is situated on the 1cm laterally from left midclavicular line. The right absolute cardiac dullness is situated along the left edge of the sternum. Upper border of the absolute cardiac dullness is on the level of 4th rib. Left border of the absolute cardiac dullness is 1cm laterally from left midclavicular line. The border of aorta is displaced 1cm laterally from the right edge of sternum, whereas the border of pulmonary trunk is along the edge of the left sternum. Auscultation of heart. On mitral valve- I sound is louder than II sound in 2x. Their rhythm is regular. Theres absence of splitting and reduplication sound. On aortic valve- II sound loudness I almost similar to the I sound. Their rhythm I regular. Theres absence of splitting and reduplication sound. On pulmonary trunk valve- II sound is equal to I sound. Their rhythm is regular. Theres absence of splitting and reduplication sound. On tricuspid valve- I sound is louder than II sound in 2x. Their rhythm is regular. Theres absence of splitting and reduplication sound. Theres absence of heart murmurs. Abdomen and abdominal wall Abdomen is distended. On auscultation, peristaltic sound can be heard. Urinary system. The right and left kidney is not palpable. This is a normal situation. On deep palpation, the morbidity in the kidney ureter points is ve. Pasternatsky symptom is ve from both sides.

INITIAL DIAGNOSIS Presence of fever up to 39.6 degrees,nausea and vomitting. Patient also suffered from watery-diarrhea.Stool was covered with mucous. So it is indicated that the patient is having Acute Shigellosis. ADDITIVE TESTS BLOOD TEST Hemoglobin Erythrocyte Colour index Leucocytes Eosinophils Stab Segmented Lymphocytes Monocytes 22 march 104 g/l 3.4 x 1012 /l 0.9 8.2 x 109 /l 0% 37% 30% 29% 5% 29 march 139 g/l 4.4 x 1012 /l 0.95 5.6 x 109 /l 3% 4% 68% 20% 5%

Conclusion: Blood analysis shows that present bacterial infection. URINE TEST

Colour yellow transparent Density 1.014 Epithelial cells 2-3 Leucocytes -1-2 Conclusion : Urine test ic normal. BACTERIOLOGICAL COPROCYTOGRAMM 22 march Microscopy ColorConsistenceShapeMucusLeucocyte Erythrocytes Fatty acid brown fluid not made out ++ cover visual field 8-15 v/f Moderate 29 march brown fluid porridge type ++ 4-6 v/f moderate

Conclusion : presence of many liquid and present of mucus. Characterized collitic syndrome . SEROLOGICAL Bacteria examination : Shigella Sonnei Swab no 7013 (1st) Sensitive to anatoxin,cefatoxin, gentamycin, norfloxacin. Swab no 6999 (2nd) : DIFFERENTIAL DIAGNOSIS 1. PAIN ACUTE APPENDICITIS Localized in right iliac region. Pain is acute, piercing. Coughing increases pain. Nausea precedes vomiting. I st-vomit is reflex in nature.II & III st-depend on expressiveness of peritonitis & intoxication. Infrequent SALMONELlOSIS Localised in umbilical region. Pain is cramping characteristic. Nausea precedes vomiting sometimes.

2. NAUSEA & VOMITING

3. STOOL

Watery diarrhea. Coprocytogramm shows enteric syndrome.

FINAL DIAGNOSIS: Patient has Acute Shigellosis (Shigella Sonnei) Collitis syndrome severe form TREATMENT a) regime ward b) rehydration therapy Dehyration Isotonic NaCl 0.9%, Ringer Sol, Trisol(Philip) Sol 1 Glucose 5% 1

Water Salt

1 2-3

2 1

Oral rehydration I Stage (4-6 Hours) Compensation of fluid and electrolyte. I = 400ml 4-6 Hours II = 400ml 18-20 Hours c) Drugs 1.Rp.: Ceftriaxoni 0.5 D.T.D N10 S. To dissolve in 100ml physiological solution,IV in drops every 6 hours 2.Rp.: Amikacini 0.125 D.T.D N10 S. 0.25 IM/IV 2t/d 3.Rp.: Supp. Nystatini 250000 UA D.T.D N20 S. 1 Supp per rectum 2t/d