Self-Assessment Questions (SAQs) for Study Session 34

Answer

• a.The diseases that you should suspect as causes of bloody diarrhoea are shigellosis (bacillary dysentery) and amoebiasis (amoebic dysentery).
• b.The diseases that you should suspect as causes of watery diarrhoea include cholera or a viral diarrhoeal disease (although rotavirus infection is not common in adults).
• c.If the patient describes his condition as greasy diarrhoea, you should suspect giardiasis.

Irrespective of the type of diarrhoea, the adult patient should be started on rehydration with ORS and referred to a higher level health facility for laboratory investigation and treatment.

Answer

• a.Your diagnosis is infection with ascaris worms (ascariasis). You should treat the five-year-old child with 1 tablet of albendazole (400 mg) or 1 tablet of mebendazole (500 mg) to be taken orally.
• b.You should also give health education to the mother and the community on measures to interrupt faeco-oral transmission via hand-to-mouth transfer of the ascaris eggs from the soil, and prevention of transmission in contaminated water and food. Using latrines, safe disposal of faeces, and avoiding open defaecation in fields prevents contamination of soils with faeces containing the worm eggs.

Answer

• a.The common causes of anaemia to be considered include malaria, malnutrition, a recent history of bleeding, and hookworm infection.
• b.The evidence that suggests hookworm infections is the absence of other obvious causes (e.g. if malaria is not locally endemic, or the malaria rapid diagnostic test is negative), and the presence of risk factors for hookworm – walking barefooted in areas where faeces contaminate the soil.
• c.Whatever the cause, refer Abebe to a higher level health facility for laboratory diagnosis and treatment if he has hookworms, or diagnosis of another cause, and treatment for his anaemia.

Answer

Some differences between amoebiasis and shigellosis are:

• Amoebiasis is more common in young adults, but shigellosis is more common in children below ten years
• Amoebiasis is an endemic disease that rarely causes an epidemic, whereas shigellosis (though also endemic) can rapidly spread and cause an epidemic
• The bloody diarrhoea in amoebiasis contains some formed stools, but in shigellosis only blood and mucus comes out when the patient strains to defaecate
• A patient with amoebiasis is rarely ill enough to remain in bed, whereas someone with shigellosis may be bedridden due to severe dehydration.

Answer

• a.The route of exit for the eggs of ascaris worms and hookworms is the same – with the faeces. Prevention and control measures that are common to both diseases are use of latrines, safe disposal of faeces, and avoiding open defaecation in fields. This prevents contamination of soils with infected faeces. Another similarity is that routine deworming of children aged two to five years every six months with albendazole or mebendazole reduces the reservoir of both diseases in the community.
• b.The difference is that the route of entry for ascariasis is through the mouth, while for hookworm infection it is through the skin, usually on bare feet. Prevention and control measures for ascariasis involve prevention of hand-to-mouth transmission of the infectious agents, and avoiding contamination of food and drinking water. In addition, to the measures described in (a), prevention and control measures for hookworm include wearing shoes.