Question
A 5-year-old girl was brought in by her mother with the symptoms of fever, vomiting (7-8 episode
- (a) What is the clinical diagnosis. (
- (b) Name SIX common probable causes of this clinical condition. (
- (c) Name two rapid tests to detect these causes. (
- (d) What are the confirmatory tests that can be done in the laboratory. (e) Name the antimicrobial given empirically for this condition.seen. (f) Give details of vaccines available for these microbial agents. Name two other drugs which can be used for treating this condition”.(sub (1+3+2+2+2+1+4) g)Give details of vaccines available for these microbial agents.
Answer
(a) Clinical diagnosis: Acute infectious (viral/bacterial) gastroenteritis — fever with repeated episodes of vomiting is the clinical picture described.
(b) Six common probable causes:
- Rotavirus.
- Norovirus.
- Escherichia coli (enterotoxigenic/enteropathogenic strains).
- Shigella species.
- Salmonella species (non-typhoidal).
- Vibrio cholerae.
(c) Two rapid tests to detect these causes: Rotavirus antigen detection (ELISA/immunochromatographic rapid card test) on stool, and a stool rapid antigen test for adenovirus/norovirus (immunochromatographic card test) — both provide rapid point-of-care results.
(d) Confirmatory laboratory tests:
- Stool culture — for bacterial pathogens (Salmonella, Shigella, Vibrio cholerae), on appropriate selective media (e.g., MacConkey, XLD, TCBS).
- ELISA for rotavirus antigen — confirmatory for rotavirus.
- RT-PCR — for viral pathogens (rotavirus, norovirus), the most sensitive confirmatory method.
- Stool microscopy — for pus cells/red cells and ova/cysts, to help distinguish inflammatory (invasive bacterial) from non-inflammatory (viral/toxin-mediated) diarrhoea.
(e) Antimicrobial given empirically: in a child presenting predominantly with vomiting, viral aetiology (rotavirus) is most likely and antibiotics are generally not indicated; however, if bacterial dysentery is suspected clinically (e.g., bloody stools), Azithromycin or Ciprofloxacin (in older children) is commonly used empirically pending culture results. The mainstay of management regardless of cause is oral rehydration therapy (ORS) and, if needed, IV fluids, rather than empirical antibiotics for uncomplicated presumed viral gastroenteritis.
(f) Vaccines available and other drugs:
- Vaccines: Rotavirus vaccine (oral, live attenuated, part of the national immunization schedule) — the principal vaccine-preventable cause among those listed; typhoid conjugate vaccine also offers indirect protection relevant to enteric pathogens broadly, though it targets Salmonella Typhi specifically rather than non-typhoidal gastroenteritis agents.
- Other drugs for treatment: Zinc supplementation (reduces duration/severity of diarrhoeal illness in children, as per WHO/UNICEF recommendation) and ORS (oral rehydration solution) — the cornerstone of management, alongside antiemetics (e.g., ondansetron) used cautiously for symptomatic relief of vomiting.
(g) Vaccine details (repeated per question structure): the Rotavirus vaccine is a live, oral, attenuated vaccine included in India’s Universal Immunization Programme, administered in a multi-dose schedule (typically 3 doses) starting at 6 weeks of age, significantly reducing the incidence of severe rotavirus gastroenteritis and associated hospitalization/mortality in young children.