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Noticed spots of blood in stool of 3 1/2 months child. Test showed mucus and pus cell in stool. Help?

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My baby is 3 1/2 months old. A week back we noticed small strands / spots of blood in her stool. There was mucous as well. She was passing stool 6-7 times a day and 4-5 times were watery. She did not pass blood in all the stool but only 2-3 times. When we showed her to pediatrician, she recommended antibiotic (Taxim O). We gave her the course for 5 days. But it did not help. On 7th day, in the morning she vomited. In the evening, again right after 2 consecutive feeds, she vomited. Emergency doctor recommended Emeset before feeds thrice daily. Also, we got USG (full abdomen) and Stool routine done. USG was ok. Stool routine showed presence of mucous and 4-5 hpf pus cells. Color was greenish and acidic. Presence of occult blood, cyst or ova was not noticed. Today is 9th day. We tried taking her off Emeset, but she vomited again. She is cranky and less cheerful since last 2 days. Another doctor has prescribed Secef Dt along with metrogyl for 5 days. I am little sceptical in giving the same antibiotic again which did not help earlier. Could you please help?
Posted Fri, 31 Aug 2012 in Child Health
Answered by Dr. Taher Kagalwala 4 hours later

I can understand your skepticism. I agree with you and would not use cefixime again. It is necessary to first remember that 4-5 pus cells per high power field does not prove the presence of a bacterial infection. A stool culture should be done to confirm that there is a bacterial infection, to identify the bacteria and to ascertain which antibiotic will be the most appropriate for your baby.

The culture results may take 3-7 days but it will be worth it. In the meantime, you can try simple co-trimoxazole syrup, which is underused in India, and will likely work. A brand name I can suggest is Septran. The dose will approximately be 0.5 ml per kg of her weight. For example, if she is 4.0 kg, give her 2 ml, twice a day, for six days.

Metrogyl is not recommended. I am sure your baby is only on milk, and amoebiasis is not a concern in such a small child. Stop it if you have started it.

I am wondering if the blood that you saw in the first few days was mixed with the stool or due to soreness of the nappy area of her buttocks ... it seems that there is no more blood in her stools, so rest easy.

Please revert to me with the following additional data: her birth weight, her present weight, whether she has fever or had it any time in the last week, what feeds is she on, and is her urine output normal.

Thank you and wish your baby a speedy recovery.

- Dr. Taher
Above answer was peer-reviewed by
Follow-up: Noticed spots of blood in stool of 3 1/2 months child. Test showed mucus and pus cell in stool. Help? 6 hours later
Thanks Doctor. Her birth weight was 4 Kgs. Currently she is 7.5 kgs. While she has not gained weight in last 10 days, she has not lost either. She did not have fever anytime in the last week. She is on breast milk completely. Her urine output is slightly lesser in last 2 days but not too less.

The blood in stool has been infrequent. It has not happened since yesterday. We had checked the nappy area. While it was reddish, we did not see sign of any cuts / bruises.

The doctor who recommended antibiotic + metrogyl, said he suspected amoebiasis because of the symptoms. He ruled out giardiasis since we had given her Taxim O and it didn't work. He had checked the stomach and it was soft. There was no hardness / lump and the stomach was not bloated as well. His reasoning was that though amoebiasis is not common in such small child, she could have got it from licking bedsheet / covers / clothes / her own hands etc.

My biggest concern currently is her vomits. Everytime we feed her, we are in the fear that she will cough and then vomit out everything she has had. 2 hours back when she got up from sleep, she was crying because of hunger. My wife gave her feed immediately without giving her morning dose of emecet. The baby vomited a part of the milk 15 minutes post feed.

I was also wondering if she could have milk allergy. Should we stop breast milk for a couple of days and see?

I will get stool culture done XXXXXXX (today being a public holiday in India) but the results can be expected 5 days from then.
Answered by Dr. Taher Kagalwala 1 hour later

I am sorry for a little delay in replying, but the clock in Saudi Arabia is 2.5 hours behind IST. First of all, Happy Independence day to you and your family.

This is the first time I have heard of such a justification for amoebiasis. In any case, if metrogyl is giving some benefit, it's best you continue it. Add Septran if you can.

Coming to the vomiting. Breast milk allergy is an imaginary illness for all practical purposes. There is a very, very rare congenital lactase deficiency where babies will not accept any animal milk, including human milk. Otherwise, it stands to reason that humans cannot be allergic to human milk! Even if we assume that there is lactase deficiency (just as a hypothesis), the main problem will be indigestion of milk and loose stools, not vomiting. Hence, forget about this for the moment.

I guess you will have to be a lot more careful about giving Emeset before feeds ... try not to feed her without this. If the vomits continue in spite of this, switch over to Domstal Baby drops, giving her about 8 drops three times a day. However, to my mind, she will settle down within a few days with your current medicine and a switch over may not be needed.

Her weight was high at birth. If this is the norm in your family or your spouse's, it's okay, but otherwise, Indian babies are about 2.8-3.5 kg at birth. Was there pregnancy diabetes in your wife? That could explain the higher birth weight. Her weight gain in the first 100 days of life has been excellent. I would not worry that she has not put on any weight in the last week, as she is unwell. Kindly continue to monitor her weight at least twice a week as long as she is ill, and then, once a month.

I suggest that you also put her on oral Zinc syrup. This is now a WHO-recommended therapy for all children with gastro problems. There are many brands of oral zinc syrups available in the market. I would suggest you speak to her pediatrician and start one of those - e.g. Zinsy, Z and D drops or similar.

To summarise: her growth is all right. Add Septran. Continue emeset for the time being. Get her stool culture done (major hospitals may accept the sample despite this being a public holiday). Continue breastfeeding and Metrogyl.

Thank you once again. I will be next online after 5 hours as I am going to the hospital for work. If you need me urgently, please call me directly on my cell number which is on my profile.

- Dr. Taher
Above answer was peer-reviewed by
Follow-up: Noticed spots of blood in stool of 3 1/2 months child. Test showed mucus and pus cell in stool. Help? 2 hours later
Thanks Dr. Taher. This clears up a lot on my next course of action. Just a few additional questions:

1. Will Metrogyl and Septran affect the Stool culture results? If yes, should I not give the same to her till I initiate stool culture test?

2. I had given first course of metrogyl + secef DT yesterday night. Today she had stool with a chunk of mucuos (mucous amount more than usual). Is that ok? Also, as I understand, your advice is to atleast stop the secef DT while we might continue metrogyl if it is helping.

3. She has her vaccination due on 20th August. I have heard that during infection, we can't vaccinate. Will there be any issue if the vaccination is delayed by 1 or 2 weeks?

4. We had put her on zinc drops (Z&D) in last few days. But whenever we give it her, she is drowsy throughout the day. Is it ok?

5. Will Septran have any side effects or can be taken without any worries till stool culture results are out?

6. I have heard about cow milk protein allergy in breast-fed babies wherein mother's taking cow milk can have same kind of effects in baby? Is it a possibility or the same can be ruled out?

Sorry for being so inquisitive but she being my first baby probably I am worried more than others.
Answered by Dr. Taher Kagalwala 1 hour later

Thanks for reverting. Your inquisitive nature is, in fact, helping me brush up on my counselling skills! ;-)

1. If you start metrogyl today, no effect on cultures, as we are testing for bacteria and metrogyl will work on amoeba. You could collect the sample early tomorrow and then start the Septran.

2. Yes. You understood correctly.

3. No worries for vaccines. If she is still having diarrhoea or liquid stools, you should delay the vaccines by a week. Otherwise, for mild fever, cough or cold, there is no need to delay vaccination.

4. Zinc has nothing to do with drowsiness ... it is a nutritional product. It is probable that the effect you saw was due to other factors. You can safely use zinc for 10-14 days.

5. Technically, any medicine can have side effects ... if you google co-trimoxazole and then decide you will get so scared you will never be able to use any medicine! On practical grounds, there are no major side effects unless there is a strong history of sulpha allergies in your or your spouse's family. If this is positive, don't use Septran, Otherwise ... no problems.

6. Yes, what you say is possible, but does not necessitate withdrawal of breast feeding. If you have a fear of this, switch over the mom to buffalo's milk.

Hope that answers all your queries point-wise.

With best wishes,

Dr. Taher
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