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What Causes Watery Diarrhea, Fever And Blood In Stool?

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Posted on Sat, 31 Jan 2015
Question: Hi. My 3 year old daughter started having watery diarrhea 2 weeks ago with fever of 102F for the first 2-3 days. On the 2nd day she had a streak of red blood in her stool which we attributed to a fissure. On the 6th day she was feeling much better but still had watery diarrhea 2-3 times per day, but this time it had about 2-3 tablespoons of red blood in the stool when I changed her diaper. Went to the hospital. They tested her for Rotavirus, C. Diff. and a stool culture. Everything was negative. Nothing grew in the culture after 72 hours. The following day, day 7, she had red jelly substance in her diaper. Went back to hospital. They did a CAT scan with and without contrast to check for intasusseption. Other than a thickening in her sigmoid colon probably due to inflammation from diarrhea, her abdominal CT was normal. CBC and Chemistries were normal. She was not anemic and is not loosing weight. The following day her stools started to firm up like the consistency of oatmeal. There was no visible blood. The stool has remained that way. Her pediatrician has repeated the culture and it was negative, but positive for white blood cells. As of today her stool is still the consistency of oatmeal going 1-3 times per day. The foul smell, cramping and fever have all gone and not returned. She does have a random streak of blood occasionally. We are seeing a pediatric gastroenterologist on Monday, but I am wondering what you think this could be?
doctor
Answered by Dr. Diptanshu Das (1 hour later)
Brief Answer:
Bacterial infection is the likely cause. Could also be viral

Detailed Answer:
Hi

Thanks for asking on HealthcareMagic.

I have gone carefully through the details provided by you. I am sorry to hear that your child is not doing fine. Since the stool contained white blood cells, it indicates that there was a possible bacterial infection which could be the likely cause of the blood in stool. It could also be related to the foul smell in stool and the associated fever. Occasianally, stool culture could be negative in spite of a bacterial infection. Rotaviral diarrhoea is generally not associated with bleeding but if that was due to anal fissue, it is a different issue.

I would like to know if antibiotics have already been given and if so, from when and how long. If antibiotics have not been prescribed, I would suggest a course of antibiotics to be given.

Since you mention that she is not losing weight, I would not consider malabsorption as a possible cause.

Hope that helps.

Regards
Dr. Diptanshu Das
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Diptanshu Das (1 hour later)
She has not been put on antibiotics. I am hoping that the pediatric gastroenterologist will consider doing that before invasive testing. Would it be normal to still have mucous tinged with red blood almost 2 weeks later? Thank you so much for your response. My greatest fear is that we will go to his office and he will want to do a endoscopy before trying other things.
doctor
Answered by Dr. Diptanshu Das (6 minutes later)
Brief Answer:
Antibiotics suggested

Detailed Answer:
Thanks for writing back. Although your doctor has a ground in not prescribing antibiotics till now, I would perhaps played safe and given antibiotics.
A colonoscopy would be more relevant in case of lower gastrointestinal bleeding as in her case, rather than upper gastrointestinal endoscopy.

Hope that helps.

If you found my answer helpful, please close the thread with a positive review and a 5 star rating.

Regards
Dr. Diptanshu Das
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Diptanshu Das (28 minutes later)
One more question.....Would you say that antibiotics should be give before a colonoscopy would be indicated? I really dont want her to have to go through a colonoscopy.
doctor
Answered by Dr. Diptanshu Das (10 hours later)
Brief Answer:
Dose of antibiotic not related to colonoscopy

Detailed Answer:
Thanks for writing back. Sorry for not being able to reply earlier.

I had suggested colonoscopy only because you mentioned endoscopy which is for upper gastrointestinal tract and so it was inappropriate. Otherwise probably I would not have suggested any of the two.

The course of antibiotics is independant of the decision of colonoscopy and so does not really matter whether given earlier or later. I was trying to rule out bacterial infection as a possible cause where this simple step could provide a solution. I would have suggested going for it before looking further.

Wishing for a quick recovery of your daughter.

Regards
Dr. Diptanshu Das
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3875 Questions

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What Causes Watery Diarrhea, Fever And Blood In Stool?

Brief Answer: Bacterial infection is the likely cause. Could also be viral Detailed Answer: Hi Thanks for asking on HealthcareMagic. I have gone carefully through the details provided by you. I am sorry to hear that your child is not doing fine. Since the stool contained white blood cells, it indicates that there was a possible bacterial infection which could be the likely cause of the blood in stool. It could also be related to the foul smell in stool and the associated fever. Occasianally, stool culture could be negative in spite of a bacterial infection. Rotaviral diarrhoea is generally not associated with bleeding but if that was due to anal fissue, it is a different issue. I would like to know if antibiotics have already been given and if so, from when and how long. If antibiotics have not been prescribed, I would suggest a course of antibiotics to be given. Since you mention that she is not losing weight, I would not consider malabsorption as a possible cause. Hope that helps. Regards Dr. Diptanshu Das