Acute intestinal infections accompanied by hemocolitic syndrome (acute bloody diarrhea, or dysentery) in children remain a significant global health challenge. Diarrheal diseases are a leading cause of pediatric morbidity and mortality worldwide, accounting for an estimated 444,000 deaths annually in children under 5 years of age​. A substantial subset of these severe cases involve bloody diarrhea, which typically indicates invasive infection and carries higher risks of complications than non-bloody diarrhea. Globally, Shigella – the bacterium causing bacillary dysentery – is a primary etiologic agent of acute bloody diarrhea in young children and is responsible for a considerable portion of diarrheal deaths and illness episodes in this age group​. Estimates suggest Shigella causes on the order of 75,000 deaths in children under 5 each year and hundreds of thousands of cases across all ages​. Other pathogens such as Enterohemorrhagic Escherichia coli (EHEC), Campylobacter, and Entamoeba histolytica also contribute to pediatric hemocolitic syndrome, further underlining its global importance. Campylobacter infection, for example, is one of the most common causes of bacterial gastroenteritis worldwide and frequently leads to bloody diarrhea in young children​. Acute bloody diarrhea not only can result in life-threatening dehydration and sepsis, but also may cause long-term effects such as malnutrition, growth faltering, or renal injury (in cases complicated by hemolytic-uremic syndrome). Given the substantial disease burden and the potential for severe outcomes, optimizing the understanding of pathogenesis and improving treatment strategies for hemocolitic syndrome in children is highly relevant to global child health.

Acute intestinal infection; Hemocolitic syndrome; Bloody diarrhea; Dysentery; Children; Etiopathogenesis; Treatment optimization; Global health

World Health Organization (WHO). Diarrhoeal Disease. WHO Fact Sheet, updated 2 April 2023. (Key statistics on childhood diarrhea incidence and mortality; defines dysentery as acute bloody diarrhea and emphasizes ORS and zinc in treatment.)

GBD 2016 Diarrheal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1211-1228. (Reports global burden of pediatric diarrhea; identifies Shigella as a leading cause of diarrheal deaths in young children and provides mortality estimates.)

Aslam A, Hashmi MF, Okafor CN. Shigellosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Feb. (Comprehensive overview of Shigella infection including epidemiology, pathophysiology, clinical features, and management; notes global incidence ~188 million and Shigella as the most common cause of dysentery in under-5 children.)

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World Health Organization (WHO). Escherichia coli (STEC) Fact Sheet. WHO Newsroom, updated 2018. (Details on Shiga toxin-producing E. coli infections; states that up to 10% of STEC cases progress to hemolytic-uremic syndrome and advises against antibiotics due to HUS risk.)

Zulfiqar H, Mathew G, Horrall S. Amebiasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jun. (Review of Entamoeba histolytica infection; describes clinical presentation of amoebic dysentery and its management with metronidazole.)

World Health Organization (WHO). Campylobacter. WHO Fact Sheet, 1 May 2020. (Global epidemiology of Campylobacter; highlights that Campylobacter is among the top causes of diarrheal disease and often causes bloody diarrhea in young children, with key preventive measures.)

Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017;65(12):1963-1973. (Evidence-based guidelines covering evaluation and treatment of diarrheal illnesses; includes recommendations on stool diagnostics, rehydration, antibiotic use in dysentery, and avoidance of antimotility drugs.)

Kotloff KL, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS). Lancet. 2013;382(9888):209-222. (Large case-control study in Africa and Asia; found Shigella to be a leading cause of moderate-to-severe diarrhea, particularly in toddlers, underscoring its significance in dysenteric illnesses.)

Khan WA, Seas C, Dhar U, et al. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin in a double-blind, randomized, controlled trial. Ann Intern Med. 1997;126(9):697-703. (Clinical trial in Bangladesh demonstrating that a 3-day course of azithromycin is as effective as ciprofloxacin for pediatric shigellosis; supports use of azithromycin in children.)

Traa BS, Walker CL, Munos M, Black RE. Antibiotics for the treatment of dysentery in children. Int J Epidemiol. 2010;39 Suppl 1:i70-i74. (Systematic review/Cochrane analysis on antibiotic therapy in childhood dysentery; concludes that appropriate antibiotics significantly reduce duration of illness and stool pathogen clearance time in Shigella dysentery.)