Enteric fever and invasive bacterial enteritis — branching viva

Opening (2-3 minutes)

Examiner: Two children with fever and abnormal stools. Walk me through how you separate them. ^[1]

Strong answer: I separate invasive from non-invasive disease. The 9-year-old has a stepwise fever with relative bradycardia, constipation and abdominal pain after travel to Pakistan — that is enteric fever until proven otherwise, and I draw blood culture before antibiotics. The 4-year-old has bloody diarrhoea with little fever after a farm visit — that is Shiga-toxin producing E. coli colitis until I prove otherwise, and I send stool, watch for haemolytic uraemic syndrome, and avoid routine antibiotics. ^{[1] [12]}