Tade had been treating herself for 5 days with metronidazole for what she assumed was stomach infection. The diarrhoea had blood in it and she was feverish. Mascot Healthcare cultured the stool and found the actual pathogen — Campylobacter — which needed a completely different antibiotic.
Secondary school teacher, Mushin. Presented with 5-day history of crampy diarrhoea with blood and mucus, fever of 38.4 °C, and severe lower abdominal pain. Had completed a self-prescribed course of metronidazole without improvement. Stool MCS confirmed Campylobacter jejuni.
Infective Enterocolitis (Campylobacter jejuni)Tade had treated herself for "stomach runs" before with metronidazole — and it had always worked. This time was different from the start: there was blood in the stool from day one, and by day three she had a fever that paracetamol barely controlled. But she persisted with the metronidazole.
On day five, a colleague who was a nurse told her: "Blood in stool with fever is different — that's not ordinary stomach upset. You need to see a doctor today." Tade came to Mascot Healthcare that afternoon.
The doctor examined her. The abdomen was tender in the left iliac fossa and periumbilical area. Stool MCS was sent urgently. Blood tests showed a white cell count of 14.2 × 10⁹/L and CRP 87 mg/L — significant systemic inflammation. The stool culture result at 48 hours: Campylobacter jejuni, sensitive to azithromycin.
Infective enterocolitis (inflammatory bowel infection) presents with bloody or mucoid diarrhoea, fever, and cramping — indicating an invasive bacterial pathogen, not a simple viral gastroenteritis.
Diarrhoea containing blood and mucus — 5–8 episodes daily; the blood was a red flag.
Intense cramping centred in the lower abdomen and left iliac fossa.
Systemic fever indicating invasive infection — beyond simple viral gastroenteritis.
A persistent urge to pass stool even when the bowel was empty — a sign of rectal/colonic inflammation.
Five days on metronidazole — no improvement; Campylobacter is resistant to metronidazole.
Metronidazole TDS × 5 days — appropriate for amoebiasis and Giardia; not effective for Campylobacter.
Loperamide (Imodium) — contraindicated in bloody diarrhoea with invasive infection; can worsen the condition.
ORS and water — appropriate; insufficient alone.
Paracetamol — appropriate for fever control.
A targeted course of medication was prescribed based on the sensitivity result — the preferred treatment for Campylobacter enteritis. IV fluids were given for rehydration (oral intake had been poor). Blood tests were repeated at 72 hours — WCC normalised.
Tade was advised: no anti-diarrhoeal medication during the acute illness; ORS for fluid replacement; hand hygiene to prevent household spread (Campylobacter is faecal-oral transmitted); food safety review (source likely undercooked chicken or contaminated food).
A follow-up stool culture at 2 weeks confirmed clearance.
Infective Enterocolitis — Campylobacter jejuni (stool MCS confirmed; WCC 14.2, CRP 87)
Targeted course of medication; IV fluids; ORS; no anti-diarrhoeal medication; hand hygiene; follow-up stool culture
Diarrhoea resolving by day 2 of treatment. Fever cleared at 48 hours. Stool culture at 2 weeks: negative.
Complete resolution within 4 days of starting treatment. Follow-up stool culture confirmed clearance. Tade identified a shared meal at a school function as the likely source.
Bloody diarrhoea with fever is not the same as ordinary gastroenteritis. It requires medical assessment, stool culture, and targeted antibiotic therapy — not self-prescribed metronidazole.
Loperamide should never be taken when diarrhoea contains blood. It is safe for simple diarrhoea — dangerous in inflammatory enterocolitis.
Blood in diarrhoea means you need a stool test, not just metronidazole. The right antibiotic depends on what's causing it.
Book an appointment at Mascot Healthcare, Akoka — same-day slots often available, 4.9★ rated.