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Shiga bacillus dysentery associated with marked leukocytosis and erythrocyte fragmentation
Abstract:
Granulocytic leukemoid reactions (white blood cell counts greater than 50,000 with myelocytes and promyelocytes in the peripheral blood) were documented in 15 per cent of 273 patients with dysentery due to Shigella dysenteriae, type 1 (Shiga bacillus) in Bangladesh. Peak granulocytosis occurred during the second week of illness, when the children were commonly afebrile and diarrhea had ceased or was subsiding. More than half of the patients with leukemoid reactions subsequently developed a fall in hematocrit associated with striking erythrocyte fragmentation on blood smears. Thrombocytopenia occurred during the period of hemolysis in most. Transient oliguric renal failure developed in several patients. Most made a complete recovery. The pathogenesis of the syndrome and the reason for its high incidence were not determined.
Insights
Shigella dysenteriae type 1 infection in Bangladesh caused granulocytic leukemoid reactions in 15% of patients. This often led to anemia, hemolysis, thrombocytopenia, and transient renal failure, though most recovered.
Area of Science:
- Infectious Diseases
- Hematology
- Pediatrics
Background:
- Dysentery caused by Shigella dysenteriae type 1 (Shiga bacillus) is a significant public health concern.
- Granulocytic leukemoid reactions, characterized by elevated white blood cell counts with immature granulocytes, are not fully understood in the context of bacterial infections.
Purpose of the Study:
- To investigate the incidence and clinical manifestations of granulocytic leukemoid reactions in children with Shiga bacillus dysentery.
- To describe the hematological and renal complications associated with these reactions.
Main Methods:
- Retrospective analysis of 273 patients with Shigella dysenteriae type 1 dysentery.
- Documentation of white blood cell counts, peripheral blood smear findings, hematocrit, and renal function.
- Clinical observation of patient recovery.
Main Results:
- Granulocytic leukemoid reactions were observed in 15% of patients.
- Peak granulocytosis occurred in the second week of illness, often as fever subsided.
- Over half of patients with leukemoid reactions experienced decreased hematocrit, erythrocyte fragmentation, and thrombocytopenia. Transient oliguric renal failure was noted in several cases.
Conclusions:
- Shiga bacillus dysentery can precipitate a complex hematological syndrome including leukemoid reactions, hemolysis, and thrombocytopenia.
- While most patients recovered, the underlying pathogenesis and high incidence of this syndrome remain unclear.