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Chronic vulvovaginitis caused by antibiotic-resistant Shigella flexneri in a prepubertal child
Maria Baiulescu1, Patricia R Hannon, John F Marcinak
1Department of Pathology, University of Illinois College of Medicine, Chicago, IL 60612, USA.
Insights
A prolonged Shigella flexneri vulvovaginitis infection in a child was resistant to multiple antibiotics. Ciprofloxacin successfully treated the persistent infection after other therapies failed.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gynecology
Background:
- Vulvovaginitis is a common pediatric condition, often caused by bacterial or fungal pathogens.
- Shigella flexneri, typically an enteric pathogen, is an uncommon cause of vulvovaginitis in children.
- Prolonged or recurrent vulvovaginitis can significantly impact a child's quality of life.
Observation:
- A 7-year-old girl presented with a 3-year history of symptomatic vulvovaginitis.
- Symptoms included intermittent vaginal bleeding, dysuria, and foul-smelling vaginal discharge.
- The patient had received multiple courses of antibiotics including ampicillin, trimethoprim-sulfamethoxazole, cefixime, and amoxicillin/clavulanic acid without resolution.
Findings:
- Cultures confirmed the presence of Shigella flexneri as the causative agent.
- The infection demonstrated resistance to several commonly prescribed antibiotics.
- A 14-day course of ciprofloxacin ultimately eradicated the Shigella flexneri infection.
Implications:
- This case highlights Shigella flexneri as a potential, albeit rare, cause of persistent pediatric vulvovaginitis.
- It underscores the importance of appropriate microbiological diagnosis in refractory cases of vulvovaginitis.
- Ciprofloxacin may be an effective treatment option for antibiotic-resistant Shigella flexneri vulvovaginitis in children.
Abstract:
A 7-year 8-month-old girl was diagnosed with a prolonged course of vulvovaginitis caused by Shigella flexneri. The child was symptomatic with intermittent vaginal bleeding, dysuria and foul smelling vaginal discharge for a 3-year period. Initial attempts to resolve the infection with successive courses of antibiotic therapy using ampicillin, trimethoprim-sulfamethoxazole, cefixime and amoxicillin/clavulanic acid failed. The child's infection was finally resolved by a 14-day course of ciprofloxacin.