Shigellosis in children: a prospective hospital based study
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P Dutta1, S K Bhattacharya, D Sen
1National Institute of Cholera and Enteric Diseases, Calcutta.
Abstract:
From 1985 to 1988, fecal samples of 950 hospitalized children suffering from diarrhea or dysentery were screened for Shigella species using standard methods. Shigella species were isolated as sole pathogen from 192 (20.2%) cases and S. flexneri type 2 was the predominant serotype. Shigella infection was prevalent throughout the year with high isolation rate during the summer and early monsoon months. Shigella strains isolated during the period were resistant to most of the commonly used drugs for the treatment of shigellosis. Nearly 16% of the Shigella strains were also resistant to nalidixic acid. Presence of blood and mucus in stools (dysentery) was the common clinical presentation of shigellosis cases. Malnutrition was associated with longer duration of illness. High cases fatality rate (16.7%) was observed among hospitalized children infected with Shigella.
Insights
Shigella infections in hospitalized children caused significant illness and high fatality rates. Most isolated Shigella strains showed resistance to common antibiotics, posing treatment challenges.
Area of Science:
- Microbiology
- Pediatrics
- Infectious Diseases
Background:
- Shigella species are a major cause of bacterial dysentery and diarrhea globally.
- Antibiotic resistance in Shigella poses a significant public health threat, complicating treatment strategies.
Purpose of the Study:
- To investigate the prevalence, serotypes, antimicrobial resistance, and clinical outcomes of Shigella infections in hospitalized children.
- To identify risk factors associated with Shigella infection and its severity.
Main Methods:
- Fecal samples from 950 hospitalized children with diarrhea or dysentery were analyzed between 1985 and 1988.
- Standard microbiological methods were employed for Shigella isolation and serotyping.
- Antimicrobial susceptibility testing was performed on isolated Shigella strains.
Main Results:
- Shigella species were identified as the sole pathogen in 20.2% of cases, with S. flexneri type 2 being the predominant serotype.
- Shigella infections occurred year-round, peaking in summer and early monsoon months.
- A high prevalence of resistance to commonly used antimicrobial drugs was observed, with 16% of strains resistant to nalidixic acid.
- Dysentery (bloody, mucus-filled stools) was a common clinical presentation.
- Malnutrition was linked to prolonged illness duration.
- A case fatality rate of 16.7% was recorded among infected hospitalized children.
Conclusions:
- Shigella infections represent a significant cause of morbidity and mortality in hospitalized children.
- Widespread antimicrobial resistance among Shigella strains necessitates careful drug selection for treatment.
- Prompt diagnosis and management are crucial, especially in malnourished children, to reduce mortality.