Acute non-outbreak shigellosis: ten years experience in southern Taiwan

We conducted a retrospective study of both the clinical and laboratory characteristics of shigellosis in southern Taiwan.

We collected shigella dysentery cases at Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital from 1996 to 2005. Fifteen children and twelve adults were enrolled and their clinical presentations analyzed.

Watery diarrhea (63.0%) was the most prevalent symptom in this study. Although the C-reactive protein (CRP) level was higher in patients with bloody diarrhea than those with watery diarrhea (123.5 +/-73.4 mg/L vs. 40.5 +/-36.7 mg/L, p= 0.005), there was no significant difference in the hospital stay (p= 0.072) and total number of days with fever (p= 0.981) between these 2 groups. The white blood cell (WBC) and neutrophil counts were significantly lower in patients with Shigella flexneri (S. flexneri) than those with Shigella sonnei(S. sonnei) enterocolitis (p= 0.038 and p= 0.001). WBC counts lower than 13,500/ mm(3) (OR = 3.17, 95% CI: 1.63-6.14, p= 0.005) and neutrophil counts lower than 9,400/ mm(3) (OR = 12.00, 95% CI: 1.16-123.68, p= 0.030) were more likely to be encountered in infections caused by S. flexnerithan S. sonnei. Resistance was highest to trimethoprim-sulfamethoxazole (TMP-SMX) (56%), with ampicillin (28%) second. There was no significant difference between children and adults in total number of days with fever (p= 0.532), incidence of bloody diarrhea (p= 1.000), WBC count (p= 0.177), CRP level (p= 0.858), or hospital stay (p= 0.734).

Shigellosis should be considered in patients with watery diarrhea even without a contact history. There were lower blood WBC and neutrophil counts in S. flexneithan in S. sonneienterocolitis. TMP-SMX and ampicillin should be used cautiously because of high resistance. There were no specific differences in the clinical and laboratory presentations between children and adults with shigellosis.