Factors Associated With Mortality in Toxic Encephalopathy Due to Shigellosis in Children

To study the clinical characteristics and factors associated with mortality among children with Shigella encephalopathy.

The data collection was done prospectively from January, 2018 to May, 2019 with retrospective data from June, 2016 to December, 2017. The study cohort consisted of 58 children <12 years of age with Shigella encephalopathy admitted to the pediatric intensive care unit. Shigella encephalopathy was confirmed if culture or real time polymerase chain reaction (PCR) of a stool sample or rectal swab was positive, with temporal association of diarrhea with seizures, altered sensorium or both. Association of mortality with risk factors was tested using chi square test, and the strength of association was estimated in terms of relative risk (RR) and 95% CI.

Seizures and altered sensorium were the predominant neurological symptoms. Shock occurred in 32 (55%) children, while blood in stools was a feature in only 6 (10%) children. S. sonnei was the commonest species identified on stool culture (19;33%). On univariate analysis, prolonged seizures, shock, prolonged altered sensorium, multi-organ dysfunction, lymphocytopenia at admission and need for mechanical ventilation were significantly associated with mortality. On multivariate regression, delayed presentation (presentation to the hospital 48 hours after the onset of symptoms) and prolonged altered sensorium (>12 hours) were found to be independently associated with mortality.

Recognition of factors associated with mortality in Shigella encephalopathy may assist in better monitoring of sicker children and improved outcomes.