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The leukemoid reaction in shigellosis
Insights
In hospitalized shigellosis patients, leukemoid reactions were linked to young children and Shigella dysenteriae 1 infections. This condition significantly increased the case fatality rate, highlighting a critical health concern.
Area of Science:
- Infectious Diseases
- Hematology
- Pediatrics
Background:
- Shigellosis is a significant cause of diarrheal disease globally.
- Leukemoid reactions, an elevated white blood cell count, can occur during severe infections.
- Understanding factors associated with severe outcomes in shigellosis is crucial for public health.
Purpose of the Study:
- To investigate the association between leukemoid reactions and clinical outcomes in shigellosis patients.
- To identify specific Shigella serotypes linked to leukemoid reactions.
- To determine the impact of leukemoid reactions on the case fatality rate of shigellosis.
Main Methods:
- Retrospective analysis of hospitalized shigellosis patients in Bangladesh.
- Comparison of demographic and microbiological data between patients with and without leukemoid reactions.
- Statistical analysis to determine significant associations.
Main Results:
- Leukemoid reactions occurred in 3.8% of shigellosis patients, predominantly in children under 4 years.
- Leukemoid reactions were significantly associated with younger age (<10 years) and Shigella dysenteriae 1 infection.
- Patients with leukemoid reactions had a higher case fatality rate (21%) compared to those without (7.4%).
Conclusions:
- Leukemoid reactions in shigellosis are strongly associated with young children and Shigella dysenteriae 1.
- The presence of a leukemoid reaction indicates a more severe shigellosis infection with a higher risk of mortality.
- This finding underscores the need for close monitoring and aggressive management of shigellosis in vulnerable pediatric populations.
Abstract:
Leukemoid reactions occurred in 136 patients (3.8%) hospitalized with shigellosis in Bangladesh. Sixty-eight percent of the patients with leukemoid reactions were children less than 4 years old. When compared with patients without leukemoid reactions, the leukemoid reactions were significantly associated with children aged less than 10 years. The most common serotype of Shigella in the patients with leukemoid reactions was Shigella dysenteriae 1, isolated from 96 patients (71%), whereas the most common species in patients without leukemoid reactions was Shigella flexneri, isolated from 2,119 patients (62%). The case fatality rate in patients with leukemoid reactions was 21% compared with 7.4% in patients without leukemoid reactions. These findings indicated that in patients with shigellosis, the leukemoid reaction was significantly associated with young children, isolation of S dysenteriae 1, and increased case fatality rate.