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Polymicrobial and recurrent bacteremia with Shigella in a patient with AIDS
M Kristjánsson1, B Viner, J N Maslow
1Infectious Diseases Section, VA Medical Center, Boston, MA 02130.
Abstract:
Shigella gastroenteritis is uncommon among HIV seropositive patients and may be complicated in some patients by bacteremia; S. flexneri being the most frequently detected serogroup. While recurrent Salmonella bacteremia is common among HIV-seropositive patients, recurrent Shigella bacteremia is not. We report here an HIV-seropositive patient with Shigella gastroenteritis, polymicrobial bacteremia due to S. flexneri and S. boydii, and recurrent gastroenteritis and bacteremia with S. boydii. Relapsing infection with the same strain of S. boydii was determined using pulsed field gel electrophoresis. Thus, HIV-seropositive patients who develop Shigella infections may require prolonged treatment and/or suppressive therapy, similar to those infected with Salmonella. Patients who develop recurrent disease should be suspected as having polymicrobial bacteremia since the incidence of this may be underestimated among patients with AIDS, particularly those with concurrent gastroenteritis.
Insights
Shigella gastroenteritis is rare in HIV-positive individuals but can lead to bacteremia. This case highlights recurrent Shigella boydii bacteremia in an HIV-positive patient, suggesting prolonged treatment may be needed.
Area of Science:
- Infectious Diseases
- Immunocompromised Hosts
- Microbiology
Background:
- Shigella gastroenteritis is infrequent in HIV-seropositive individuals.
- Bacteremia can complicate Shigella infections, with S. flexneri being common.
- Recurrent Salmonella bacteremia is known in HIV-positive patients, but recurrent Shigella bacteremia is not well-documented.
Observation:
- A case of an HIV-seropositive patient with Shigella gastroenteritis and polymicrobial bacteremia is presented.
- The patient experienced recurrent gastroenteritis and bacteremia caused by Shigella boydii.
- Pulsed field gel electrophoresis confirmed relapsing infection with the same S. boydii strain.
Findings:
- HIV-seropositive patients with Shigella infections may experience recurrent bacteremia.
- Polymicrobial bacteremia, involving multiple bacterial species, can occur in these patients.
- The incidence of polymicrobial bacteremia in patients with AIDS and gastroenteritis might be underestimated.
Implications:
- HIV-seropositive patients with Shigella infections may require extended treatment or suppressive therapy.
- Recurrent Shigella infections in this population warrant suspicion for polymicrobial bacteremia.
- Findings suggest a need for careful monitoring and tailored treatment strategies for Shigella infections in immunocompromised individuals.