Enteric protein loss during shigellosis

To determine whether protein-losing enteropathy occurs during shigellosis, we measured concentrations of alpha 1-antitrypsin in sequential stool samples from 110 adults hospitalized with acute dysentery due to Shigella infection. Mean stool concentrations of alpha 1-antitrypsin on admission were 10.9 micrograms/mg dry weight of stool. Stool alpha 1-antitrypsin concentrations were significantly (p < 0.001) lower on the 3rd and 5th study days (4.1 and 2.2 micrograms/mg, respectively) than on admission. Admission mean alpha 1-antitrypsin concentrations in patients with Shigella dysenteriae type 1 infection (14.4 micrograms/mg) were significantly (p < 0.05) higher than in patients infected with other species of Shigella (9.3 micrograms/mg). Stool alpha 1-antitrypsin concentrations were significantly correlated with the number of erythrocytes in the stool, and inversely correlated with serum protein concentration. Patients in whom antimicrobial treatment failed, most often because they were infected with a resistant strain of Shigella, had significantly higher concentrations of alpha 1-antitrypsin on all three study days. We conclude that Shigella infection is associated with a protein-losing enteropathy, that this enteropathy is more severe with S. dysenteriae type 1 infection, and that the enteropathy improves with appropriate antimicrobial therapy.