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Shigellosis in children from north India: a clinicopathological study
B R Thapa1, K Ventkateswarlu, A K Malik
1Department of Gastroenterology and Microbiology Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
This study investigated bacterial causes of acute diarrhea in children, finding Shigella infections common, especially in those under two. Most Shigella strains showed resistance to common antibiotics but sensitivity to others.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute diarrhea is a major cause of childhood illness.
- Bacterial pathogens, particularly Shigella, are significant contributors to diarrheal diseases.
- Understanding causative agents and antibiotic sensitivity is crucial for effective treatment.
Purpose of the Study:
- To identify bacterial pathogens in children with acute diarrhea.
- To determine the antibiotic sensitivity patterns of isolated Shigella strains.
- To describe clinical manifestations and complications associated with Shigella infections.
Main Methods:
- Stool samples from 1488 children with acute diarrhea were analyzed for bacterial culture and sensitivity.
- Detailed clinical data were collected for 53 hospitalized children.
- Proctosigmoidoscopy was utilized for lesion assessment and sample collection.
Main Results:
- Shigella was identified in 10% of cases, with Shigella dysenteriae being the most prevalent species.
- Children under two years old and summer months showed peak prevalence.
- High resistance rates were observed for tetracycline, ampicillin, chloramphenicol, and cotrimoxazole, while sensitivity was noted for neomycin, furazolidine, and cephaloridine.
Conclusions:
- Shigella is a common cause of acute bacterial diarrhea in children, presenting with severe symptoms including dysentery and systemic complications.
- Antibiotic resistance patterns necessitate careful selection of treatment, highlighting the ineffectiveness of several commonly used drugs.
- Proctosigmoidoscopy aids in diagnosis and management, and Clostridium difficile should be considered in severe cases.
Abstract:
Stool samples of 1488 children suffering from acute diarrhoea were studied for bacterial culture and sensitivity. Shigella culture was positive in 143 (10 per cent) children and 53 hospitalized children could be studied in detail. Thirty-six (68 per cent) children were under 2 years of age and peak prevalence was observed in summer months. Fever and diarrhoea were universal features; 96 per cent had blood and mucus in the stools, but 32 per cent started with watery diarrhoea lasting 1-3 days followed by dysentery. Two cases (4 per cent) had watery diarrhoea. Abdominal pain dehydration, and malnutrition were present in more than two-thirds of the cases. Central nervous systemic (CNS) manifestations, renal failure, respiratory manifestations, and subacute intestinal obstruction were seen in 45, 25, 17, and 5 per cent of cases, respectively. Shigella dysenteriae was the commonest organism grown in 57 per cent, followed by Shigella flexneri in 36 per cent, Shigella boydii in 4 per cent, and Shigella sonnei in 4 per cent cases. In the majority, the organisms were sensitive to neomycin (83 per cent), furazolidine (86 per cent), and cephaloridine (87 per cent), whereas Shigella strains were resistant to tetracycline in 93 per cent, ampicillin in 83 per cent, chloramphenicol in 91 per cent and cotrimoxazole in 66 per cent cases. Proctosigmoidoscopy was useful in defining the nature of mucosal lesion, to collect swabs for culture and biopsy specimen for histopathology. Four (8 per cent) cases had pseudomembrane and in two cases Clostridium difficile could be identified. Eight (15 per cent) cases died and two of them had shigellaemia.(ABSTRACT TRUNCATED AT 250 WORDS)