Abstract
Objective
To study the clinical characteristics and factors associated with mortality among children with Shigella encephalopathy.
Methods
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.
Results
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.
Conclusions
Recognition of factors associated with mortality in Shigella encephalopathy may assist in better monitoring of sicker children and improved outcomes.
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References
Troeger C, Blacker BF, Khalil IA, Rao PC, Cao S, Zimsen SR, et al. GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and etiologies of diarrhea in 195 countries: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18:1211–8.
Khalil IA, Troeger C, Blacker BF, Rao PC, Brown A, Atherly DE, et al. Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: The Global Burden of Disease Study. 1990–2016. Lancet Infect Dis. 2018;18:1229–40.
Taneja N, Mewara A Shigellosis: Epidemiology in India. Indian J Med Res. 2016;143: 565–76.
Ashkenazi S, Dinari G, Zevulunov A, Nitzan M. Convulsions in childhood shigellosis: Clinical and laboratory features in 153 children. Am J Dis Child. 1987;141:208–10.
Bardhan P, Faruque AS, Naheed A, Sack DA. Decrease in shigellosis-related deaths without Shigella spp.-specific interventions, Asia. Emerg Infect Dis. 2010;16:1718–23.
Afroze F, Ahmed T, Sarmin M, Smsb Shahid A, Shahunja KM, Shahrin L, et al. Risk factors and outcome of Shigella encephalopathy in Bangladeshi children. PLoS Negl Trop Dis. 2017;11:e0005561.
Pourakbari B, Mamishi S, Kohan L, Sedighi L, Mahmoudi S, Fattahi F, et al. Lethal toxic encephalopathy due to childhood shigellosis or Ekiri syndrome. J Microbiol, Immunology and Infection. 2012;45:147–50.
Sakamoto A, Kamo S. Clinical, statistical observations on ekiri and bacillary dysentery; a study of 785 cases. Ann Paediatr. 1956;186:1–18.
Goren A, Freier S, Passwell JH. Lethal toxic encephalo-pathy due to childhood shigellosis in a developed country. Pediatrics. 1992;89:1189–93.
Yuhas Y, Weizman A, Ashkenazi S. Bidirectional concentration-dependent effects of tumor necrosis factor alpha in Shigella dysenteriae-related seizures. Infection and immunity. 2003;71:2288–91.
Mandal J, Ganesh V, Emelda J, Mahadevan S, Parija SC. The recent trends of shigellosis: A JIPMER perspective. J Clin Diagn Res. 2012;6:1474–7.
Ballal M, Devadas SM, Chakraborty R, Shetty V. Emerging trends in the etiology and antimicrobial susceptibility pattern of enteric pathogens in rural Coastal India. Int J Clin Med. 2014;5:425–32.
Tejashree A, Vijaykumar GS, Rao R, Mahale RP, Gopala-krishnan R, Ponna Y. Spectrum of enteric pathogens in a tertiary hospital. Transworld Med J. 2013;1:69–73.
Madhavan A, Balakrishnan S, Vasudeva panicker J. Antibiotic susceptibility pattern of Shigella isolates in a tertiary healthcare center. J Lab Physicians. 2018;10:140–4.
Vinh H, Nhu NT, Nga TV, Duy PT, Campbell JI, Hoang NV, et al. A changing picture of shigellosis in Southern Vietnam: Shifting species dominance, antimicrobial susceptibility and clinical presentation. BMC Infect Dis. 2009;9:204.
Christopher PR, David KV, John SM, Sankarapandian V. Antibiotic therapy for Shigella dysentery. Cochrane Database Syst Rev. 2010;8:CD006784.
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MPJ: designed study, collected the data and wrote the initial draft of the paper; MGG, PK: helped in writing the manuscript and interpretation of the data; VKG: patient management and helped in collection of the data; BG: expert in statistics who did the statistical analysis; PP, GA, PMA: conducted microbiological analysis.
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Institutional ethics committee of the Government Medical College, Kozhikode; No. GMCKKD/RP2018/IEC/15, dated 11 January, 2018.
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Jayakrishnan, M.P., Geeta, M.G., Krishnakumar, P. et al. Factors Associated With Mortality in Toxic Encephalopathy Due to Shigellosis in Children. Indian Pediatr 57, 1029–1032 (2020). https://doi.org/10.1007/s13312-020-2030-4
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DOI: https://doi.org/10.1007/s13312-020-2030-4