SHIGELLOSIS

IN CHILDREN
PRESENTED BY: MOTI KHATARI
GROUP: 50
COURSE: 5
Introduction

Shigella infection (shigellosis) is an intestinal infection caused by a

family of bacteria known as shigella. The main sign of shigella
infection is diarrhea, which often is bloody.
Shigella is very contagious. People get infected with shigella when
they come in contact with and swallow small amounts of bacteria
from the stool of a person who is infected with shigella.
For example, this can happen in a child care setting
when staff members don't wash their hands well
enough after changing diapers or helping toddlers
with toilet training. Shigella bacteria can also be
passed in infected food or by drinking or swimming
in unsafe water.

Children under age 5 are most likely to get shigella

infection, but it can occur at any age. A mild case
usually clears up on its own within a week. When
treatment is needed, doctors generally prescribe
antibiotics.
•
Symptoms

Signs and symptoms of shigella infection usually begin a day or two after
contact with shigella. But it may take up to a week to develop. Signs and
symptoms may include:
• Diarrhea (often containing blood or mucus)
• Stomach pain or cramps
• Fever
• Nausea or vomiting
Symptoms generally last for about ve to seven days. In some cases,
symptoms may last longer. Some people have no symptoms after they've
been infected with shigella. However, their feces may still be contagious up to
a few weeks.
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Causes
Infection occurs when you accidentally swallow shigella bacteria. This can
happen when you:
• Touch your mouth. Direct person-to-person contact is the most
common way the disease is spread. For example, if you don't wash your
hands well after changing the diaper of a child who has shigella
infection, you may become infected yourself.
• Eat contaminated food. Infected people who handle food can spread
the bacteria to people who eat the food. Food can also become infected
with shigella bacteria if it grows in a eld that contains sewage.
• Swallow contaminated water. Water may become infected with
shigella bacteria either from sewage or from a person with shigella
infection swimming in it.
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 Complications
Shigella infection usually clears up without complications. But it may take weeks or months
before your bowel habits return to normal.
Complications may include:
• Dehydration. Constant diarrhea can cause dehydration. Signs and symptoms include
lightheadedness, dizziness, lack of tears in children, sunken eyes and dry diapers.
Severe dehydration can lead to shock and death.
• Seizures. Some children with a shigella infection have seizures. Seizures are more
common in children who run a high fever, but can occur in children who do not
have a high fever. It's not known whether the seizures are a result of the fever or
the shigella infection itself. If your child has a seizure, contact your doctor
immediately.
• Rectal prolapse. In this condition, straining during bowel movements or inflammation
of the large intestine may cause the mucous membrane or lining of the rectum to
move out through the anus.
•
• Hemolytic uremic syndrome. This rare complication of shigella, more commonly caused
by a type of E. coli bacteria than by shigella bacteria, can lead to a low red blood cell count
(hemolytic anemia), low platelet count (thrombocytopenia) and acute kidney failure.
• Toxic megacolon. This rare complication occurs when your colon becomes paralyzed,
preventing you from having a bowel movement or passing gas. Signs and symptoms
include stomach pain and swelling, fever and weakness. If you don't receive treatment for
toxic megacolon, your colon may break open (rupture), causing peritonitis, a life-threatening
infection requiring emergency surgery.
• Reactive arthritis. Reactive arthritis develops in response to an infection. Signs and
symptoms include joint pain and in ammation, usually in the ankles, knees, feet and hips;
redness, itching and discharge in one or both eyes (conjunctivitis); and painful urination
(urethritis).
• Bloodstream infections (bacteremia). Shigella infection can damage the lining of the
intestines. In rare cases, shigella bacteria can enter the bloodstream through the damaged
intestinal lining and cause a bloodstream infection.
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 Prevention
• Wash hands with soap and water for at least 20 seconds frequently
• Watch small children when they wash their hands
• Throw away soiled diapers properly
• Disinfect diaper-changing areas after use
• Don't prepare food for others if you have diarrhea
• Keep children with diarrhea home from child care, play groups or school
• Avoid swallowing water from ponds, lakes or untreated pools
• Avoid sexual activity with anyone who has diarrhea or who recently recovered
from diarrhea
• Don't go swimming until you have fully recovered.
Diagnosis

Stool culture should be obtained in all suspected cases of shigellosis. Specimens

should be processed immediately after collection. Ova and parasite stool studies
should be collected to rule out other causes of infectious diarrhea such as Entamoeba
histolytica and parasitic worms.
Other laboratory tests, such as a white blood cell (WBC) count, may be performed in
persons with severe symptoms or to rule out other causes. Creatinine and blood urea
nitrogen (BUN) should be monitored to assess the hydration status of the patient.
Laboratory studies generally reveal the following findings:
• Fecal leukocytes and erythrocytes

• Mildly elevated hematocrit, sodium, and urea nitrogen levels: These are indicative of volume
depletion in cases of shigellosis.

• Leukocytosis: Rare.

• Positive findings on stool culture of a fresh fecal specimen

• Immunocompromised patients (eg, infected with human immunodeficiency virus [HIV]): Blood
cultures are rarely helpful in cases of shigellosis.
Treatment
Shigella infection usually runs its course in ve to seven days. Replacing lost uids from diarrhea may
be all the treatment you need, particularly if your general health is good and your shigella infection is
mild.
Antibiotics
Antibiotics may also be necessary for infants, older adults and people who have HIV infection, as well
as in situations where there's a high risk of spreading the disease.
Fluid and salt replacement
Children may bene t from an oral rehydration solution, such as Pedialyte, available in drugstores.
Many pharmacies carry their own brands.
Children and adults who are severely dehydrated need treatment in a hospital emergency room,
where they can receive salts and uids through a vein (intravenously), rather than by mouth.
Intravenous hydration provides the body with water and essential nutrients much more quickly than
oral solutions do.
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Case study

NAME: Johnny
Age:10
Sex: Male
Complaints
A 10-year-old boy admitted to our pediatric emergency department with a three-day history of
bloody mucoid diarrhea, mild diffuse abdominal pain, and tenesmus. On admission, his vital
signs were normal. There were no signs of dehydration. Abdominal examination revealed
generalized mild abdominal pain with hyperactive bowel sounds and no signs of peritoneal
irritation. The remainder of the examination revealed no abnormalities.
A stool specimen revealed abundant neutrophils and mild erythrocytes, and was cultured for
pathogenic bacteria. An initial diagnosis of gastroenteritis was made and conservative
management was instituted until stool culture results were obtained.
After 24 hours, he returned with complaints of persistent vomiting, fever, increased abdominal
pain, and fatigue. Physical examination revealed a drowsy child with signs of moderate
dehydration. The rectal temperature was 39°C, heart rate was 140/min, and blood pressure
was 90/50 mm Hg. At this point, the abdomen was rigid with signs of peritoneal irritation and
rebound tenderness at McBurney’s point. Rectal examination revealed no mass.
LAB
Laboratory studies included hemoglobin of 14.5 g/dl, hematocrit 39% and white blood cell count
18000/mm3, with 69% segmented neutrophils. Urinalysis, serum electrolytes and hepatic and
renal function tests were within normal limits. Abdominal ultrasound examination revealed a
swollen, edematous appendix. The surgical consultant agreed with our decision of acute
appendicitis, and prompt surgical exploration revealed an acutely inflamed appendix with
gangrenous changes.
DIAGNOSIS
Appendicitis associated with Shigella sonnei dysentery has been reported. Twelve of 160
patients with acute appendicitis had positive appendicial cultures for Shigella sonnei. The
precise relationship between Shigella sonnei infection and appendicitis is not clear. We
considered that mucosal edema precipitated appendiceal obstruction. Our patient’s
abdominal disease most likely resulted from shigella infestation of the colon and appendix.
Because Shigella flexneri was isolated from the stool obtained at admission and involved the
appendix culture, Shigella flexneri was thought to be responsible for the acute appendicitis.
TREATMENT
SURGERY for acute appendicitis
Postoperatively, the patient was treated with ampicillin, gentamicin and clindamycin. Shigella
flexneri susceptible to ampicillin was isolated from the stool and appendix material. Thus, the
treatment was completed in 10 days.
Conclusion
In conclusion, particularly in children, acute appendicitis and infective diarrheal illness can be
difficult to differentiate. Pediatricians and pediatric surgeons should thus be aware of the
possibility of appendicitis and follow up closely until the differentiation between bacterial
gastroenteritis and acute appendicitis can be made.
In most reported cases of shigella appendicitis, the tentative diagnosis of shigella colitis
undoubtedly delayed surgery, although the signs of acute appendicitis were present. Delay in
diagnosing the surgical condition under these circumstances can lead to serious
complications.
References
◦ Berkowitz’s Pediatrics : a Primary Care Approach (2014)
◦ Current Diagnosis & Treatment : Pediatrics (2018)
Textbook of Pediatric Care : AAP (2009)
Visual Diagnosis & Treatment in Pediatrics (2015
Pediatrics: A critical incident analysis of contributing factors.
Pediatrics 2000;105:805 and Pediatrics 2000;106:633
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