Death in shigellosis: incidence and risk factors in hospitalized patients

Article Abstract:

Dysentery, which is characterized by severe diarrhea, can be caused by the bacteria Shigella. Although antibiotics and rehydration with fluids can reduce fatalities, shigellosis still remains a disease of poverty and deprivation and a major cause of death among children living in developing countries. Risk factors for lethal Shigella infections were investigated by studying all patients with shigellosis attending the Dhaka Treatment Center in Bangladesh between 1974 and 1988. Characteristics of 67 patients who died of shigellosis and 134 patients who were discharged from the center were compared. During 1974-1988, 889 (9.1 percent) of shigella-infected patients died, 32.3 percent of whom were under one year of age. The patients infected with the Shigella sonnei strain had the highest death rate, 10.3 percent versus 6.7 percent with Shigella dysentariae, which had the lowest death rate. Children under one year who died had characteristically stopped breast feeding. Children who were between one to two years of age had low body temperature, severe malnutrition, severe dehydration, altered consciousness, abdominal swelling, low blood concentrations of platelets (clotting cells), proteins, sodium, and sugar, kidney failure and bacteria in the blood. Children who were younger, had a marked reduction in blood proteins and platelets, and had an altered state of consciousness were more likely to die. The management of patients with shigellosis is complex. Since many body systems are affected by the bacterial infection, rehydration and antibiotic therapy alone are unlikely to alter the death rate. Improvement of nutrition and socioeconomic conditions eradicated shigellosis in the US, Poland and Japan. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Risk factors

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Therapy for Shigellosis. II. Randomized, double-blind comparison of ciprofloxacin and ampicillin

Article Abstract:

Shigella is an enteric (gastrointestinal) pathogen that causes dysentery (diarrhea). Shigellosis, dysentery caused by Shigella, is commonly treated with ampicillin or trimethoprim-sulfamethoxazole. However, certain strains of Shigella, such as Shigella dysenteriae type 1, Shigella flexneri from Asia and Africa, and Shigella sonnei from the United States, are resistant to ampicillin and trimethoprim-sulfamethaoxazole. Nalidixic acid has been used effectively against Shigella dysenteriae in Bangladesh, and quinolone drugs have been useful in treating strains that are resistant to nalidixic acid. Ciprofloxacin and ampicillin were evaluated for their ability to alleviate the clinical symptoms of shigellosis in 121 men who were hospitalized with severe disease in Bangladesh. Treatment with ciprofloxacin, in doses of 500 milligrams (mg) every 12 hours for 5 days, resulted in clinical improvement in 57 of 60 patients. Ampicillin, 500 mg every 6 hours for 5 days, produced clinical improvement in 23 of 26 patients with ampicillin-sensitive strains of Shigella, and in 15 of 45 patients infected with ampicillin-resistant strains of Shigella. Patients treated with ampicillin had an average of 46 stools during the 5-day study period, while patients treated with ciprofloxacin had an average of 29 stools. These findings indicate that ciprofloxacin may be an effective and safe alternative to ampicillin in the treatment of shigellosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug resistance in microorganisms, Microbial drug resistance, Ampicillin, Shigella

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Treatment of shigellosis: III. Comparison of one- or two-dose ciprofloxacin with standard 5-day therapy

Article Abstract:

A single one-gram dose of ciprofloxacin may be an effective and safe treatment for patients with shigellosis unless they are infected with Shigella dysenteriae type 1. Shigellosis is a type of dysentery, or diarrhea with dehydration and fever, that is caused by different species of the bacterium Shigella. Among 128 men suffering from dysentery, 40 were treated with a single one-gram dose of ciprofloxacin, 43 were treated with two one-gram doses of ciprofloxacin and three were treated with 500 milligrams of ciprofloxacin every 12 hours over a five-day period. All of the patients who were not infected with Shigella dysenteriae type 1 responded to treatment. Among the 40 patients infected with Shigella dysenteriae type 1, those treated with one dose of ciprofloxacin were less likely to respond to treatment than those treated with two doses. All of the patients with Shigella dysenteriae type 1 who were treated with ten doses responded to treatment.

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