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| Year : 1982 | Volume
: 28
| Issue : 4 | Page : 206-9 |
Shigellosis in infants and children.
Kale VV, Iyer LL, Jain MK
How to cite this article:
Kale V V, Iyer L L, Jain M K. Shigellosis in infants and children. J Postgrad Med 1982;28:206 |
Diarrhoeal disease is one of the principal causes of deaths all over the world and more so in developing countries. In the paediatric age group, it accounts for more fatalities than any other disease. Roughly 25 per cent of the deaths in infancy are due to diarrhoea. There are many reports[2], [8], [10], [12], [13] about shigellosis from various parts of the country but they are mainly relating to adults. There are very few reports[1] on shigellosis in infants and children in whom the infection may not manifest as classical dysentery but also presents as an acute gastro-enteritis or acute enteritis. This study was carried out to find out the shigella serotypes prevalent in infants and children and their antibiotic sensitivity patterns.
Stool samples or rectal swabs of patients suffering from bowel disturbances were collected. A total of 400 samples from hospitalised and out patients attending the K.E.M. Hospital, Bombay between October 1979 and November, 1980 were obtained. Faecal samples from 56 normal healthy children were also studied. Each sample was collected at the bed side in buffered glycerol solution and another aliquot inoculated in selenite broth. The former was inoculated immediately on receipt in the laboratory on Desoxycholate citrate agar, MacConkey's agar and blood agar. The selenite broth sample was processed in a similar fashion after enrichment for 18-20 hours. Shigella organisms were identified by standard biochemical and serological reactions.[6] Serotyping of shigella into various subgroups was done at the upgraded department of Pathology and Bacteriology, K.G. Medical College, Lucknow.
Antibiotic sensitivity test was done by a disc diffusion method.[3] The following antibiotics-streptomycin, chloramphenicol, ampicillin, tetracycline, kanamycin, gentamicin, sulphadiazine, colistin, neomycin, furazolidone, and trimethoprim were used.
Shigella organisms were isolated in 21 of 400 cases studied (5.25 per cent). These included 8 males and 13 females. The age distribution of isolates was as follows: 2 cases from 0-1 month, 15 from 2months-2 years, 3 from 2-5 years and 1 from 5-15 years. The infection with shigella seemed to be more common upto 2 years of age (17/21 isolates, 80.9 per cent) and thereafter it shows a gradual decline in the incidence. There were two cases from the neonatal period. According to the clinical diagnosis, 10 strains (47.5 per cent) were isolated from cases of acute dysentery, 6 strains (28.6 per cent) from gastro-enteritis and 5 (23.8 per cent) from acute enteritis. Only about 50 per cent isolates were from acute dysentery group. The distribution of shigella serotypes is described in [Table 1.] The predominant isolate belonged to group B with 19 strains (90.4 per cent). Only two strains were group A (9.6 per cent). There were no isolates from group C and D. Shigella species were not isolated from the stool samples of the 56 normal healthy controls. The antibiotic sensitivity patterns of the isolates are shown in [Table 2.] All the strains were sensitive to kanamycin, gentamicin, furazolidone, colistin, trimethoprim and neomycin. There was resistance to chloramphenical, ampicillin, streptomycin, tetracycline and sulphadiazine.
Reports of epidemic outbreaks of shigellosis in India are frequent but studies of sporadic (endemic) cases are uncommon. The magnitude of the problem of shigella infections in infants and children is thus not adequately defined. There is only a single report on shigellosis in children in nonepidemic situations by Agarwal and co-workers from Lucknow.[1]
In the present study, shigella organisms were isolated in 5.25 per cent (21/400) cases. Though this figure is of little numerical significance, these organisms warrant special attention because of severe symptoms which they often cause. Some cases may be mild but most patients have severe diarrhoea with the characteristic blood and mucus in the stool. Agarwal et al[l] found the isolation rate to be 6.5 per cent in his study. Sharma and co-workers[12] and Khan et al[8] found the isolation rate of 13.4 per cent and 10.4 per cent respectively. This discrepancy in isolation rate could be due to the fact that these workers studied cases from all age groups. In general, it is seen that the incidence of shigellosis is less in infants and children when compared with adults. In the present study, of 211. isolates a majority (80.9 per cent) were mainly from infants upto 2 years of age.; There were two cases from neonatal period. Agarwal et all observed that infection was common in older children in their series.
In the present study Shigella. flexneri was the predominant serotype (90.4 per cent) and Shigella dysenteriae came next with 9.6 per cent. Our findings are in agreement with those of Boyd,[5] Panda and Gupta,[10] and Agarwal et all and in all these studies the incidence of Shigella flexneri varied from 48 to 80 per cent. In the studies carried out by Stephen et al[13] and Arya and coworkers[2] the predominant group was Shigella dysenteriae followed by Shigella flexneri. The present study is also conspicuous by the absence of groups C and D.
In the present series lb was the most predominant subgroup in group B. Agarwal and coworkers[1] observed that la was the most frequent subgroup in children in their study. The remaining two strains of group A in the present study were Shigella dysenteriae 1. In the study of Agarwal et al[1] as well as of Arya et al,[2] all strains of Shigella dysenteriae belonged to type 1. The shigella infection is not the feature of acute dysentery because majority of strains of shigella (50 per cent) were isolated from cases of enteritis and gastro-enteritis.
Antibiotic sensitivity tests of shigella isolates showed that all strains were sensitive to gentamicin, kanamycin, furazolidone, trimethoprim, neomycin and colistin. Agarwal and coworkers[1] found that all strains were sensitive to all the above antibiotics except kanamycin. Resistance to sulphadiazine has always been high in all studies. Gross et al[7] observed in their study that multiple drug resistance i.e. resistance to 3 or more antibiotics had increased by 36 per cent in a span of four years during 1974-78. Agarwal et al[1] observed multiple drug resistance in 34 per cent of strains in their study. In the present series, multiple drug resistance was observed in 50 per cent of cases. The most common resistance patterns were Su (23.8 per cent of all strains), SSuT (28.5 per cent), SuT (19 per cent) and Ch ASSuT (19.4 per cent). These findings indicate a need for general control of antibiotic use, particularly in developing countries where oral antibiotics are freely used for the treatment of diarrhoea in children.
The authors wish to thank the Dean, K.E.M. Hospital and Seth G.S. Medical College, Bombay-400 012 for allowing us to publish the data and also to Prof. R. M. L. Mehrotra of the Upgraded Department of Pathology, K.G. Medical College, Lucknow, for serotyping of shigella strains.
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| 2. | Arya, D., Chitkara, N. L., Agarwal, K. C. and Ganguly, N. K.: Shigellosis in Chandigarh. Ind. J. Pathol. & Microbiol., 20: 15-21, 1977. |
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| 4. | Bhatt, P. and Rajan, D.: Comparative evaluation of desoxycholate medium and xylose-lysine desoxycholate medium in isolation of shigella. Amer. J. Clin. Path." 64: 399-404, 1975. |
| 5. | Boyd, J. S. K.: Laboratory findings in chemical dysentery in the middle east forces between August 1940 and June, 1943. J. Path. & Bact., 58: 237-241, 1946. |
| 6. | Edwards, R. R. and Ewing, W. H.: "Identification of Enterobactericeae", 3rd Edition, Burges Publishing Co., Minnesota, 1972. |
| 7. | Gross, R. J., Rowe, B., Cheasty, T. and Thomas, L. V.: Increase in drug resistance among Shigella dysenteriae, Sh. flexneri, Sh. boydi, Brit. Med. J., 283: ii, 575-576, 1981. |
| 8. | Khan, A. M., Agarwal, S. K., Satyavrat and Mehrotra, R. M. L.: Shigella serotypes in recent isolations at Lucknow. Ind. J. Med. Res., 69: 393-398, 1979. |
| 9. | Nelson, J. D., Hele, K. R. N., Lula, H. J. and Edythe, W.: Trimethoprim-sulfamethoxazole therapy for shigellosis. J. Amer. Med. Assoc., 235: 1239-1242, 1976. |
| 10. | Panda, G. K. and Gupta, S. P.: Shigella serotypes in Utter Pradesh. Ind. J. Med. Res., 52: 235-240, 1964. |
| 11. | Sen, R.: Isolations of strains of the mannitol negative variety of Shigella flexneri subserotype-4a. Ind. J. Pathol. & Bacteriol., 12: 33-36, 1969. |
| 12. | Sharma, A., Majumdar, S. K. and Chakravar y, A. N.: Bacteriological findings of dysenteric disorders in Calcutta. Ind. J. Med. Res., 55: 1181-1193, 1967. |
| 13. | Stephen, S., Kaiwar, R., Indrani, R. and Adiyutharao, K. N.: Shigellosis in South West coast of India. Ind. J. Pathol & Microbiol., 21: 233-239, 1978. |
| 14. | Wadgaonkar, S. P., Bahulikar, A. V., Wadia, R. S., Sharma, V. V., Shukla, R. N., Sardesai, H. V. and Grant, K. B.: Shigellosis in Poona. J. Assoc. Phys. Ind., 25: 13-19, 1977. |
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