Clinical dysentery in hospitalized children

Epidemiology of Salmonellosis Among Infants in the United States: 1968-2015

OBJECTIVES

Describe characteristics of gastroenteritis, bacteremia, and meningitis caused by nontyphoidal Salmonella among US infants.

METHODS

We analyze national surveillance data during 1968-2015 and active, sentinel surveillance data during 1996-2015 for culture-confirmed Salmonella infections by syndrome, year, serotype, age, and race.

RESULTS

During 1968-2015, 190 627 culture-confirmed Salmonella infections among infants were reported, including 165 236 (86.7%) cases of gastroenteritis, 6767 (3.5%) bacteremia, 371 (0.2%) meningitis, and 18 253 (9.7%) with other or unknown specimen sources. Incidence increased during the late 1970s-1980s, declined during the 1990s-early 2000s, and has gradually increased since the mid-2000s. Infants' median age was 4 months for gastroenteritis and bacteremia and 2 months for meningitis. The most frequently reported serotypes were Typhimurium (35 468; 22%) for gastroenteritis and Heidelberg for bacteremia (1954; 29%) and meningitis (65; 18%). During 1996-2015 in sentinel site surveillance, median annual incidence of gastroenteritis was 120, bacteremia 6.2, and meningitis 0.25 per 100 000 infants. Boys had a higher incidence of each syndrome than girls in both surveillance systems, but most differences were not statistically significant. Overall, hospitalization and fatality rates were 26% and 0.1% for gastroenteritis, 70% and 1.6% for bacteremia, and 96% and 4% for meningitis. During 2004-2015, invasive salmonellosis incidence was higher for Black (incident rate ratio, 2.7; 95% confidence interval, 2.6-2.8) and Asian (incident rate ratio, 1.8; 95% confidence interval, 1.7-1.8) than white infants.

CONCLUSIONS

Salmonellosis causes substantial infant morbidity and mortality; serotype heidelberg caused the most invasive infections. Infants with meningitis were younger than those with bacteremia or gastroenteritis. Research into risk factors for infection and invasive illness could inform prevention efforts.

Bacterial resistance to commonly prescribed antibiotics was rare among children hospitalised for clinical dysentery

AIM

Temporal changes in common pathogens that cause clinical dysentery have been described in Europe. We aimed to describe the distribution of pathogens and their antibiotic resistance in hospitalised Israeli children.

METHODS

This study retrospectively studied children hospitalised for clinical dysentery, with or without a positive stool culture, from 1 January 2016 to 31 December 2019.

RESULTS

We diagnosed 137 patients (65% males), with clinical dysentery at a median age of 3.7 (interquartile range 1.5-8.2) years. Stools were cultured in 135 patients (99%), and the results were positive in 101 (76%). These comprised Campylobacter (44%), Shigella sonnei (27%), non-typhoid Salmonella (18%) and enteropathogenic Escherichia coli (12%). Only one of the 44 Campylobacter cultures was resistant to erythromycin and one of the 12 enteropathogenic Escherichia coli cultures was resistant to ceftriaxone. None of the Salmonella and Shigella cultures were resistant to ceftriaxone or erythromycin. We did not find any pathogens that were associated with a typical clinical presentation or laboratory results on admission.

CONCLUSION

The most common pathogen was Campylobacter, in line with recent European trends. Bacterial resistance for commonly prescribed antibiotics was rare, and these findings support the current European recommendations.

The changing epidemiology of bacillary dysentery and characteristics of antimicrobial resistance of Shigella isolated in China from 2004-2014

Background

Bacillary dysentery caused by bacteria of the genus Shigella is a significant public health problem in developing countries such as China. The objective of this study was to analyze the epidemiological pattern of bacillary dysentery, the diversity of the causative agent, and the antimicrobial resistance patterns of Shigella spp. for the purpose of determining the most effective allocation of resources and prioritization of interventions.

Methods

Surveillance data were acquired from the National Infectious Disease Information Reporting System (2004–2014) and from the sentinel hospital-based surveillance system (2005–2014). We analyzed the spatial and temporal distribution of bacillary dysentery, age and sex distribution, species diversity, and antimicrobial resistance patterns of Shigella spp.

Results

The surveillance registry included over 3 million probable cases of bacillary dysentery during the period 2004–2014. The annual incidence rate of bacillary dysentery decreased from 38.03 cases per 100,000 person-years in 2004 to 11.24 cases per 100,000 person-years in 2014. The case-fatality rate decreased from 0.028% in 2004 to 0.003% in 2014. Children aged <1 year and 1–4 years were most affected, with higher incidence rates (228.59 cases per 100,000 person-years and 92.58 cases per 100,000 person-years respectively). The annual epidemic season occurred between June and September. A higher incidence rate of bacillary dysentery was found in the Northwest region, Beijing and Tianjin during the study period. Shigella flexneri was the most prevalent species that caused bacillary dysentery in China (63.86%), followed by Shigella sonnei (34.89%). Shigella isolates were highly resistant to nalidixic acid (89.13%), ampicillin (88.90%), tetracycline (88.43%), and sulfamethoxazole (82.92%). During the study period, isolates resistant to ciprofloxacin and cefotaxime increased from 8.53 and 7.87% in 2005 to 44.65 and 29.94% in 2014, respectively.

Conclusions

The incidence rate of bacillary dysentery has undergone an obvious decrease from 2004 to 2014. Priority interventions should be delivered to populations in northwest China and to individuals aged <5 years. Antimicrobial resistance of Shigella is a serious public health problem and it is important to consider the susceptibility profile of isolates before determining treatment.

Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children

PURPOSE

To characterize the clinical and laboratory manifestations of non-typhi Salmonella gastroenteritis associated with bacteremia in children less than 36 months old.

METHODS

The study group included 17 patients, aged 2-34 months, with non-typhi Salmonella gastroenteritis and bacteremia, hospitalized in a tertiary pediatric medical center during the period 1995-2010. Clinical data were collected by medical chart review. Culture-related data were taken from the microbiology laboratory files. The results were compared with an assigned, age-matched, control group of 17 infants hospitalized with non-typhi Salmonella gastroenteritis without bacteremia.

RESULTS

Eleven cases (65%) occurred during the summer season. All patients presented with diarrhea, usually mixed with blood or mucus (clinical dysentery 65%). All but one had a high-grade fever (average 39.5°C). Three patients (19%) experienced convulsions during the acute episode of gastroenteritis. None of the patients had been previously treated with antibiotics. The most prevalent Salmonella serotype identified in the stool and blood was group C. Toxic appearance and convulsions on admission were more common among children with non-typhi Salmonella bacteremia, as opposed to those with non-typhi Salmonella gastroenteritis alone. No other epidemiological or laboratory differences were found.

CONCLUSIONS

Non-typhi Salmonella gastroenteritis poses a risk of bacteremia not only in infants younger than 3 months of age, but also in children younger than 36 months of age.

Presumptive shigellosis: Clinical and laboratory characteristics of Bangladeshi patients

The aim of the study was to examine some selected clinical and laboratory parameters in distinguishing non-Shigella invasive diarrhoeas from culture-confirmed Shigella cases. We conducted a clinic-based, cross-sectional study at the Dhaka Hospital of ICDDR,B located in Bangladesh. In total, 389 patients of all age groups and of both genders, with a history of diarrhoea of less than 96 h and presence of visible blood and/or mucus in the stool were presumed to have shigellosis and enrolled in the study. Shigella was isolated from faecal cultures in 227 (58.4%) patients. The remaining 162 (41.6%) patients did not have Shigella isolated from their faecal cultures and constituted the comparison group. Another 238 randomly selected patients with non-Shigella diarrhoea from the Diarrhoeal Disease Surveillance System database of the Dhaka Hospital constituted another comparison group. Cases of culture-proven Shigella were similar to non-Shigella invasive diarrhoeal patients with presumptive shigellosis with regard to several biosocial variables. The nutritional status of children with shigellosis was significantly inferior to those with non-Shigella diarrhoea. The presence of macrophages more than 5/HPF in stool microscopic examination was significantly more frequent among patients infected with Shigella. Empirical antimicrobial therapy for shigellosis might be considered for malnourished diarrhoeal children presenting with history of visible blood and/or mucus in stool, and children older than 1 y of age. Further studies are needed in different geographical settings to identify clinical and laboratory parameters that could help identify patients with shigellosis.

Evaluation of shigellosis in a Turkish children's hospital

BACKGROUND

The aim of the present study was to evaluate cases of Shigella and determine the pattern of antimicrobial resistance of shigella species in central Turkey.

METHODS AND RESULTS

One hundred and ninety-eight patients with shigella gastroenteritis presenting to Sami Ulus Children's Hospital from June 2002 to December 2002 were included in the study. The clinical and laboratory data of the patients with shigellosis were collected by chart review. Male/female ratio was 1.35 and mean age was 4.83 +/- 3.2 years (range: 1-16 years). Shigella sonnei (83.3%) was the most common serogroup. This was followed by S. flexneri (10.1%), then S. dysenteria (5.1%), and S. boydii (1.5%). The antibiotic susceptibility of the shigella strains was determined. Most strains of Shigella species were resistant to trimethoprim-sulfamethoxazole (90.4%). All strains were found to be sensitive to ciprofloxacin (100%). Ampicillin susceptibility was 86.4% and cefotaxim (and/or ceftriaxon) susceptibility was 98%.

CONCLUSION

Ampicillin is the drug of choice in the treatment of shigella infection in this region of Turkey. Cefotaxim or ceftriaxon was the second choice of antibiotics. Thus, Shigella is an important etiologic agent of diarrhea in Turkey. To determine the antibiotic susceptibility of the Shigella strains and appropriate empiric antibiotic treatment in Turkey, further studies will be needed.

Shigella infections in children: new insights

Shigellosis , the acute enteric infection caused by bacteria of the genus Shigella , has a worldwide distribution with an estimated annual incidence of 164.7 million cases, of which 163.2 million occur in developing countries, and 1.1 million deaths. Sixty-nine percent of all episodes and 61 percent of all Shigella -related deaths involve children younger than 5 years old. In the United States, 10,000 to 15,000 cases of shigellosis are reported each year. Although usually confined to the colonic mucosa, shigellosis sometimes can cause extraintestinal complications. Recent publications have shed light on the clinical characteristics of Shigella -induced bacteremia, surgical complications, urogenital symptoms, and neurologic manifestations, and on the unique manifestations in the neonatal period. The mainstay of treatment of shigellosis in children is correction of the fluid and electrolyte loss, which often is achieved by the administration of oral rehydration solutions. Appropriate antibiotic therapy shortens the duration of both clinical symptoms and fecal excretion of the pathogen. However, the increasing antimicrobial resistance of shigellae worldwide constitutes a major problem. Regarding the pathophysiology of shigellosis and its complications, recent data not only elucidated the molecular mechanisms involved but also linked manifestations of disease to the interplay of bacterial virulence factors and host responses. The improved understanding of the pathophysiology is hoped to lead to innovative therapeutic approaches against shigellosis and new generations of vaccine candidates.