Academic journal article Journal of Health Population and Nutrition

Clinical and Microbiological Profiles of Shigellosis in Children

Academic journal article Journal of Health Population and Nutrition

Clinical and Microbiological Profiles of Shigellosis in Children

Article excerpt

INTRODUCTION

Diarrhoeal disease continues to be a leading cause of morbidity and mortality worldwide. Despite the advances occurring in water treatment and sanitary conditions, diarrhoea continues to remain a leading public-health problem worldwide. Also, there is an increased recognition in the importance of Shigella species as an enteric pathogen due to its potential devastating consequences resulting from strains resistant to all available antimicrobial agents. Shigellosis, in the past, was quite different from the current scenario. Shigella dysenteriae, once the most common species causing severe disease, has been replaced by Shigella flexneri in most of the countries (1).

The burden of shigellosis in a tertiary-care hospital of north India over a period of six years was found to be around 4% (2). The clinical spectrum of shigellosis in children ranges from mild, self-limiting, non-inflammatory diarrhoea to severe, inflammatory, bloody diarrhoea with fever, abdominal cramps, and extra-intestinal complications. Several mechanisms have been proposed to explain the varied clinical presentations, the most common being the ability to invade the intestinal cells. The presence of several virulence genes, along with the host immune status, can modulate the presentation. Therefore, in this study, an attempt was made to detect virulence genes in Shigella species by multiplex PCR.

Antibiotic therapy is recommended in shigellosis to prevent complications and the spread of disease. Over the last few decades, Shigella has demonstrated unique ability to acquire horizontally-transferred genetic material, thereby making previously-efficacious drugs, like sulphonamides, tetracycline, ampicillin, and cotrimoxazole largely ineffective. The situation recently is further worsened by the emergence of multidrug-resistant strains worldwide. Therefore, the present study was also carried out to correlate the antibiotic susceptibility pattern of Shigella isolates with the clinical features.

MATERIALS AND METHODS

The study was undertaken at the Department of Microbiology in JIPMER, Puducherry, India, from October 2010 to March 2012. The Ethics Committee of the institute approved the study.

A total of 33 children were included in the present study based on the inclusion criteria: children aged less than 12 years, either sex, those who came to hospital with symptoms of diarrhoea (passing stools at least 3 times in 24 hours) or dysentery (bloody stools or mucoid stools), and stool culture positive for Shigella species. Informed and written consents were obtained from the parents or guardians.

Collection and processing of stool specimens

Stool samples were plated on MacConkey and xylose lysine deoxycholate agar (Himedia, Mumbai, India). Also, the sample was inoculated in Selenite F enrichment broth and subcultured after 18 hours on the abovementioned plates. Identification of Shigella species was done using standard biochemical tests and confirmed using antisera (Denka-Seiken, Tokyo, Japan).

Antibiotic susceptibility pattern of the strains isolated

Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method (3) for the antibiotics: ampicillin 10 [micro]g, trimethoprim-sulphamethoxazole 1.25/23.75 [micro]g, ciprofloxacin 5 [micro]g, ceftriaxone 30 [micro]g, tetracycline 30 [micro]g, and chloramphenicol 30 [micro]g (Himedia Laboratories, Mumbai). The minimum inhibitory concentration (MIC) for ciprofloxacin and ceftriaxone were performed using Epsilometer test (E-test) strips according to the manufacturer's instructions (AB Biomeriuex, India). The inoculum for the susceptibility testing and the interpretation were done as per CLSI (Clinical Laboratory Standards Institute) guidelines (3). ATCC Escherichia coli 25922 was used as the control for interpretation of zone diameters. Combination disc method according to CLSI guidelines was used in order to detect ESBL production in ceftriaxone-resistant Shigella isolates. …

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