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Breast-feeding, hydration education critical for parents of children with shigellosis
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Children with Shigella encephalopathy had a higher case fatality and their mothers were more likely to stop breast-feeding in the neonatal period than those children with shigellosis who did not have encephalopathy, according to published data.
“Clinicians should be more careful about the non-breast-fed infant and should be vigilant about [patients with a] short history of diarrhea that presents with dehydration but have the features of shigellosis. Treatment should be started promptly and more aggressively,” said study author Mohammod Jobayer Chisti, MB BS, of the Clinical Sciences Division at the International Centre for Diarrheal Disease Research in Dhaka, Bangladesh.
Chisti and his colleagues at Dhaka Hospital set out to identify clinical and sociodemographic predicting factors for Shigella encephalopathy among children aged 0 to 15 years who had a positive stool culture for Shigella. Twenty-nine patients had Shigella encephalopathy, defined as any child with shigellosis having disorientation, drowsiness, confusion, convulsion or coma. Researchers randomly selected 87 patients who had shigellosis without encephalopathy from a group of 730 patients enrolled in the Diarrheal Disease Surveillance system. The children were treated at the Dhaka Hospital during 1997 to 2006.
Among the children with Shigella encephalopathy, six had convulsions and 23 were disoriented but did not have convulsions. The researchers found a 7% case-fatality rate in the encephalopathy group compared with 0% in the group without encephalopathy (P=.013). In univariate analysis, the researchers found that patients with encephalopathy more often presented with watery stool devoid of blood or mucous (P<.001) and with adventitious sounds in the lungs (P=.03). Patients with encephalopathy were also less likely than those without encephalopathy to receive vitamin A (P=.018),
Logistic regression analysis revealed that children with encephalopathy were more likely to have stopped breast-feeding in the neonatal period (P=.001), to have had dehydrating diarrhea with a duration of less than one day (P=.004), to be severely stunted (P=.033), to have had pneumonia (P=.582) and to have an illiterate father (P=.038).
The researchers also reported observing a relatively older age in the encephalopathy group compared with the group of patients without encephalopathy, as well as a higher proportion of boys.
The researchers reported no differences between the two groups for maternal illiteracy, lower socioeconomic status, measles within the previous six months, history of abdominal pain, frequency of diarrhea, fever, undernutrition, wasting or isolation of the Shigella species.
“Education of parents about the value of exclusive breast-feeding and of prompt hydration in children with Shigella is critical to minimize morbidity and deaths,” the researchers concluded.
The case-fatality rate reported in this study is lower than rates previously reported, according to the researchers, who hypothesized that this is due to the improved management of these patients, including prompt rehydration and management of malnourished children. The study also confirmed previous findings of no association of any particular Shigella disease with encephalopathy.
“As the death rates are four times more in children with Shigella encephalopathy compared to the children with Shigella without encephalopathy, this should alert clinicians about the more aggressive use of antibiotics and supportive management,” Chisti said.
Chisti MJ. Pediatr Infect Dis J. 2010;29(5):444-447.