SHIGELLOSIS IN CHILDREN FROM NORTH-INDIA - A CLINICOPATHOLOGICAL STUDY

Stool samples of 1488 children suffering from acute diarrhoea were stu died for bacterial culture and sensitivity, Shigella culture was posit ive in 143 (10 per cent) children and 53 hospitalized children could b e studied in detail, Thirty-six (68 per cent) children were under 2 ye ars of age and peak prevalence was observed in summer months, Fever an d diarrhoea were universal features; 95 per cent had blood and mucus i n the stools, but 32 per cent started with watery diarrhoea lasting 1- 3 days followed by dysentery, Two cases (4 per cent) had watery diarrh oea, Abdominal pain dehydration, and malnutrition were present in more than two-thirds of the cases, Central nervous systemic (CNS) manifest ations, renal failure, respiratory manifestations, and subacute intest inal obstruction were seen in 45, 25, 17, and 5 per cent of cases, res pectively, Shigella dysenteriae was the commonest organism grown in 57 per cent, followed by Shigella flexneri in 36 per cent, Shigella boyd ii in 4 per cent, and Shigella sonnei in 4 per cent cases, In the majo rity, the organisms were sensitive to neomycin (83 per cent), furazoli dine (86 per cent), and cephaloridine (87 per cent), whereas Shigella strains were resistant to tetracycline in 93 per cent, ampicillin in 8 3 per cent, chloramphenicol in 91 per cent and cotrimoxazole in 66 per cent cases, Proctosigmoidoscopy was useful in defining the nature of mucosal lesion, to collect swabs for culture and biopsy specimen for h istopathology. Four (8 per cent) cases had pseudomembrane and in two c ases Clostridium difficile could be identified, Eight (15 per cent) ca ses died and two of them had shigellaemia, All were under the age of 2 years, severely malnourished and had protracted course of the disease in spite of antimicrobial therapy, Thirty-eight per cent of cases had persistent diarrhoea (more than 2 weeks) due to shigellosis, Sigmoido scopy was useful in monitoring the colitic illness and in differentiat ing shigellosis from other inflammatory diseases of the large bowel.