EPIDEMIOLOGIC, CLINICAL AND MICROBIOLOGICAL FEATURES OF SHIGELLOSIS AMONG HOSPITALIZED CHILDREN IN NORTHERN ISRAEL

The epidemiological, clinical, and bacteriological aspects of shigello sis were studied in a population of hospitalized children in northern Israel. During the 6-year period 1987-92, 262 children were hospitaliz ed due to shigella infection. Shigellosis represented 10% of pediatric admissions for diarrhea, Admissions for the disease peaked during the summer and autumn. The median age of the patients was 3 years. Shigel la sonnei was isolated in 74% of patients and S. flexneri in 21%, comp ared with relative frequencies of 87% and 10%, respectively, in the no n-hospitalized population of the area, detected during the same period (p < 0.001), Shigella sonnei represented 82% of isolates of hospitali zed Jewish patients but only 60% of hospitalized Arab children, many o f whom live in poverty and overcrowding (p < 0.001). Shigella flexneri was particularly frequent among hospitalized infants, and was associa ted with Arab origin, large families and residence in agricultural set tlements. Duration of hospitalization was 4.7 +/- 2.3 days for S. sonn ei infections and 5.8 +/- 3.6 days for S. flexneri (p < 0.005). No cas es of shigella sepsis, hemolytic uremic syndrome, or fatalities were o bserved. Overall, 37% of all shigella isolates from hospitalized child ren were resistant to ampicillin, 71% to cotrimoxazole, 28% to both an d 13% were resistant to greater than or equal to 3 different drugs. It is concluded that shigellosis is an important cause of hositalization in northern Israel. Resistance to antimicrobial drugs is widespread a mong all Shigella spp. Although S. sonnei is the most common species, S. flexneri is particularly frequent in infants.