EPIDEMIC SHIGELLA DYSENTERY IN CHILDREN IN NORTHERN KWAZULU-NATAL

Objectives. To describe the epidemiology, clinical features, managemen t and outcome of children with Shigella dysenteriae type I infection a dmitted to a rural district hospital. Design. Prospective cohort study . Setting. Hlabisa Hospital, KwaZulu-Natal. Subjects. Children aged un der 12 years admitted with a history of bloody mucoid diarrhoea betwee n February and December 1995. Main outcome measures. Number of admissi ons, age, sex, clinical features, complications and outcome. Results. Between February and December 1995, 158 cases of bloody diarrhoea were admitted, compared with 6 the previous year. Shigella dysenteriae typ e I, resistant to ampicillin, tetracycline, chloramphenicol, trimethop rim and sulphamethoxazole, but susceptible to nalidixic acid and ceftr iaxone, was isolated. The mean age of patients was 30 months. Patients typically presented with frequent bloody mucoid diarrhoea, fever, abd ominal pain and dehydration. One hundred and sixteen (73%) recovered, 17 (11%) were transferred for tertiary care, 4 (3%) absconded, and 21 died (case fatality rate = 13%; 95% confidence interval (CI) 8 - 20). Seventeen (11%) developed haemolytic uraemic syndrome and 4 (3%) a pro tein-losing enteropathy. The malnourished (adjusted relative risk (RR) 3.3, 95% CI 1.6 - 7.1; P < 0.01) and those aged less than 2 years (ad justed RR 4.2; 95% CI 1.0 - 17.2; P = 0.05) were more likely to die. D ysentery deaths accounted for 19% of total paediatric hospital mortali ty. Conclusion. A serious epidemic of shigella dysentery has establish ed itself and is having a significant impact in this area. The virulen ce and drug resistance of the organism has resulted in high levels of morbidity and mortality Broad public health measures will be needed to contain the epidemic. Further community-based surveillance is urgentl y needed, as is research to determine modes and risk factors for trans mission.