SHIGELLOSIS IN NEONATES AND YOUNG INFANTS

To determine the clinical features and outcome of shigellosis in young infants, we reviewed the hospital records of 159 infants less than or equal to 3 months of age (including 30 neonates) and 159 children 1 t o 10 years of age with shigellosis who were admitted to the Diarrhoea Treatment Centre in Dacca, Bangladesh. Infants more commonly had a his tory of nonbloody diarrhea (82.8% vs 42.7%; p <0.001), moderate or sev ere dehydration (59.9% vs 32.1%; p <0.001), or bacteremia (12.0% vs 5. 0%; p = 0.027) and less commonly had fever (32.7% vs 58.6%; p <0.001), abdominal tenderness (1.9% vs 12.6%; p <0.001), or rectal prolapse (0 % vs 8.3%; p = 0.001). Infections caused by Shigello boydii (20.8% vs 6.3%; p <0.001) and Shigella sonnei (7.5% vs 1.3%; p = 0.006) were mor e common, and Shigella dysenteriae type 1 (9.4% vs 31.4%; p <0.001) in fections were less common in infants than in older children; the propo rtion of Shigella flexneri infections was equivalent in the two groups (59.1% vs 60.4%). Infants were twice as likely to die as older childr en (16.4% vs 8.2%; p = 0.026). Only 17 infants (14.3%) were being excl usively breast fed at the onset of their illness. In a multiple logist ic regression analysis, independent predictors of death in infants wer e gram-negative bacteremia, ileus, decreased bowel sounds, hyponatremi a, hypoproteinemia, and a lower number of erythrocytes detected on mic roscopic examination of stool specimens. Diarrhea management algorithm s that rely only on clinical findings of dysentery to diagnose and tre at shigellosis are likely to be unreliable in this high-risk age group .