Shigellaemia in adult Gambians - a report of 2 cases

Abstract

Background: Shigellosis is an infection caused by the bacteria Shigella. Most commonly, it causes a febrile illness with gastrointestinal symptoms including mucoid, bloody diarrhoea with or without tenesmus. Occasionally it may become septicaemic (shigellaemia) often in the immunocompromised. Aim: To document 2 cases of bacteraemia due to Shigella in patients with enteric symptoms and clinical signs of immunosuppression. Findings: We report two cases of Shigella bacteraemia both adult females. The first case was a patient confirmed with HIV 1 infection. The second case had overt clinical signs of advanced immunosuppression but we could not confirm her HIV serostatus. Shigella flexneri was isolated from the blood in both cases. Stool cultures were negative in both patients. Molecular diagnostic techniques are now available and have the advantage of being highly sensitive and specific. Regarding outcome, the first case report was in a poor clinical state and was discharged against medical advice while the second case died within 24 hours of admission. Conclusion: It is critical that prompt identification of a case of Shigella be made by with a high index of suspicion. As part of their management, we propose that patients with febrile gastroenteritis especially in the setting of risk factors like immunosuppression or malnutrition have blood cultures early and empiric therapy initiated while awaiting results. Resistance to commonly used antibiotics is high such that ampicillin is no longer recommended as an empiric treatment. Ciprofloxacin or the third generation cephalosporins are now the drug of choice.

Key words: Shigellosis, shigellaemia, immunosuppression, enteric symptoms, blood culture, empiric antibiotic