ISCM-CH

Fac. "MIGUEL ENRIQUEZ"

 

 

HOW DOES SHIGELLOSIS BEHAVE IN CHILDREN

 

AUTHORS: LYNNE MORALES SIXTO (*)

MARIANLIE NAVARRO MAESTRE (**)

DAMIÁN ROMERO VAZQUEZ (***)

 

TUTORS: Dra. MARIA ESTHER MAGRANER TARRAW (****)

Lic. CONSUELO PENELA FERNANDEZ (*****)

 

(*) Estudiante de 6to año de Medicina.

(**) Estudiante de 4to año de Medicina.

(***) Estudiante de 5to año de Medicina.

(****) Especialista de I grado en Pediatría. Profesor asistente.

(*****) Licenciada en Lengua y Literatura Inglesa.

 

Ciudad Habana 2000

 

ABSTRACT

 

A retrospective descriptive study was made in order to analyze the behavior of Shigellosis in discharged children from Pediatric Hospital S.M.P. during 1995- 1999. It was taken as an investigative reference the clinical histories of these patients with the diagnosis of Shigellosis from Statistics Department of the Pediatric Hospital S.M.P. Results showed that most affecting patients by this disease were kids under one year of age representing the 54.86% out of 751 cases. The major incidence that occurred in 1996 lowering year by year up to 1999 which tends to increase with 179 patients.

 

INTRODUCTION

 

Enteric infections comprise the second commonest medical problem after respiratory infectious diseases and, in some populations reach hiperendemic proportions (1).

Since a lot of time have been considered to dysenteric syndrome as a whip for mankind but only in last 90 years have been known the most frequent bacteriology of epidemic dysenteric (1,2).

The infection by Shigella commonly occurs during warm months in lukewarm clime as well the rainy season in tropical weather (1,2).

There are no preferences by any sex because both are equally affected. In the first six months of life the disease is rare and different authors state that it was due to specifically antibodies against the bacteria contained in the human milk in epidemic zones (1,2,3).

Shigellosis is an acute bacterial infection caused by the genus Shigella that produces an unspecific colitis affecting preferably the rectosigmoid colon. "Bacilar dysentery " is synonymous of Shigellosis (2,3).

The genus Shigella is divided into 4 major subgroups, which are subdivided into serologically determined types: S. flexneri, S. sonnei, S. boydii and S. dysenteriae. There are gram negative bacilus, motionless, belonging to Enterobactericeae family (1,2,3,4).

The source of infection is the excreta of infected individuals or convalescent carries. Direct spread is by the fecal – oral route; indirect spread, by contaminated food and inanimate obcjets (4)

 

Epidemics occur most frequently in overcrowded populations with inadequate sanitation. Bacilary dysentery is particularly common in younger children living in endemic areas. During last 20 years have been produced important epidemics in Central America, Central Africa and India. At industrialized societies the fundamental cause of bacilar dysentery is the S. sonnei, and in the worldwide epidemics is the S. dysenteriae (2,4).

The incubation period is 1 to 4 days. In young children, onset is sudden, with fever, irritability, anorexia, nausea or vomiting, diarrhea, abdominal pain and distention, and tenesmus. Within 3 days, blood, pus, and mucus appear in the stools. The number of stools generally increases rapidly to more 20 per day, and weight loss and dehydration become severe (2,4).

As extraintestinal feature, S. dysenteriae infection may present with delirium, convulsions, and coma but little or no diarrhea; it may be fatal in 12 to 24 hours (2,3,4,5,6,7).

The most frequent complication is dehydration with a renal insufficiency risk and death. Dysentery may produce an inadequate releasing of antidiuretic hormone and deep hyponatremia (2,3). Other important complications, especially in very little children with insufficient nutritional state are the sepsis plus disseminated intravascular coagulation. At this point the bacteriemia is due to S. dysenteriae. The hemolytic – uremic syndrome may complicate the disease. The mortality rate when this septic feature appears is increased (20– 50%) (2,3,5,6,7).

Death caused by Shigella in kids with good nutrition is uncommon. In dying children during a bacilar dysentery; malnutrition, thrombocytopenia, hyponatremia, severe dehydration, renal insufficiency, and bacteriemia are frequent (2).

In spite of the fact that the mortality by Shigellosis is low, the incidence and morbidity is high in pediatric ages; that’s why a very deep knowledge of this disease is necessary, and also the reasons in order to treat it adequately, and mainly to prevent it. Taking into account what has been previously exposed we decided to carry out this work.

 

OBJECTIVES

 

 

General objective:

 

 

Specific objectives:

 

1-To know the behavior of Shigellosis by ranking ages.

 

2-To analyze the incidence of the disease in the studied period

 

MATERIAL AND METHOD

 

A retrospective descriptive study was made in order to analyze the behavior of Shigellosis in 751 discharged children from Pediatric Hospital S.M.P. with this diagnosis during 1995- 1999.

 

Methodic

 

For the elaboration of this work we proceded to define and categorize the following variables:

  1. From 0 to 1 year
  2. From 1to 4 years
  3. From 4 to 9 years
  4. From 10 to 14 years

Techniques of collecting data

In this research was taken into account the notes contained in the discharged patient’s charts with the diagnosis of Shigellosis from Statistics Department of the Pediatric Hospital S.M.P in the studied period.

An emptying sheet was made to write down the gathered notes to be processed in the statistics system EPINFO later.

The results are showed by means of boxes and statistics graphics to the better understood and analyzed.

 

DISCUSSION AND RESULTS

 

Table 1 shows how the major number of children with Shigellosis was under one year of age representing the 54.86% out of 751 cases, lowering the pathology’s incidence by age’s increasing in such a manner that the fourth age affecting group had the lowest incidence with only 15 cases of Shigellosis (2%).

This coincides with the literature studied, which states that although the infection by Shigella could be produced at any age, it is more frequent between the second and the third year of life and as long as the age increases, the incidence gets down (1,2).

To explain that we must remember the complete development of the inmunologyc system in older kids and the enhancement of their hygienic habits. It is important to point out that these theories can not totally explain the Shigellosis behavior by ranking ages (1,2,3).

(See table 1 and graphic 1).

Regarding table 2 there was a great incidence of Shigellosis in 1996 lowering it by years until 1999 where there an increased with 179 cases.

Population Shigellosis’s incidence is according to life conditions in heaping together, low standards of personal hygiene, inefficient supply of drinking water and inadequate drainage installations. When one of these elements suffers a change, that explains the behavior of the pathology in the studied sample (2,3,4).

(See table 2 and graphic 2).

Table 3 shows the incidence of Shigellosis by years and rankings ages. You may appreciate that in kids less than 1 year the major incidence was in 1996 up to 1999 with a new increase.

In children from 1 to 4 years a similar situation occurred but in the third and fourth age affecting groups the major incidence was only in 1996 without later enlargement.

(See table 3 and graphic 3).

 

CONCLUSIONS

Concerning the latest scientific studies about Shigellosis we have gathered what follows:

  1. After analyzing the ranking ages in which Bacilar dysentery was produced we arrived to the conclusion that kids less than 1 year were the most affected.
  2. 1996 was the year who reported the major incidence of Shigellosis followed by 1999.


RECOMMENDATIONS AND PROPHYLAXIS

 

Preventing spread by contaminated food, water, and flies requires good sanitation, with the following measures: thorough handwashing before handling food; immersion of soiled garments and bedclothes of dysentery patients in covered buckets of soap and water until they can be boiled; used of screens on houses; use of mosquito netting. Proper isolation (especially stool isolation) should be used with patients and carriers. A live oral vaccine is being developed, and field trials in endemic areas seem successful (4).

 

 

Bibliografía

 

  1. Butler, Thomas. Shigelosis. En: Tratado de Medicina Interna de Cecil. Vol. 3. 6 ed. Ciudad de la Habana; editorial Ciencias Médicas. 1996. P. 1901- 1903.
  2. Gómez, H. F., Cleary, T. G. Shigella. En: Tratado de Pediatría de Waldo Nelson. Vol. 2. 15 ed. Madrid; Interamericana. 1998. P. 992-995.
  3. Ferrer Gurgui, M. Infecciones por Shigella. En: Medicina Interna de Farreras. Vol. 2. 13 ed. Madrid; editorial Harcourt Brace. 1997. P. 2296- 2298.
  4. Berkow, Robert. Shigellosis. In: The Merck Manual of diagnosis and therapy. 16 ed. Editorial Board. 1994.
  5. Riley, L. W., Pape, J. W. and Johnson Jr., W. D. Infections caused by Salmonella and Shigella. In: Internal Medicine of Jay H. Stein. 4 ed. St. Louis; editorial Mosby. 1994. P. 2140- 2146.
  6. Keush, G. T. Shigellosis. En: Principios de Medicina Interna de Harison. Vol. 1. 14 ed. Madrid; Interamericana. 1998. P. 1095- 1099.
  7. Gibson, L. L., Rose, J. B. and Haas, C. N. Use of quantitative microbial sisk assessment for evaluation of the benefits of laundry sanitation. Am J Infect Control 1999 dec; 27 (6): S 34-9.

 

 

ANEXES

TABLE #1: Distribution of frequency by ranking ages in children with the diagnosis of Shigellosis from Pediatric Hospital S.M.P during 1995 to 1999.

Ranking ages

Number of cases

%

<1

412

54.86

1 – 4

272

36.22

5 – 9

52

6.92

10 – 14

15

2.00

Total

751

100

Source: Clinical Histories.

Table #2: Incidence by years of the Shigellosis in the Pediatric Hospital S.M.P during 1995 to 1999.

Years

Number of cases

%

1995

74

9.85

1996

200

26.63

1997

169

22.50

1998

129

17.18

1999

179

23.84

Total

751

100

Source: Clinical Histories.

Table #3: Distribution by years and age affecting groups of the studied sample in the Pediatric Hospital S.M.P from 1995 to 1999.

Age affecting groups

 

<1

1- 4

5 - 9

10 - 14

Total

Years

#

%

#

%

#

%

#

%

#

%

1995

36

48.65

29

39.19

7

9.46

2

2.70

74

100

1996

106

53

73

36.5

16

8

5

2.5

200

100

1997

88

52.07

64

37.87

12

7.10

5

2.96

169

100

1998

79

61.24

40

31.01

10

7.75

0

0

129

100

1999

103

57.54

66

36.87

7

3.91

3

1.68

179

100

Total

412

54.86

272

36.22

52

6.92

15

2

751

100

Source: Clinical Histories.