Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Article in Press
Brief Report
Case Report
Case Report and Review
Case Reports
Case Series
Commentary
Editorial
Erratum
How do I do it
How I do it?
Invited Editorial
Letter to Editor
Letter to Editor/Case Reports/Images
Letter to the Editor
Letters to Editor
Letters to the Editor
Mini Review
Original Article
Original Articles
Original Research
Other Type
Others
Review Article
Short Paper
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Article in Press
Brief Report
Case Report
Case Report and Review
Case Reports
Case Series
Commentary
Editorial
Erratum
How do I do it
How I do it?
Invited Editorial
Letter to Editor
Letter to Editor/Case Reports/Images
Letter to the Editor
Letters to Editor
Letters to the Editor
Mini Review
Original Article
Original Articles
Original Research
Other Type
Others
Review Article
Short Paper
View/Download PDF

Translate this page into:

Letters to Editor
4 (
1
); 65-66
doi:
10.4103/0974-2727.98682

Shigella Flexneri bacteremia in Adult

Department of Microbiology, Fortis Escort Heart Institute, Okhla Road, New Delhi, India
Address for correspondence: Dr. Shweta Sharma, E-mail: drshweta04@yahoo.co.in
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

We report an uncommon case of Shigella bacteremia in adult with history of dysentery. A 65-year-old nondiabetic, hypertensive male was admitted with complaints of gastroenteritis for 7 days, and fever and pain in abdomen since 3 days. There was a history of chronic kidney disease, dilated cardiomyopathy, and permanent pacemaker device implanted since past 7 years. On examination, the patient was febrile (38.4°C) and hemodynamically stable. Laboratory investigation revealed a hemoglobin level of 11.9 g/dL, platelet count of 205 × 109/L and high total leukocyte count (18.3 × 109/L). Blood urea nitrogen was 68 mg/dL and serum creatinine 3.9 mg/dL. On echocardiography, ejection fraction was of 30%. Ultrasonography of abdomen showed the presence of cortical cyst in the right kidney. Colonoscopy done showed extensive ulceration in left colon suggestive of acute ulcerative colitis. The stool examination revealed the presence of occult blood. Stool, urine and two blood samples were sent for the aerobic culture. No growth was observed in the urine and stool culture. Shigella flexneri grew in both the blood culture samples with the same antibiotic susceptibility pattern. Patient was treated initially with Injection ciprofloxacin, metronidazole for 4 days, and then Injection cefoperazone sulbactam was added. However, patient did not respond even after 48 h of treatment. Then these antimicrobials were discontinued by physicians and injection meropenem was started. Patient started responding; his total count decreased and became afebrile. Subsequent blood cultures were negative. Blood cultures were processed by automated method (BactALert 240).[1] The identification and sensitivity was performed by conventional as well as by automated method (Vitek2 compact, Biomerieux).[2] The isolate was found sensitive to cefoperazone sulbactam, piperacillin tazobactam, cefepime, imipenem, meropenem, and resistant to ceftriaxone, ciprofloxacin, trimethoprim sulfamethoxazole. On serotyping that was done at National Institute of Cholera and Enteric Diseases, Kolkata, it was found to be S. flexneri type 3a.

Though an invasive disease, it usually do not reach the tissue beyond the lamina propria and hence very rarely cause bacteremia and positive blood cultures except under very special circumstances like immunocompromised status. Since the mechanism of bacteremia remains unclear, invasiveness may be associated with a mixture of soluble bacterial proteins encoded by a 140-MD plasmid.[3] For the bacteriological diagnosis of Shigella enteritis only stool culture has practical value. Scragg and Rubidge reported S. bacteremia cases who were stool culture negative.[1] In our case also, the blood but not the stool culture was positive. Common sp implicated in cases of septicaemia is Shigella dysenteriae type 1[4] In the reported case, it is due to S. flexneri type 3a. On pubmed literature search, there were limited reports of S. bacteremia in children with no case report in adult from India.[5]

Thus, though S. bacteremia is a rare phenomenon, it does occur. Prompt and frequent cultures of blood are recommended especially where either the patient is immunocompromised or febrile with diarrhea. This may be of great significance in determining the treatment and the outcome of the disease.

REFERENCES

  1. , , , . Shigella infection in African and Indian children with special reference to Shigella septicaemia. J Pediatr. 1978;93:796-7.
    [Google Scholar]
  2. Clinical And Laboratory Standards Institute: M100-S21 Performance Standards for Antimicrobial Susceptibility testing. In: Twentieth Informational Supplement. Wayne PA: CLSI; .
    [Google Scholar]
  3. , , , , . Shigella flexneri bacteremia in a child. Saudi Med J. 2003;24:403-5.
    [Google Scholar]
  4. , , , , , , . Shigella bacteremia in adults. A report of five cases and review of literature. Arch Intern Med. 1987;147:2034-7.
    [Google Scholar]
  5. , , , , . Shigella septicemia. Indian Pediatrics. 2002;39:777-9.
    [Google Scholar]

    Fulltext Views
    57

    PDF downloads
    58
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections