Intestinal obstruction during shigellosis: incidence, clinical features, risk factors, and outcome.
To determine the incidence and outcome of intestinal obstruction during shigellosis, the authors assessed 1211 consecutive patients with shigellosis admitted during a 15-month period to a diarrhea treatment center in Dhaka, Bangladesh. Obstruction was identified in 30 (2.5%) patients. Ten (33.3%) of these patients died, compared with 97 (8.2%) of the 1181 patients without obstructions (P less than 0.001; RR = 4.1). In a case-control study, patients with obstructions were compared with 30 control patients with shigellosis but without obstructions. Case and control patients were similar in age (median, 18 months vs. 24 months; NS). Before admission to the hospital, case patients had less often been breast-fed than control patients (33% vs. 85%; P = 0.006) and had more often received antimicrobial agents (53% vs. 13%; P = 0.001). Case patients more often had abdominal tenderness (73% vs. 13%; P less than 0.001), altered consciousness (50% vs. 17%; P = 0.006), and Shigella dysenteriae type 1 infection (73% vs. 27%, P = 0.001) and had a higher median blood leukocyte count (40 x 10(3)/microL vs. 14 x 10(3)/microL; P = 0.007) and serum potassium concentration (5.0 mmol/L vs. 4.3 mmol/L; P = 0.016), and lower median serum sodium (123 mmol/L vs. 131 mmol/L; P = 0.003) and total protein (52 g/L vs. 60 g/L; P = 0.025) concentrations than did control patients. Eight (27%) patients with obstructions developed the hemolytic-uremic syndrome, compared with none of the control patients (P = 0.003). It was concluded that obstruction is an ominous complication of shigellosis and that therapies in addition to provision of antimicrobial agents need to be evaluated.
Bennish
M L
ML
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Azad
A K
AK
Yousefzadeh
D
D
D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D002675:Child, Preschool; D003108:Colonic Diseases / Q000453:epidemiology / Q000469:parasitology; D004405:Dysentery, Bacillary / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D012307:Risk Factors