[Neonatal shigellosis].
BACKGROUND
Neonatal shigellosis is rare and is usually encountered in unsanitary countries. It is occasionally responsible for manifestations of bacteremia such as septic shock and rash.


METHODS
A boy was born at 40 weeks of gestational age, while the end of labor was marked by temperature at 38 degrees C. His weight was 3,640 g and his height was 49.5 cm. The temperature of the newborn was 38 degrees C at 1 hour of life. He had hepatomegaly and X-rays showed abdominal distension. Gastric aspirates taken at that time showed Gram-negative bacilli and Gram-positive cocci. The patient was given amoxicillin intravenously and netilmicin intramuscularly. The infant still had a fever at 33 hours of life and produced aqueous stools containing blood and mucus. At H40, he developed shock requiring infusion of human albumin. He was given cefotaxime and was admitted to the intensive care unit, where a hepatosplenomegaly was also noted. He was given respiratory support, albumin infusion, dobutamine and dopamine. Antibiotics included cefotaxime, gentamicin and metronidazole. His total white cell count was 2,400/mm3, with 71% mature neutrophils; his platelet count was 190,000/mm3. Stool cultures showed the presence of Shigella flexneri, but blood cultures did not grow. A generalized rash was seen 4 days later; this persisted for less than 24 hours, while the platelet count was 25,000/mm3. The patient was then given ceftriazone and gentamicin. His stool cultures contained Shigella flexneri on the 4th and 9th day, but not on the 14th day. His mother had diarrhea 7 weeks before delivery, but stool cultures before and after delivery did not grow.


CONCLUSIONS
Diagnosis of neonatal shigellosis is difficult. Cutaneous manifestations, possibly indicating bacteremia, have been seen in older children but never in the neonates.
Mokhtari
M
M
Unité de Réanimation Pédiatrique Polyvalente, Hôpital Saint-Vincent-de-Paul, Paris.
Gourrier
E
E
el Hanache
A
A
Wood
C
C
D003968:Diarrhea, Infantile / Q000209:etiology; D004405:Dysentery, Bacillary / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005243:Feces / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012763:Shigella flexneri; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy
Les shigelloses néonatales.