Shigella bacteraemia over a decade in Soweto, South Africa.
Shigella infection rarely penetrates beyond the intestinal mucosa to cause bacteraemia. AIDS patients may be at increased risk. We investigated Shigella bacteraemia rates over a decade in a South African population with a high HIV prevalence and analysed presentation and outcome. A retrospective cohort analysis was performed for hospitalized patients for 2003-2006. The rates were compared to those for 1996-1998. Adult medical rates decreased from 0.195/1000 in 1996-1998 to 0.087/1000 admissions in 2003-2006, and paediatric rates were 0.807/1000 and 0.809/1000 admissions, respectively. Twenty patients were children (median age 7 months) and 14 were adults (median age 41 years). The main clinical presentations were acute (<or=7 days) diarrhoea [94% children and 27% adults (P=0.035)], chronic diarrhoea (27% adults) and pyrexia but no diarrhoea (36% adults and one child). Seventy-five percent of children were tested for HIV infection and 30% were found to be HIV-seropositive. The 10 adults tested were all HIV-positive. All children survived while 50% of adults died (P=0.002). Shigella flexneri caused 88% of cases. Shigella bacteraemia has not increased over a decade in a population with a high HIV burden but did seem to be HIV-related in adults. Children and adults differed in presentation and outcome.
Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, P.O. Bertsham 2013, Johannesburg, South Africa.
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NE
Davies
A S
AS
Karstaedt
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012760:Shigella / Q000302:isolation & purification; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult