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|Title: ||Effects of age, duration of illness and infecting species on the pathology of fatal childhood shigellosis|
|Authors: ||Azad, A.K.|
|Issue Date: ||14-Nov-2007 |
|Series/Report no.: ||J Diarrhoeal Dis Res|
|Abstract: ||Objective: Understand the pathogenesis of the complications and the pathophysiologic mechanisms involved in the persistence of the diarrhoeal illness, and determine the severity of colitis associated with infection due to different species of Shigella, on the basis of results from the recent series of autopsies.
Methods: At the ICDDR.B's Dhaka-based hospital, the Clinical Research and Service Centre, over 100,000 diarrhoea patients are seen annually. At the histopathology laboratory, autopsies are conducted on a sub-sample of patients who die in the hospital.
Results: Infants with infection due to Shigella flexneri more often presented with watery stool and bacteraemia than did the older children. Large areas of deep ulceration of the colonic mucosa and even ulceration involving the entire colonic mucosa were common in infantile 5. flexneri infection. Hypoproteinaemia and bacteraemia in such cases may be the consequences of exudation of proteins through the denuded colonic mucosa and loss of the protective mucosal barrier. Cases with a prolonged course of diarrhoeal illness were found to have persistent mucosal abnormalities, including large areas of deep ulceration of the colonic mucosa. In contrast to S. flexneri infection, S. dysenteriae type 1 infection was generally associated with higher instances of shock, leukocytosis, azotaemia, severe hypoproteinaemia, intestinal obstruction associated with transmural inflammation of colon, and disseminated intravascular coagulation. They also had significantly higher frequencies of pseu do membranous inflammation of the terminal ileum and colon, severe necrotizing haemorrhagic colitis, microvascular thrombosis of the mucosa and submucosa of colon, and glomerular capillary thrombosis. An association of infantile S. dysenteriae I infection with severe necrotizing haemorrhagic colitis, leukaemoid reaction, and development of glomerular capillary thrombosis with or without haemolytic-uraemic syndrome was apparent.
Conclusions: A routine programme of autopsies helps clinicians better understand the underlying complications associated with fatal cases of diarrhoeal illnesses.
Texas Technical University, Texas, USA|
|Appears in Collections:||Public health sciences conference papers|
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