Neurologic manifestations of childhood shigellosis

Abstract

Objective: Review the neurologic manifestations of shigellosis in children. Methodology: Eight hundred sixty-three consecutive patients with shigellosis, admitted to the treatment centre of ICDDR.B during a one-year period, were prospectively studied. Patients were divided into four groups based on history and findings of physical examinations: conscious; unconscious; seizure witnessed in hospital; and seizure by history but not witnessed. Results: Of the 71 patients aged about 15years, 14% were unconscious either on admission or during hospitaliza-tion; none had seizures. Seven hundred ninety-two patients were aged less than 15 years; 9% were unconscious, 5% had a seizure witnessed, and 3% had a seizure by history. Patients aged less than 15 years, who had a seizure witnessed, had a significantly higher median weight-for-age (67% of NCHS median vs. 57%); higher mean temperature (38.7°C vs. 37.9°C); lower mean sodium (126 mmol/L vs. 129 mmol/L); and were more often bactaeremic (24% vs. 7%) and hypoglycaemic (blood glucose <2.2 mmol/L; 24% vs. 2%) than conscious patients. When the analysis was restricted to patients aged less than five years and to those infected with Shigella flexneri (who accounted for 64% of all patients with shigellosis), the findings were similar. Shigella was not significantly associated with any of the 4 neurologic categories. In the multiple regression analysis of patients aged less than 15 years, factors independently associated with unconsciousness were: shock, elevated admission temperature, elevated immature and total leukocyte counts, and weight-for-age less than 60% of the median; for witnessed seizure, factors independently associated were: shock, weight-for-age less than 60% of the median, and elevated immature leukocyte count. Forty-eight percent of the 73 unconscious patients aged less than 15 years died in the hospital compared to 29% of the 41 patients who had a seizure witnessed (p=0.081), 6% of the conscious patients (p<0.001), and none of the 24 patients who had a seizure by history (p<0.001). Conclusion: Both diminished consciousness and seizure were associated with a poor outcome in children with shigellosis. Prompt reduction of fever and correction of metabolic alterations may reduce the incidence of these potentially lethal complications and deaths.