Characteristics of Children With Shigella Encephalopathy

Abstract

Encephalopathy is a serious neurologic complication from shigellosis often with fatal outcome but data on simple clinical and sociodemographic predicting factors are limited. We sought to identify those factors in children. In this unmatched case-control design, children of both sexes, aged 0 to 15 years having positive stool culture for Shigella from 1997 to 2006 were studied. Children with Shigella encephalopathy constituted the cases (n = 29), whereas randomly selected children with shigellosis having no encephalopathy constituted controls (n = 87). The case-fatality was significantly higher among the cases than among controls (7% vs. 0%, RR: 4.2, CI: 3.0-5.9, P = 0.013). In logistic regression analysis, children with Shigella encephalopathy more often had an illiterate father (OR: 5.4, 95% CI: 1.1-27.1, P = 0.038), stopped breast-feeding in the neonatal period (OR: 41.3, 95% CI: 4.2-403.1, P = 0.001), had dehydrating diarrhea (OR: 9.9, 95% CI: 2.1-45.9, P = 0.004) with a duration of <1 day (OR: 29.4, 95% CI: 2.1-43.2, P = 0.004), and were more likely to be severely stunted (OR: 6.4, 95% CI: 1.2-34.9, P = 0.033). Education of parents about the value of exclusive breast-feeding and of prompt hydration in children with Shigella is critical to minimize morbidity and deaths.