Spectrum of dysentery in children presenting to a tertiary level teaching hospital in New Delhi

Abstract

Dysentery accounts for significant morbidity in pediatric population with a high case fatality rate, if left untreated. Further, the easy availability of antibiotics has led to widespread emergence of resistant strains. The aims of this study were: (1) to study the clinical spectrum of dysentery in children, and (2) to determine various enteropathogens causing dysentery in children. 60 children in the age group 1 month to 12 years, presenting with dysentery (defined as loose stools with visible blood), were enrolled. The stool samples were cultured to determine various enteropathogens and their antibiotic sensitivity pattern. About 61.7% of children were in the age group of 6 months to 2 years. 71.7% had no dehydration at presentation. No complication was documented in our study. 80% of stool samples were grossly bloody and 58.3% were grossly mucoid. Enteropathogens were identified in 44 cases (73.3%). Leading isolates were Shigella in 23 cases (38.3%), Escherichia coli in 18 (30%). Salmonella were seen in 2 patients, accounting for 3.3% and Aeromonas in one patient. Among the Shigella, Shigella flexneri was the most frequent isolate (73.9%). Majority of Shigella were resistant to nalidixic acid (95.7%), norfloxacin (87%), and amoxicillin (56.5%). Most isolates were sensitive to cefotaxime, gentamycin and amikacin (95.6% each). Among the E. coli, EHEC were seen in 9 out of 18 (50%) cases, followed by ETEC and EPEC in 22.2% patients each. EIEC were seen in 5.6% of cases. Majority of E. coliwere resistant to amoxicillin (95%), nalidixic acid (88.9%), norfloxacin (66.7%), and cefotaxime (56%). However, most strains were sensitive to gentamycin (88.8%) and amikacin (100%). We conclude that enteropathogen resistance to commonly used antibiotics is rapidly rising however, resistance to extended spectrum cephalosporins is still rare. Thus, local susceptibility patterns should be assessed periodically to guide antimicrobial therapy. Key words: Dysentery, enteropathogens, antibiotic resistance.