Lethal toxic encephalopathy due to childhood shigellosis or Ekiri syndrome

Shigellosis represents a major burden of disease in developing countries. A low infectious dose allows the disease to be spread effectively. Although shigellosis is mostly a self‐limiting disease, antibiotics are recommended to reduce deaths, disease symptoms and organism‐shedding time. However, in India, antimicrobial resistance among the genus Shigella is more common than among any other enteric bacteria. Notably, new serotypes or subserotypes in Shigella are reported from various parts of the world. Identification of new subserotypes of Shigella spp. is becoming a major issue as these strains are nontypeable by conventional serotyping. The commercially available antisera may not cover all possible epitopes of the O lipopolysaccharide antigen of Shigella serotypes. Therefore, molecular methods which most closely approach the resolution of full serotyping are necessary to identify such strains. In addition, the knowledge of a prevalent serotype in various geographic regions may assist in formulating strategies such as the development of a vaccine to prevent infection especially when the immunity to disease is serotype specific, and to understand the disease burden caused by new Shigella serotypes.

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“…Shigella serogroups associated were S. flexneri , S. sonnei and S. dysenteriae (Agha and Goldberg ; Pourakbari et al . ).…”

Section: Extraintestinal Complications Of Shigella Serotypesmentioning

confidence: 97%

“…Neurologic recovery is often attainable, even though a fatal form of encephalopathy called Ekiri syndrome may occur in certain cases. Shigella serogroups associated were S. flexneri, S. sonnei and S. dysenteriae (Agha and Goldberg 2008; Pourakbari et al 2012).…”

Section: Neurological Complicationsmentioning

confidence: 99%

Update on:Shigellanew serogroups/serotypes and their antimicrobial resistance

Sethuvel

Ragupathi

Anandan

et al. 2016

Lett Appl Microbiol

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“…Encephalopathy is usually reversible, but sometimes it can be fulminate and fatal [ 11 ]. A lethal form of encephalopathy known as Ekiri syndrome (in Japanese ‘epidemic dysentery’) is characterized by rapidly developing seizure and coma with only mild colitis [ 12 , 13 ]. Although, neurological abnormalities and other extra intestinal manifestations are more common in children with Shigella dysentery type 1 infection, all four species of Shigella ( S .…”

Section: Introductionmentioning

confidence: 99%

Risk factors and outcome of Shigella encephalopathy in Bangladeshi children

et al. 2017

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BackgroundAlthough, Shigella encephalopathy, a serious extra-intestinal complication of shigellosis, significantly increases the risks of death, data are very limited on predicting factors particularly related to electrolyte profiles in children below five years of age with Shigella encephalopathy. Our objective was to determine the clinical as well as laboratory predicting factors and outcome of children with Shigella encephalopathy.Methodology/Principal findingsIn this unmatched case-control design, children aged 2–59 months having a positive stool culture for Shigella and who had their serum electrolytes been done from July 2012 to June 2015 were studied. Children with Shigella encephalopathy, defined as having abnormal mentation, constituted the cases, and those without encephalopathy constituted the controls. During the study period, we identified a total of 541 children less than five years of age, who had Shigella in their stool culture. Only 139 children fulfilled the study criteria and among them 69 were cases and 70 were controls. The cases more often had fatal outcome compared to the controls (7% vs. 0%, P = 0.02). In logistic regression analysis, the cases were independently associated with shorter duration (1.2 ± 0.4 days) of diarrhea prior to admission, dehydrating diarrhea, sepsis and hyponatremia (p<0.05 for all). Among 139 Shigella isolates, S. flexneri (88/139, 63%) and S. sonnei(34/139, 24%) were the dominant species. S. dysenteriae was not isolated throughout the study period. S.sonnei was more frequently isolated from the cases (24/69, 35%) than the controls (10/70, 14%), whereas the isolation of S. flexneri was comparable between the groups (40/69, 58% vs 48/70, 69%). A total of 94 (67.6%) isolates were resistant to trimethoprim-sulphamethoxazole, 84 (60.4%) to ciprofloxacin, 66/138 (48%) to ampicillin, 5 (3.5%) to ceftriaxone, 17 (12.2%) to mecillinum and 35 (25%) to azithromycin.Conclusions/SignificanceThe case-fatality-rate was significantly higher among the children with Shigella encephalopathy compared to those without encephalopathy. Early identification and aggressive management of simple risk factors for Shigella encephalopathy may help to reduce morbidity and deaths in such children especially in resource-limited settings.

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“…7 A more recent study found 5 cases of lethal encephalopathy among 1295 children (0.4%) presented to the hospital with shigellosis. 6 However, it is unknown whether the Ekiri syndrome is the same as more recently reports on lethal toxic encephalopathy in children. It is possible that the high death rate among these Japanese children with Shigella enteric infection was a result of the standard of living in those times.…”

Section: Discussionmentioning

confidence: 94%

“… 4 5 All the known Shigella spp ( Shigella sonnei , Shigella flexneri , Shigella dysenteriae and Shigella boydii ) can cause this complication, with a prevalence of 12%–45% in children. 6 A lethal toxic encephalopathy with rapid onset of neurological abnormalities and only a mild colitis is known as the Ekiri syndrome. 7…”

Section: Introductionmentioning

confidence: 99%

An adult case with shigellosis-associated encephalopathy

et al. 2018

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A 45-year-old man was presented at the emergency department with altered neurological status and a 1-day history of diarrhoea and fever. The patient’s sexual history revealed multiple male partners. As bacterial meningitis or viral encephalitis was suspected, treatment was started accordingly. Cerebrospinal fluid investigations only showed a slight increase of leucocytes, and microbiological studies remained negative. Stool culture revealed Shigella flexneri, after which Shigella-associated encephalopathy was suspected. The patient recovered quickly with antibiotic treatment. The incidence of Shigella infections in the Western world is rising due to sexual transmission among men who have sex with men. Shigella-induced encephalopathy is a notorious complication among children with a severe form known as the Ekiri syndrome, though rarely seen in adults. This is the second report of encephalopathy in an adult with S. flexneri enteric infection.

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Lethal toxic encephalopathy due to childhood shigellosis or Ekiri syndrome

Cited by 13 publications

References 12 publications

Update on:Shigellanew serogroups/serotypes and their antimicrobial resistance

Update on:Shigellanew serogroups/serotypes and their antimicrobial resistance

Risk factors and outcome of Shigella encephalopathy in Bangladeshi children

An adult case with shigellosis-associated encephalopathy

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