Background: 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.
Methods: 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).
Results: 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).
Conclusion: 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.
From the *Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and †Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh.
Accepted for publication: November 12, 2009.
Supported by ICDDR,B and the United States Agency for International development (USAID) co-operative agreement number HRN-A-00–96–9005–00.
Address for correspondence: Abu Syed Golam Faruque, MPH, Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. E-mail: email@example.com.