Clinical manifestations and microbiology of Shigella diarrhoea in children admitted to Teaching Hospital, Jaffna, Sri Lanka

Introduction : Diarrhoeal diseases are an important public health problem in Sri Lanka.  Objectives: To determine the organisms that caused diarrhoea, the clinical profile, socio-demographic details including living conditions, microbiological analysis and response to treatment.  Method: A retrospective study was done from October 2014 to January 2015.  Hospital records were used to analyse living conditions, water supply and general wellbeing of the children in addition to clinical and microbiological data.  Results : A total of 346 (4% of total admissions) cases were admitted with diarrhoeal illness to the paediatric wards during the study period.  One hundred and twenty one (35%) children had blood and mucous diarrhoea of whom Shigella sp . was isolated from the stools of 15. The mean age of children with proven shigellosis was 2.3±1.1years. Seven of the patients with proven shigellosis had poor growth indicated by the low weight for height i.e. between the -2SD and -3SD.  Shigella flexneri II was identified in 14 patients and Shigella sonnei from one patient . Eight (53%) patients with S. flexneri were treated with IV gentamicin to which there was a clinical response. Majority (12) of the households did not have a proper water supply and 10 families had to travel >5 km to get clean drinking water facilities. All 15 cases demonstrated poor hygienic practices. Conclusions : Blood and mucus diarrhoea accounted for 121 of 346 admissions for diarrhoea during a one year period in Jaffna Hospital. A positive aetiological diagnosis was made in only 15 patients, with S. flexneri isolated from 14 and S. sonnei from one patient