Shigella Septicemia: Prevalence, Presentation, Risk Factors, and Outcome

The prevalence, presentation, and outcome of bacteremia due to Shigella and other gramnegative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P < .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P < .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P < .01). The fatality rate in shigella bacteremia (21%) was higher (P < .005) than in nonbacteremic shigellosis (10%) but lower (P < .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P < .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.