Factors Associated With Mortality in Toxic Encephalopathy Due to Shigellosis in Children
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Factors Associated With Mortality in Toxic Encephalopathy Due to Shigellosis in Children MACHINARY PUTHENPURAYIL JAYAKRISHNAN,1 MADATHIL GOVINDARAJ GEETA,1 PADINHARATH KRISHNAKUMAR,2 VK GIREESHAN,1 BIJU GEORGE,3 P PRATHIKSHA,4 GOVINDAKARNAVAR ARUNKUMAR4 AND PM ANITHA5 From Departments of 1Pediatrics, 3Community Medicine and 5Microbiology, Government Medical College, Kozhikode, Kerala; 2Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala; and 4Manipal Institute of Virology, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka; India.
Correspondence to: Dr Machinary Puthenpurayil Jayakrishnan, Additional Professor of Pediatrics, Government Medical College, Kozhikode, Kerala, India. [email protected] Received: February 21, 2020; Initial review: February 25, 2020; Accepted: July 27, 2020.
Objective: To study the clinical characteristics and factors associated with mortality among children with Shigella encephalopathy. Methods: The data collection was done prospectively from January, 2018 to May, 2019 with retrospective data from June, 2016 to December, 2017. The study cohort consisted of 58 children 12 hours) were found to be independently associated with mortality. Conclusions: Recognition of factors associated with mortality in Shigella encephalopathy may assist in better monitoring of sicker children and improved outcomes. Keywords: Diarrhea, Ekiri syndrome, Morbidity, Outcome, S. sonnei. Published online: August 09, 2020; PII: S097475591600225
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higellosis continues to be an important cause of diarrhea-related mortality in developing countries [1,2] with Shigella flexneri being the predominant species endemic in India [3]. The most common extra-intestinal complication in shigellosis is encephalopathy, presenting with seizures, headache, lethargy, confusion or hallucinations [4]. Over the last few decades, there has been a substantial reduction in deaths related to shigellosis [5]. Children with Shigella encephalopathy usually recover without any neurological deficits [4]. A recent study from Bangladesh has reported high case fatality in children with Shigella encephalopathy [6] We have also noticed an increase in mortality due to Shigella encephalopathy in our center which prompted us to analyze the hospital records which showed that there was only one death between 2013 and 2015 (unpublished data). Lethal toxic encephalopathy or Ekiri INDIAN PEDIATRICS
syndrome (a severe form of encephalopathy resulting in rapid prog-ression to coma and death) is reported in children with shigellosis from abroad but not from India [7]. The present study aimed to describe the clinical charac-teristics of Shigella encephalopathy in children and to identify factors associated with mortality. METHODS The study was conducted in the Pediatric Intensive Care Unit (PICU) of the Government Medical College, Kozhikode, a tertiary referral centre. Children between 1 month and 12 years of age admitted from 1 June, 2016 to 31 May, 2019 with a diagnosis of Shigella encephalopathy wer
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