Childhood Dysentery Due to <i>Shigella sonnei</i> and the Challenges of Antibiotic Resistance: A Report from an Outbreak

Abstract

Background: Dysentery is most often caused by Shigella species in underdeveloped countries. This bacterial pathogen presents with fever, watery or bloody diarrhea, and abdominal pain that can be extremely life-threatening for infants and children under five years of age. Objectives: In this study, we investigated the clinical and laboratory findings of children diagnosed with shigellosis during an outbreak of gastroenteritis in late summer 2022, which can help to understand some new epidemiological and clinical aspects of less common Shigella strains. Methods: This cross-sectional study was performed on all children and adolescents who were admitted with diarrhea during an outbreak of gastroenteritis to Besat Hospital, the referral center for pediatric infectious disease in Hamadan province, Iran. During this investigation, demographic information, laboratory findings, results of culture and antibiogram, and epidemiological information were recorded and analyzed. Results: Diarrhea was the initial clinical manifestation in 59.4% of children, followed by vomiting, fever, and abdominal pain. The most common manifestation was diarrhea (100%), which was bloody in 57.6% of cases. The result of stool culture was positive for Shigella sonnei in 28 patients (65.1%). All cases of S. sonnei that grew in stool culture were resistant to cefixime, ceftriaxone, cotrimoxazole, cephalexin, and azithromycin. Conclusions: Given the prevalence of S. sonnei as a cause of dysentery outbreaks in Iran and its antibiotic resistance patterns, ciprofloxacin should be considered as the first-line therapy for Shigella gastroenteritis. This recommendation aligns with World Health Organization (WHO) guidelines but has yet to be incorporated into Iranian treatment protocols. Considering the results of this study, we also recommend establishing a surveillance system for shigellosis to monitor disease trends and enable timely outbreak detection.