case report of a survival from Ekiri syndrome

Lethal toxic encephalopathy of shigellosis [Ekiri syndrome] is a rare complication of the shigella infection presented with fever, severe toxicity, seizure and diffuse brain edema, coma and death in the absence of dehydration and is nearly always lethal. This report is about a child who has survived the Ekiri syndrome. A three-year old child was admitted to the emergency ward because of fever, one attack of generalized tonic-clonic seizure, drowsiness and diarrhea with no signs of dehydration. The differential diagnosis was meningitis, shigellosis and atypical febrile convulsion. All test results for blood, urine, stool and cerebro-spinal fluid samples were normal except for serum sodium [119 mmol/1] and stool exam [many RBCs]. He was treated with anticonvulsants because of the recurrent seizures and ceftriaxone with probability of shigellosis. The emergency brain CT scan showed diffuse brain edema. After 48 hours the consciousness was improved. Stool culture showed the growth of Shigella flexneri. Second brain CT scan revealed a dramatic decrease of the brain edema. Because neurological symptoms are among the extra intestinal complications of the shigellosis, it is recommended to put this disease in the list of differential diagnosis of unexplained neurological signs in endemic areas and consider the specific medications in the treatment programs

Multidisciplinary studies of disease burden in the Diseases of the Most Impoverished Programme.

With limited healthcare resources, rational prioritization of healthcare interventions requires knowledge and analysis of disease burden. In the absence of actual disease-burden data from less-developed countries, various types of morbidity and mortality estimates have been made. Besides having questionable reliability, these estimates do not capture the full burden of a disease since they provide only the number of cases and deaths. The modelling methods that include disability are more comprehensive but are difficult to understand, and their reliability is affected by baseline approximations. To provide policy-makers with information needed for rational decision-making, the Diseases of the Most Impoverished (DOMI) Programme of the International Vaccine Institute has used a multidisciplinary approach to describe the burden of disease due to typhoid fever, shigellosis, and cholera. Recognizing the relative advantages and disadvantages of various methodologies, the programme employs passive clinic-based surveillance in defined communities to provide prospective data. The prospective data are complemented with retrospectively-collected information from existing sources, frequently less accurate and complete but readily available for the whole population over extended periods. To create a more complete picture, economic and qualitative studies specific to each disease are incorporated in these prospective studies. The goal is to achieve a more complete and realistic picture by combining the results of these various methodologies, acknowledging the strengths and limitations of each. These projects also build in-country capacity in terms of treatment, diagnosis, epidemiology, and data management.

Vacunación contra la shigelosis / Vaccination against shigelosis

Se define como shigelosis a la enfermedad intestinal producida por las diferentes especies del género Shigella, de las cuales el humano es el principal hospedero. Shigella es un bacilo corto, Gram-negativo, de la familia Enterobacteriaceae. La shigelosis se manifiesta en tres formas: 1) disentería clásica (sangre, moco, pus), 2) diarrea acuosa no complicada y 3) una combinación de disentería y diarrea acuosa. La mayoría de los casos de diarrea acuosa no son distinguibles de las que son ocacionadas por otras etiologías. Concluye el documento enfatizando que, no existe hasta el momento actual ninguna vacuna contra Shigella que pueda ser recomendable para la aplicación en población general. Todos los esfuerzos hasta ahora realizados han quedado en pequeños estudios en voluntarios, en los cuales se han obtenido fracasos y en otros ensayos se han vislumbrado posibles vacunas para emplear en el futuro. Dentro de los modelos experimentales de vacunas que hasta el momento hay, se está intentando corregir los posibles errores y por otra parte conjuntar los mecanismos de acción propuestos para cada tipo de vacuna. Finalmente si la shigelosis es un problema de salud pública, principalmente en los países en vías de desarrollo, son importantes los esfuerzos para lograr obtener una vacuna que en lo futuro pueda reducir uno de los principales problemas de morbilidad infantil