Virulent shigella variant on the prowl in Kerala

Infection different from usual diarrhoeal disorders

The recent death of a girl from Kasaragod due to shigellosis has turned the spotlight on the need to be alert against a virulent form of the bacteria now being increasingly found among infected people in Kerala.

Health workers have been asked to detect early symptoms as the infection is different from usual diarrhoeal disorders. “Normally, the diarrhoea caused by shigella leads to blood in stools. However, most of the cases now being reported have only watery stools with no presence of blood or mucus,” K.K. Purushothaman, Professor, MES Medical College Hospital, Perinthalmanna, Malappuram, said.

He pointed out that their condition progressed very fast to critical and life-threatening state as well. In the case of Devananda, who succumbed to the infection in Kasaragod, this happened within 24 hours. As the shigella dysentery usually manifests after an incubation period of more than a day, nobody suspected its presence in her, Dr. Purushothaman noted. He said that the possibility of shiga toxin, which may cause neurological symptoms like coma or seizures in infected people, had been common earlier, but these were not lethal.

“Ekiri syndrome, the worst case scenario of shigellosis, is being reported here for the past few years. Health workers should be alert towards symptoms such as loss of memory, confusion, disorientation, strange behaviour, etc. and seizures if children have loose stools,” Dr. Purushothaman said.

Paediatricians started observing this pattern in 2016 when a death due to the infection was reported at the Institute for Maternal and Child Health (IMCH), Government Medical College Hospital, Kozhikode.

M.P. Jayakrishnan, Additional Professor, IMCH, told The Hindu on Sunday that more and more infected people were found to have the presence of shigella sonnei, a more virulent form of the bacteria. A team of doctors, including Dr. Jayakrishnan, conducted a study among 58 patients for three years. More than quarter of the children who were covered under the study were found to have died.

The study found that most of them were not admitted to the hospital on time. They were also found to have prolonged disorientation and above mentioned symptoms. “... timely initiation of antibiotics shortens the duration of illness and results in bacterio-logical clearance,” the study said. It was published in Indian Pediatrics in 2020.

Dr. Purushothaman said that medicines are normally given to address electrolyte imbalance, low blood sugar levels, or convulsions to patients with diarrhoea. “But in the coming days putting them on antibiotics too could be needed. Since conventional diagnostic tools such as culture and sensitivity take time, molecular diagnosis should be the top priority. Since our labs are now equipped with machines for PCR and TRUENAT tests, kits should be brought for analysis,” Dr. Purushothaman added.