Pathogenesis

Shigellas are nonmotile, gram-negative, nonlactose-fermenting rods and are members of the family Enterobacteriaceae. There are four species of Shigella: S. dysenteriae (serogroup A), S. flexneri (serogroup B), S. boydii (serogroup C), and S. sonnei (serogroup D). Infection with Shigella occurs after ingestion of as few as 10 to 100 organisms. This low dose of organisms probably explains the person-to-person spread and the high secondary attack rate when an index case is introduced into a family.

Shigella strains invade intestinal epithelial cells with subsequent multiplication, inflammation, and destruction.4 The organism infects the superficial layer of the gut, rarely penetrates beyond the mucosa, and seldom invades the bloodstream. However, bacteremia can occur in malnourished children and immunocompromised patients.

Table 76-1 Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss

Virilblt

Mild (l-SPU

MndrrjlL- |6-9<M

MQ'Jtot.r Hiri)

Blood pctiure

Hormal

Normal

fioimal to reduced

Qudltyafputo«

Nanul

Nmn.il :[>i,J-pl-.lly 1 kHnMvii

Modir-njly dWMWd

1*7*1 iaLc

Homul

Inciffii!«)

I'xii'iHcd vbriKjyt j'tl«in wvcie cas«)

Skin lurgoi

normal

Decmitd

[iecteased

fijnwnello

Haml

Smfctn

Sin ken

Mutous mefnl^dne*

Slightly diy

Dry

Dry

iye*

llormal

5tnken orbits/ ctecieased teais

Owpty smnkiii ofhlis/ detneasid rears

Enjiepniii«

Wjim. ncrtL>l capillary refill

OiayMf upaijry itiii

Ooof, flWtllCd

Meftul smus

Noaril

Normal (o liiife«

Manual to lernjrijic rattimjiow

Urino oulpul

Slightly (lw.ri.wed

Leu (kill 1 mUkg/h

Lt-ii llvjn 1 inLAcf/h

lhlrU

Slightly Increased

Mndftalrfy Increased

Vtoy Ihhity

fluid n.uioctfW'l

OPT SOiTiLAyOvCi

fjfil |(X) rtiL/lq orti 2-J hCd'J

L0< ta«d Hinge's 40 rnL^g ^ ■ 30 «n»*Jljei. T'x.i>

t-4 houK

J0-1U ml /kg i skin 1 iiukh. alennesi, and pJse hart>ntn rLlunWd IS normal Si LHlatcd Ringort Of ncrinalMbne JO mL/kcn repeat if n««W<y. ifld then replac e carter and eiec tiofyle def k Its over l-J

days, ^kxwotl t>y OflT 100 HUVty (htf * howl

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