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Objective  To determine the clinical manifestations and outcome of shigellosis among children infected with different species of  Shigella .    Methods  We identified all patients <15 years infected with  Shigella  admitted to the icddr, b Dhaka hospital during one year. Study staff reviewed admission records and repeated the physical examinations and history of patients daily.    Results  Of 792 children with shigellosis 63% were infected with  S. flexneri , 20% with  S. dysenteriae  type 1, 10% with  S. boydii , 4% with  S. sonnei , and 3% with  S. dysenteriae  types 2–10. Children infected with  S. dysenteriae  type 1, when compared to children infected with other species, were significantly (P<0.05) more likely to have severe gastrointestinal manifestations: grossly bloody stools (78% vs. 33%), more stools in the 24 h before admission (median 25 vs. 11), and rectal prolapse (52% vs. 15%) - and extra-intestinal manifestations - leukemoid reaction (22% vs. 2%), hemolytic-uremic syndrome (8% vs. 1%), severe hyponatremia (58% vs. 26%) and neurologic abnormalities (24% vs. 16%). The overall fatality rate was 10% and did not differ significantly by species. In a multiple regression analysis young age, malnutrition, hyponatremia, lesser stool frequency, documented seizure, and unconsciousness were predictive of death.    Conclusions  Both severe intestinal disease and extra-intestinal manifestations of shigellosis occur with infection by any of the four species of  Shigella , but are most common with  S. dysenteriae  type 1. Among these inpatient children, the risk of death was high with infection of any of the four Shigella species.

Gastrointestinal and Extra-Intestinal Manifestations of Childhood Shigellosis in a Region Where All Four Species of Shigella Are Endemic