Shigella-associated diarrhea in children in Tripoli - Libya

Objectives: To determine the prevalence of Shigella species in Libyan children with diarrhea and in controls and susceptibility of the isolates to antibiotics. Methods: Between September, 1992 and August, 1993, stool specimens from 157 children with diarrhea (cases) and 157 age and sex matched controls were examined for the presence of Shigella. The children aged between a few days and 3 years. Results: Shigella spp. were isolated from 9 (5.7%) cases and 2(1.3%) controls (odds ratio, 4.7; p=0.03) with Shigella flexneri type 2 the predominating serotype. Most (56%) of Shigella strains from cases were isolated in autumn. The prevalence of shigellae were significantly higher in children older than one year and were not isolated from children less than six months old. All (100%) cases were on artificial feeding, 78% used untreated water for drinking. Blood and mucus were observed in the stool of 56% of cases. Clinical examination revealed 67% with fever and 33% with vomiting. One case diagnosed as septicemic and another one as having generalized convulsions. All isolates were sensitive to ceftriaxone, ciprofloxacin, gentamicin, nalidixic acid, and norfloxacin. Drug resistance to 3 or more drugs was found in 45% of the isolates. Conclusions: Because most of the isolates were resistant to trimethoprim-sulphamehtoxazole (64%), this antibiotic should no longer be considered the drug of choice in the treatment of Shigella-associated diarrhea in Libya. The present study shows that Shigella-associated diarrhea in children is still a public health problem in Libya and proper measures to combat it should be taken.