Shigellosis with Resultant Septic Shock and Renal Failure

Abstract

Septic shock is a rare, potentially life-threatening complication of bacterial dysentery. The clinical presentation of septic shock includes hypotension, bleeding, hypoxia, acidosis, and jaundice. Historically gram-negative organisms were the most frequent cause of nosocomial bloodstream infections. However isolation of gram-positive organisms has become increasingly frequent with Staphylococcus species accounting for over one half of all nosocomial bloodstream pathogens. Bacterial dysentery is an acute diarrheal illness characterized by abdominal cramping, fever, and the production of mucoid, bloody stools. Laboratory findings include positive stool culture and increased leukocytes in direct fecal exam. Chemistry and hematology values may be abnormal. The disease is usually self-limiting but administration of antibiotics and rehydration therapy may be warranted in severe cases. This case study describes a 53 year old male who presented with diarrhea and diabetic acidosis and subsequently developed respiratory distress and renal failure due to shigellosis. Discussion of disease pathogenesis and treatment are provided.

ABBREVIATIONS: CBC = complete blood count, GI = gastrointestinal, ER = emergency room, BUN = blood urea nitrogen, GFR = glomerular filtration rate, spp. = species, WBC = white blood cell, LPS = lipopolysaccharide, TLR4 = toll-like receptor 4, O&P = ova and parasite, RBC = red blood cell.