Abstracts

Rationale: The CDC has recently reported a spike in cases of multi-drug resistant Shigella sonnei infections in the United States since 2014. Neurologic manifestations of Shigella infection has been well reported in many parts of the world. We report on two recent cases of Shigella sonnei presenting to the emergency department in Washington, DC with new onset seizures. We then present our review of the literature regarding neurologic manifestations of shigellosis.Methods: Case analyses with literature review were employed.Results: Patient 1 is a 6-year-old girl who presented from an outside hospital in status epilepticus after 1 day of fever, abdominal pain and diarrhea. She had a remote history of febrile seizures at age 2 and she had a family history of epilepsy. She required PICU treatment including sedation and a brief period of intubation. She had no further seizures after successful treatment of status epilepticus. Lumbar puncture revealed normal CSF studies, EEG showed only medication effects, and her neurologic exam was non-focal. Since discharge, she has had an episode of unprovoked generalized seizure with bioccipital epileptiform activity on subsequent EEG and incomplete bilateral posterior myelination on her MRI. Patient 2 is a 5-year-old girl who presented to the ED just prior to the transfer of her friend, patient 1. She had similar gastrointestinal symptoms with fever and presented after a self-limited seizure at home. She also had a remote history of febrile seizure at age 2, but had been seizure free for 3 years. She had an additional self-limited generalized seizure with a non-focal exam during her hospital course. It was later revealed that the two girls had spent the prior day together and had shared several meals. Stool cultures were sent and both were positive for Shigella sonnei. Their dramatic presentations prompted a literature review of shigellosis associated seizures.Conclusions: Infection with Shigella sonnei has been well reported to precipitate seizures, most commonly in children 5 and under and even in the absence of fever. Convulsions are reported in shigellosis four times as often as any other gastrointestinal infection, with evidence that it is a separate etiology from simple febrile seizures. The literature does not support Shigella infection as a predisposing factor to developing epilepsy. Shigella is endemic in many parts of the world, where neurologic symptoms associated with the infection greatly increase the mortality of the disease. With recent spikes of Shigella infection in the United States, providers should remain vigilant of the organism as a possible cause of seizures separate from simple febrile seizures.