The impact of shigellosis and recommended treatment in children

ABSTRACT Shigella is a primary cause of moderate-to-severe diarrhea in children living in impoverished areas of the world. Shigella is known for causing dysentery (blood in the stool). However, majority of the children infected with Shigella present with watery diarrhea. The current World Health Organization (WHO) guidelines for treatment of shigellosis recommend treatment with antibiotics in the presence of visible blood in the stool. Thus, the non- dysentery Shigella associated watery diarrhea (NDSD) cases would not be treated with antibiotics. The absence of dysentery does not necessarily indicate a low risk of death and does not rule out Shigella as a cause of diarrhea. In particularly vulnerable younger children or with malnutrition, identification and treatment of Shigella infection might be lifesaving. Consequently, a critical question remains to be answered. Should cases of NDSD be treated with antibiotics? It may be hypothesized that these cases, if identified quickly, should be treated with antibiotics to reduce clinical severity, improve intestinal pathology, improve long-term developmental potential, and even reduce mortality. Identification of such cases will require a rapid test to document these infections so that treatment can be initiated promptly and is evidence based. and Zambia. To address these critical questions, we will carry out a randomized placebo controlled clinical trial in Bangladesh to determine if antibiotic treatment of NDSD cases in children will improve clinical outcomes, gut health, and growth in children. In addition, we will introduce a novel, simple, and rapid test "RLDT" for the detection of Shigella that has been field tested and shown to be applicable to health care facilities in resource poor endemic countries. We will assess the acceptability and feasibility of implementation of the RLDT assay. This study will help determine if there is a need for policy change for the treatment of NDSD with antibiotics. Importantly, this study will validate the need for a rapid test capable of identifying patients who will benefit from antibiotics.