Shigella sonneiBacteremia Presenting with Profound Hepatic Dysfunction

Abstract

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases of Shigella infection are reported annually in the United States. Shigella bacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of a Shigella sonnei bacteremia with marked hepatic derangement in a 27-year-old previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two close contacts in preceding days. On examination, he was fully oriented but dehydrated, icteric, and febrile. Laboratory data revealed WBC of 2200/μL, elevated AST and ALT (201 IU/L, 73 IU/L resp.), normal alkaline phosphatase, elevated total and direct bilirubin of 8.2 mg/dL and 4.4 mg/dL, albumin of 3.2 g/dL, INR of 2.9, prothrombin time of 31.7, and platelet of 96,000/μL. Workup for infectious, autoimmune and medication-induced hepatitis, Wilson's disease, and hemochromatosis was negative. Abdominal ultrasound and computed tomography of the abdomen showed hepatic steatosis and right-sided colitis. Stool and blood cultures were positive for Shigella sonnei. He was treated with ciprofloxacin with improvement in liver function. Follow-up blood test 4 months later was within normal limits.

Bifidobacterium longum BL-10 with Antioxidant Capacity Ameliorates Lipopolysaccharide-Induced Acute Liver Injury in Mice by the Nuclear Factor-κB Pathway

“…Previous research supported an association of the prevalence of Escherichia–Shigella with liver injury and hepatic failure . The changes in the gut microbiota and increase of harmful metabolites (LPS) promote liver injury exacerbation . In this study, the relative abundance of Escherichia–Shigella was significantly increased in the LPS-induced liver injury mice, and pretreatment with B.…”

Invasive nontyphoidal Salmonella infection in a patient with Roux-en-Y gastric bypass and gastrostomy tube: a case report

“…Of note, the patient in this case report had positive stool and urine cultures for Salmonella but negative blood cultures. Similarly, Shogbesan et al described a case of Shigella sonnei bacteremia in an otherwise healthy patient with a prior history of Rouxen-Y gastric bypass [15]. The gut itself has been shown to serve as a clinically significant portal of entry for bacterial infection and bacteremia, particularly in the setting of nutritional depletion combined with exposure to endotoxins [16].…”

Immunomodulatory effects of the Bifidobacterium longum BL-10 on lipopolysaccharide-induced intestinal mucosal immune injury

“…The dysbiosis in gut microbiota has been recently found to be associated with intestinal injury pathogenesis ( 55 ). The changes in the gut microbiota and increase of harmful metabolites (LPS) promote intestinal injury exacerbation ( 56 ). In this study, the relative abundance of Escherichia-Shigella was significantly increased in the LPS-induced intestinal injury mice, and pretreatment with B. longum BL-10 alleviated the liver injury in mice, as indicated by reducing the Escherichia-Shigella level.…”