A 33-year-old man was admitted to the emergency service with waste.
His partner at that time had a history of HIV infection and did not use barrier methods.
She was admitted to the emergency room with liquid stools of up to 7 episodes a day, without blood, mucus or pus, accompanied by abdominal pain and no fever.
He had a weight loss of approximately 15 kg in 3 months.
On physical examination the patient was alert, afflicted, normotensive (120/70), with a HR of 82 per min, pale and in poor general condition.
At 24 h she had fever up to 38.5°C axillary and liquid stools with blood and mucus on several occasions.
She was admitted to the same room as the first patient, with a clinical diagnosis of diarrhea in a patient with probable HIV infection.
Laboratory tests revealed: hemoglobin 9.8 g/dl; hematocrit: 28.3%; MCV 773; lymphocyte count: 24.9 pg; leukocytes: 5,500/mm; lymphocytes: 150/mm.
Direct examination of stools showed the presence of abundant PMN and Shigella sp. was developed in the coprocultive as well as in the two hemocultives.
HIV serology was reactive and confirmed by Western blot technique at the National Return Laboratory.
Bacteriological studies
The strains were sent to the Department of Bacteriology and Virology, Institute of Hygiene, to complete their study.
Gender identification was confirmed by conventional phenotypic methods using the following means of identification: triple iron sugar (TSI), mobility-indole-ornithine decarboxylase (MIO), fatty acid methyl (4-hydroxybenzyl acid).
The serogroup of Shigella strains was determined by the slide agglutination technique using commercial polyclonal antisera (BD, Difco TM) and serotype with absorbed antisera.
To study the antimicrobial susceptibility we used the disk diffusion technique in agar11.
Targeted antibacterial agents Hareke: ampicillin, ampicillin/sulphate, cefradin, cefoxitin, ceftriaxone, nalidixic acid, ciprofloxacin, tetraxazol (mping).
Susceptibility testing was not performed due to the lack of cut-off points for the interpretation of susceptibility testing for ECCAST or CLSI11.
Pulsed-field gel electrophoresis (PFGE) of the four Shigella spp. isolates was performed according to the CDC standard procedure.
The interpretation of band patterns was performed visually following the criteria of Tenover et al.
The four strains corresponded to Shigella flexneri serotype 6 and were resistant only to cotrimoxazole.
The two strains recovered from the same patient (heart and blood) showed an identical pattern and very similar to the pattern obtained with the strains of the other patient.
Strains were defined as highly related from the genetic point of view.
1.
Antimicrobial treatment and evolution
The first patient received cotrimoxazole 800/160 mg orally every 12 h for 48 h.
After knowing the bacteriological result, the treatment was switched to ampicillin 1 g iv, 4 times a day for 6 days, and then ciprofloxacin 500 mg orally every 12 hours for 14 days.
The second patient remained without antimicrobial treatment until the bacteriological result.
He received ciprofloxacin 400 mg IV twice daily for 7 days and then 500 mg orally twice daily until completing 14 days of treatment.
In both cases the evolution was favorable with remission of digestive symptoms and without appearance of other complications, so they were discharged.
