Convulsions in childhood shigellosis. Clinical and laboratory features in 153 children
S. Ashkenazi, G. Dinari, A. Zevulunov and M. Nitzan
We studied 153 children who experienced convulsions associated with
shigellosis. The male-female ratio was 1.2:1.0. Thirty-six children had a
previous history of febrile convulsions, and 31 children had a family
history of convulsive disorder. Most of the children were 0.5 to 3 years of
age, although 49 (32%) were older than 3 years of age and 20 (13.1%) were
older than 5 years of age. All children were febrile; in 75% of the
children, the temperature was over 39 degrees C. The majority of the
children had generalized, self-limited convulsions, which lasted less than
ten minutes. In 30 children the seizures were categorized as complex; ten
of them had recurrent episodes, although none had any residual neurologic
deficit. The total leukocyte count was usually within normal limits, but
the differential count characteristically showed a marked increase in the
number of band forms. Hypocalcemia (blood calcium level, less than 9.01
mg/dL [less than 2.25 mmol/L]) was observed in four patients; hyponatremia
(blood sodium level, 130 mEq/L [130 mmol/L]), in 11 patients; and
hypernatremia (blood sodium level, 157 mEq/L [157 mmol/L]), in one patient.
Electroencephalographic (EEG) studies were performed in ten children, and
lumbar punctures were performed in 34 children; both procedures usually
yielded normal results. Shigella sonnei was isolated from 69% of the
children; Shigella flexneri from 25%; Shigella boydii from 5%; and Shigella
dysenteriae from 1%. Due to the benign and self-limited nature of most of
the convulsions, neither diagnostic procedures, nor drug therapy, are
usually necessary. These measures should, however, be considered in
complicated cases characterized by focal or prolonged seizures.
