Shigellosis with bacteremia: a report of two cases and a review of the literature.

It is widely believed by both physicians and microbiologists that bacteremia is a rare event in shigellosis. We report two cases of shigellosis with positive blood cultures and review 68 cases reported in the literature between 1963 and 1981. We suggest that detection of bacteremia in shigellosis may be facilitated by a greater awareness of the following findings. 1. Eighty-seven percent of all cases of shigellosis with bacteremia reported in the literature during the 18-year period reviewed occurred in pediatric patients under 16 years of age. The majority of detected shigellemia cases were in children under 5 years of age. 2. Bacteremia is frequently intermittent and its detection is aided by collection of serial blood cultures with an adequate volume of blood. 3. Positive blood cultures were obtained most frequently on Days 1 to 2 and on Days 5 to 7 following onset of symptoms. 4. The case fatality rate of reported shigellemia cases was 46%. Although some of these findings may reflect a patient selection bias of cases reported in the literature, we believe that a greater awareness among clinicians and microbiologists of the potential value of blood cultures in the diagnosis and management of shigellosis will eventually lead to a better understanding of the pathogenesis of this infectious disease.