Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report
Background: Differentiating severe systemic inflammatory syndromes from sepsis can be challenging. The diagnostic process may be further complicated by concurrent infection and hyperinflammation, with important management implications. We report a child with suspected multisystem inflammatory syndro...
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Elsevier
2025-01-01
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| author | Sheridan J.C. Baker Laura K. Erdman Donald Brody Duncan Tania Cellucci Candy Rutherford Marek Smieja Cheryl Main Jeffrey M. Pernica Andrew G. McArthur |
| author_facet | Sheridan J.C. Baker Laura K. Erdman Donald Brody Duncan Tania Cellucci Candy Rutherford Marek Smieja Cheryl Main Jeffrey M. Pernica Andrew G. McArthur |
| author_sort | Sheridan J.C. Baker |
| collection | DOAJ |
| description | Background: Differentiating severe systemic inflammatory syndromes from sepsis can be challenging. The diagnostic process may be further complicated by concurrent infection and hyperinflammation, with important management implications. We report a child with suspected multisystem inflammatory syndrome in children, who was unexpectedly diagnosed with Shigella gastroenteritis. Case presentation: A previously healthy 6-year-old boy acutely presented with fever, vomiting, diarrhea, fluid-refractory shock, cardiac dysfunction, biochemical inflammation, and coagulopathy. He fulfilled diagnostic criteria for multisystem inflammatory syndrome in children, including SARS-CoV-2 exposure 8 weeks prior. He received both antibiotics and pulsed intravenous methylprednisolone, with rapid improvement. Stool molecular testing using a lab-developed multiplex qPCR assay revealed Shigella flexneri infection, confirmed by culture, MALDI-TOF mass spectrometry, and whole-genome sequencing. Serologic testing confirmed prior infection by the SARS-CoV-2 virus. The child fully recovered. Immunological investigations were normal. The case was investigated by the Public Health Department, but the source of Shigella infection was not identified. Conclusions: This case underscores the importance of systematic microbiological workup in suspected systemic inflammatory syndromes, to identify infections that are treatable and of public health relevance. Given the rarity of Shigella septic shock in immunocompetent individuals, this case raises the possibility that recent SARS-CoV-2 infection led to immune dysregulation and exaggerated inflammatory responses to Shigella. It also demonstrates the utility of molecular testing for rapid diagnosis and confirmation of gastrointestinal infection. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| series | IDCases |
| spelling | doaj-art-bf40fa7a27d1459eb1c74dcee97f249e2025-08-20T03:45:44ZengElsevierIDCases2214-25092025-01-0140e0227410.1016/j.idcr.2025.e02274Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case reportSheridan J.C. Baker0Laura K. Erdman1Donald Brody Duncan2Tania Cellucci3Candy Rutherford4Marek Smieja5Cheryl Main6Jeffrey M. Pernica7Andrew G. McArthur8Department of Biochemistry & Biochemical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, CanadaDivision of Pediatric Infectious Disease, McMaster Children’s Hospital, 1280 Main Street West, Hamilton, Ontario L8S 4K1, CanadaDepartment of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, 50 Charlton Ave E, Hamilton, Ontario L8N 4A6, CanadaDivision of Pediatric Rheumatology, McMaster Children’s Hospital, 1280 Main Street West, Hamilton, Ontario L8S 4K1, CanadaHamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, 50 Charlton Ave E, Hamilton, Ontario L8N 4A6, CanadaMichael G. DeGroote Institute for Infectious Disease Research, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, 50 Charlton Ave E, Hamilton, Ontario L8N 4A6, CanadaDepartment of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, 50 Charlton Ave E, Hamilton, Ontario L8N 4A6, CanadaMichael G. DeGroote Institute for Infectious Disease Research, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Division of Pediatric Infectious Disease, McMaster Children’s Hospital, 1280 Main Street West, Hamilton, Ontario L8S 4K1, CanadaDepartment of Biochemistry & Biochemical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Correspondence to: McMaster University, Department of Biochemistry and Biochemical Sciences, 1280 Main Street West, MDCL 2322, Hamilton, Ontario L8S 4K1, Canada.Background: Differentiating severe systemic inflammatory syndromes from sepsis can be challenging. The diagnostic process may be further complicated by concurrent infection and hyperinflammation, with important management implications. We report a child with suspected multisystem inflammatory syndrome in children, who was unexpectedly diagnosed with Shigella gastroenteritis. Case presentation: A previously healthy 6-year-old boy acutely presented with fever, vomiting, diarrhea, fluid-refractory shock, cardiac dysfunction, biochemical inflammation, and coagulopathy. He fulfilled diagnostic criteria for multisystem inflammatory syndrome in children, including SARS-CoV-2 exposure 8 weeks prior. He received both antibiotics and pulsed intravenous methylprednisolone, with rapid improvement. Stool molecular testing using a lab-developed multiplex qPCR assay revealed Shigella flexneri infection, confirmed by culture, MALDI-TOF mass spectrometry, and whole-genome sequencing. Serologic testing confirmed prior infection by the SARS-CoV-2 virus. The child fully recovered. Immunological investigations were normal. The case was investigated by the Public Health Department, but the source of Shigella infection was not identified. Conclusions: This case underscores the importance of systematic microbiological workup in suspected systemic inflammatory syndromes, to identify infections that are treatable and of public health relevance. Given the rarity of Shigella septic shock in immunocompetent individuals, this case raises the possibility that recent SARS-CoV-2 infection led to immune dysregulation and exaggerated inflammatory responses to Shigella. It also demonstrates the utility of molecular testing for rapid diagnosis and confirmation of gastrointestinal infection.http://www.sciencedirect.com/science/article/pii/S2214250925001301ShigellaMultisystem inflammatory syndrome in childrenShockWhole-genome sequencingCase report |
| spellingShingle | Sheridan J.C. Baker Laura K. Erdman Donald Brody Duncan Tania Cellucci Candy Rutherford Marek Smieja Cheryl Main Jeffrey M. Pernica Andrew G. McArthur Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report IDCases Shigella Multisystem inflammatory syndrome in children Shock Whole-genome sequencing Case report |
| title | Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report |
| title_full | Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report |
| title_fullStr | Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report |
| title_full_unstemmed | Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report |
| title_short | Whole-genome sequencing confirms Shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children: A case report |
| title_sort | whole genome sequencing confirms shigella flexneri infection in a child with shock and suspected multisystem inflammatory syndrome in children a case report |
| topic | Shigella Multisystem inflammatory syndrome in children Shock Whole-genome sequencing Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2214250925001301 |
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