Vol.63 No.4 July 2015
A case of a Japanese patient infected with Shigella sonnei which was undetected in the feces after administration of azithromycin
1)Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 4-23-15 Kohtohbashi, Sumida City, Tokyo, Japan
2)Department of Clinical Laboratory, Tokyo Metropolitan Bokutoh General Hospital
Abstract
A 50-year-old Japanese man complained of fever and diarrhea near the end of a 1.5-month visit to India. His fever disappeared on the second day of the illness but his diarrhea continued and he returned to Japan on the 4th day of illness. He visited our department because of persistent diarrhea on the 8th day of illness and was started on a 5-day course of tosufloxacin. Shigella sonnei and Campylobacter jejuni were found in his feces on the same day. Isolated S. sonnei was sensitive for ampicillin, but resistant against ceftriaxone, fosfomycin, and levofloxacin, and responded to azithromycin (AZM) with a MIC of 16 μg/mL. The patient was symptom-free on and after the 11th day of illness, but S. sonnei was still detected in his feces on the 14th day of illness. He received a 6-day course of amoxicillin from the 18th day of illness, but S. sonnei was still present in the feces on the 28th day of illness. From then he received a 3-day course of 500 mg AZM orally. S. sonnei was finally undetected in the patient's feces, and no symptomatic adverse reactions were identified thereafter. This case suggests that 500 mg of AZM administered orally for 3 days may be an effective alternative therapy for bacteriological eradication in the case of asymptomatic Japanese patients with shigellosis even when AZM exhibits a high MIC against the pathogen.
Key word
shigellosis, Shigella sonnei, azithromycin
Received
January 26, 2015
Accepted
March 9, 2015
Jpn. J. Chemother. 63 (4): 419-421, 2015
