To the Editor.
—Shigella bacteremia is an uncommon sequela of Shigella dysentery, particularly in adults. The host defense against dissemination of Shigella species has not been thoroughly characterized. However, secretory antibody and local cellular immunity probably play an important role.1,2 The timely review of Shigella bacteremia in adults by Morduchowicz et al3 supports this hypothesis. They noted that at least 18 (67%) of 27 adults with shigellemia had either a coexisting immunocompromising illness, or were over the age of 65 years and thus, suffering from an age-related immune impairment.4 Further support comes from the occurrence of Shigella sonnei bacteremia in a patient with acquired immunodeficiency syndrome, 5 and a patient we recently cared for with Down's syndrome (trisomy 21), a disease associated with accelerated aging and immune deficiency.6-8
Report of a Case.
—A 39-year-old woman with Down's syndrome was admitted to Shands Hospital, Gainesville, Fla,