Vitamin A Supplementation in Treatment for Acute Shigellosis

Summary of published paper

Shigellosis is one of the most severe forms of infection to affect the intestine. The infection is associated with malnutrition, growth stunting and high mortality. In recent emergencies it has been one of the major causes of mortality. In the Great Lakes emergency of 1994 cholera was said to claim 30,000 lives in the Goma camps yet 46-63,000 people were said to have perished from dysentery (shigella Dysenteria type 1). The worst outbreaks in the region were in the IDP camps in south West Rwanda were incidence rates of over 30 cases per thousand were reported at one time.

Evidence that vitamin A has a physiological role in maintaining epithelial integrity and in stimulating immune function suggests that it may prove a useful adjunct to antibiotic treatment in shigellosis. However, up until now there have not been any evaluations of the role of Vitamin A in treatment of acute shigellosis. Current guidelines on treatment of shigellosis do not advocate use of vitamin A in the treatment of this disease.

A study has recently been completed by the international Centre for Diarrhoeal Disease Research which is based in Dacca, Bangladesh. The objective of the study was to evaluate the efficacy of a single large oral dose of vitamin A in treating acute shigellosis in children in Bangladesh. The research involved a randomised double blind controlled clinical trial on 83 children aged between 1-7 years with bacteriologically proven shigellosis but no clinical signs of vitamin A deficiency. The children were given a single oral dose of 200,000Iu of vitamin A plus 25 IU of vitamin E or a control preparation of 25 IU of vitamin E.

The results of the study showed that treatment of the disease with a single oral dose of Vitamin A along with a standard anti-biotic regime reduced the severity of the illness in children aged more than one year old. However, it did not accelerate bacteriological cure. It was suggested that the vitamin A probably worked in two ways. First, as it is adequately absorbed across the gut lining even during episodes of acute diarrhoea, it is available to the lining of the colon almost immediately after absorption and may have enhanced repair of the micro-ulcers associated with the disease. Secondly, shigellosis affects epithelial tissues extensively and causes an intense inflammatory response. As Vitamin A has an effect on stimulating the immune system it may reduce this response.

The conclusion of the study was that vitamin A supplementation should be added to the standard treatment for acute shigellosis for children in countries where vitamin A deficiency is a major public health problem and shigellosis is endemic.

Reference: Single dose vitamin A treatment in acute shigellosis in Bangladeshi children: randomised double blind controlled trial. Hossain. S, Biswas. R, Kabir, I, Sarker, S, Dibley,M, Fuchs. DM (1998), BMJ, Volume 316, 7th February, pp422-425