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Significance of this study What is already known about this subject?
Pseudomonas aeruginosa is not a common enteric pathogen in healthy hosts.
Shanghai fever is a sepsis accompanied by enteric disease caused by P aeruginosa .
Hypogammaglobulinaemia is the most common underlying primary immune deficiency in previously healthy children with P aeruginosa sepsis.
What are the new findings?
The clinical features of Shanghai fever in a cohort of patients were clearly delineated.
No common primary immune deficiency was found in infants with Shanghai fever.
The high virulence of P aeruginosa strains derived from patients with Shanghai fever were confirmed by cellular and animal experiments.
Both host and microbial factors play a role in the pathogenesis.
How might it impact on clinical practice in the foreseeable future?
Understanding the mechanism, by which a specific group of virulent P aeruginosa causes enteric infection and sepsis in infants, may lead to increased awareness of the disease such that early initiation of effective treatment might be expected to reduce mortality and morbidity.
Introduction
Pseudomonas aeruginosa is one of the most important opportunistic pathogens in humans. Patients with chronic disease and compromised immune systems, such as cystic fibrosis, haematological malignancy, immunodeficiency or burns, are at greater risk of infection. 1 2 The bloodstream and respiratory and urinary tracts are the common infection sites. Despite reports of antibiotic-associated diarrhoea caused by P aeruginosa , it is generally not considered a common cause of infectious diarrhoea in healthy hosts. 3 4 Diarrhoea caused by P aeruginosa is seen almost exclusively in patients with prolonged antibiotic exposure. 3 4 On the other hand, enteric disease associated with sepsis caused by P aeruginosa has been documented as early as 1918 with the description of 'Shanghai fever', a syndrome comprising fever, diarrhoea and sepsis. 5 6 Cases of community-acquired P aeruginosa sepsis were subsequently reported in children without pre-existing conditions, primarily from Taiwan, Hong Kong and China. 7-15 The disease usually leads to serious complications and is associated with high mortality. 7-15 After more than 90 years, our understanding on Shanghai fever is still incomplete and its pathogenesis remains unknown. This study aimed to delineate the clinical features of Shanghai fever and to examine the host and microbial factors associated with the infection.
Patients and...