Recurrent Shigella flexneri Gastroenteritis With Concurrent Rotavirus and SARS-CoV-2 Detection in a Preterm Infant: A Case Report

We report a six-month-old male infant born late preterm at 35 weeks’ gestation who presented with fever, moderate dehydration, and bloody mucoid diarrhea. Stool culture yielded Shigella flexneri, while gastrointestinal multiplex testing also detected rotavirus and SARS-CoV-2. Only S. flexneri was culture-confirmed and clinically concordant with dysentery; rotavirus vaccine-strain shedding and incidental SARS-CoV-2 detection could not be excluded. The child improved with rehydration, intravenous cefotaxime, followed by oral azithromycin, and supportive care. Two later episodes at 15 and 18 months again yielded S. flexneri with the same antibiogram and responded to azithromycin. Because rotavirus strain typing, exact vaccination interval, and Shigella molecular typing were unavailable, neither viral causality nor relapse versus reinfection could be confirmed. The case emphasizes cautious interpretation of multiplex results, culture-guided therapy, household transmission risk, and infection-control measures in recurrent pediatric enteric infection.