Corneal ulceration due to Shigella flexneri

Shigella keratitis with ulceration is a rare occurrence with only four previous reports in the literature. Corneal ulceration appears to be characteristically superficial with a predilection for the inferior cornea. In the case reported here, resolution of ulceration occurred with the use of gentamicin and chloramphenicol, following a poor response to sulfacetamide. Experimental evidence strongly suggests that the course of infection is usually self-limited but that corneal scarring is a common sequelae. In the majority of the clinical cases reported to date, corneal ulceration has responded to appropriate antimicrobials with resolution, but has left residual opacification. To the extent that all of the cases were in young children, assessment of the degree of visual loss has been difficult to ascertain.

[Studies concerning dysenteric infections in a closed children's community before and after antidysenteric vaccination. I. Epidemiological considerations on acute intestinal infections]

In the closed children's community studied between 1 Jan. 1976 and 13 June 1977, a high proportion (54%) of the total number of acute intestinal infections was of dysenteric etiology, i.e. 46,9% in the 0--1 year age-group and 21,1% in the 1--3 years age-group, the dominant Shigella subtype being represented by Shigella flexneri 2a (25.1%). As only 37.2% of the total number of dysentery cases were manifested by enterocolitis and a high proportion (33.3%) ran a chronic course, the disease was not immediately diagnosed, an inadequate treatment was applied and a great number of carriers appeared. This, together with the high receptivity of such communities, accounts for the endemoepidemic character of the infection. Antidysenteric vaccination with the VADIZEN Dr. Istrati live bacillus vaccine, followed by a period of postvaccinal protection, with diminution in the number of dysentery, carriage and enteritis cases, both among the vaccinated and the non-vaccinated children, proves the utility of this vaccine in closed children's communities.

[Characteristics of the outbreak and control of an epidemic of bacillary dysentery of hydric origin]

In December 1978, an unexpected outbreak of acute gastroenteritis occurred in a shoe factory. The clinical, epidemiological and laboratory investigations established the hydric origin of the dysentery due to Shigella flexneri 3 a, caused by the illicit communication of the drinking water and industrial water mains. The antiepidemic measures promptly taken arrested the outbreak in three days ; there were no secondary, contact cases.

[Shigellosis in Tananarive (Madagascar). II : Bacteriologic and therapeutic features (author's transl)]

In acute dysenteries or diarrhoeas shigellae are the bacterial organisms which are the most frequently isolated from coprocultures. The most frequent sub-group is sub-group B (S. flexniri). In vitro, shigellae are sensible to all antibiotics but often resistant to sulfamids. Treatment is not difficult.

[Level and nature of the drug resistance of Shigella flexneri]

Characteristics of antibiotic resistance of 300 strains of Shigella flexner 2a isolated from patients within 1976--1977 in the regions where these bacteria were very rare for a long period of time were studied. It was shown that most of the isolates were resistant to chloramphenicol (88.1 per cent), tetracycline (94.8 per cent), streptomycin (89.1 per cent), polymyxin M (82.4 per cent) and others. 46.5--61.6 per cent of the isolates were resistant to neomycin antibiotics. A high level of the resistance was also noted: the bactericidal effect was registered in 52.0-74.0 per cent of the cultures at a dose of 500--1000 microgram/ml. 91.4 per cent of the strains possessed multiple dug resistance, 78.8 per cent of them being simultaneously resistant to 4--7 drugs. Transmissive R-plasmids were found in 68.8 per cent of the isolates. After exposure to acridine dyes the plasmid nature of the resistance was confirmed in 72.3 per cent of the cultures. Variability of the r-determinant sets in r-plasmids was noted. Strains (64.9 per cent) carrying r-determinants Tc, Cm, Sm and Tc, Cm were more frequent. Strains with one transmissive r-determinant were usually solitary.

Vivo clearance of enteric bacteria from the hemolymph of the hard clam and the American oyster

American oysters, Crassostrea virginica, and hard clams, Mercenaria mercenaria, were experimentally contaminated with Escherichia coli, Salmonella typhimurium, and Shigella flexneri either by intracardial injection or via the natural route of ingestion. Bacterial inactivation in the hemolymph was monitored for 72 h after exposure to these enteric pathogens at 20 and 6 degrees C. At 6 degrees C, both mean bacterial uptake by ingestion and subsequent clearance was singificantly lower that at 20 degrees C. However, substantial bacterial clearance from the hemolymph occurred for both shellfish at each temperature. At 20 degrees C, viable bacteria were no longer detectable after 24 h in hemolymph of either clams or oysters after exposure to contaminated water containing 4 x 10(3) bacteria per ml.

[Properties of the R plasmids of Sh. flexneri strains isolated in Bulgaria]

The study of 3,237 Sh. flexneri strains isolated in Bulgaria revealed that 50.72% of them were resistant to antibiotics. 95.88% of the antibiotic-resistant strains were found to have R factor of incompatibility groups F, I or N. The plasmids of incompatibility group F had the property fin+, and the plasmids of groups I and N had the property fin-. R plasmids were divided into 4 groups by their ability for phage restriction.

Increase in the population of duodenal immunoglobulin A plasmocytes in axenic mice associated with different living or dead bacterial strains of intestinal origin

Various bacterial strains were tested for their ability to stimulate immunoglobulin A (IgA) plasmocytes to populate the duodenal lamina propria in axenic mice. The mice were associated with the strains for at least 4 weeks. The strains inhabiting the conventional mouse intestine and belonging to the genera Lactobacillus, Streptococcus, Eubacterium, Actinobacillus, Micrococcus, Corynebacterium, and Clostridium (including the extremely oxygen-sensitive ones) are only slightly or nonimmunogenic, whereas the strains belonging to the genera Bacteroides and Escherichia have an immunogenic effect. The same result was obtained with Bacteroides and Escherichia strains isolated from the digestive tract of other animal species. The kinetics of appearance of intestinal IgA plasmocytes are similar in axenic mice monoassociated with a stimulatory strain and in conventional mice. The association of two or more strains with axenic mice leads either to the same or a greater number of duodenal IgA plasmocytes as that obtained with the most stimulatory strain monoassociated with axenic mice. The maximum stimulation recorded in all of these trials represents about two-thirds of that observed in conventional mice and was obtained in the duodenum of gnotoxenic mice harboring four bacterial strains isolated from the conventional mouse microflora. The orally administered killed cells of two immunogenic strains, E. coli and Bacteroides sp., are as immunogenic as the living cells, provided that their concentration in the digestive tract is sufficient.

The transfer of antibiotic resistance by R plasmids in Shigellae

Forty-five strains of Shigella species isolated at Auckland Hospital from 1972--1974 were investigated for antibiotic resistance. Forty-two strains were resistant to one or more antibiotics and 11 strains transferred antibiotic resistance by conjugation to E. coli.

[Comparative study of the virulence of the Shigella isolated from bacterial carriers and from acute dysentery patients]

The authors present the results of study of the virulence of shigellae isolated from carriers and patients suffering from acute dysentery, on a continuous culture of E1 and Hep-2 cells. The virulence of shigellae isolated from carriers displayed no significant difference from the virulence of shigellae isolated from patients with a mild and moderately severe forms of dysentery. In the patient's organism shigellae were capable of retaining the initial virulence for a long time, despite the treatment and the influence of the macroorganism's protective factors. The authors believe that this was connected with the capacity of Shigellae to parasitic life in the cells of human intestinal epithelium, and, apparently, played a definite role in the formation of carrier state.

Amebiasis. An increasing problem among homosexuals in New York City

During a five-year period at The New York Hospital, Entamoeba histolytica was identified in the stools of 20 men who had not traveled outside the New York area. All of the patients were found subsequently to homosexual. During this same period amebiasis was diagnosed in 30 men who had traveled; only two were homosexual. Of ten patients with E histolytica infection seen during the first year of this study, none were homosexual whereas eight of 11 patients in the fifth year were homosexual, suggesting a gradual increase during this period of this disease in the homosexual community.

Venereal transmission of shigellosis in Seattle-King county

In the past, shigellosis in Seattle-King County has been primarily a disease of children, their parients, and foreign travelers. During the 18 months beginning in July 1975, an outbreak of shigellosis in Seattle's community of gay men involved both Shigella flexneri and Shigella sonnei. They accounted for nearly 30% of all cases of shigellosis reported to the health department. Fellatio and/or oral-anal contact was reported by 90% of the infected homosexual men; this was probably the mechanism of transmission of most infections. Intercity spread was determined by case histories and by the finding of S. flexneri 3, a previously unusual organism in Seattle.

Clinical and laboratory assessment of the pathogenicity of serotyped enteropathogenic Escherichia coli

Only one of 167 separate isolates of enteropathogenic Escherichia coli (EEC) was shown to produce enterotoxin, and none of the 167 isolates were invasive. Clinical features of 123 hospitalized children with EEC were compared with those of 917 infants with nonbacterial gastroenteritis and 145 infants infected with Shigella. The average duration of diarrhea (five or more stools per day) in hospitalized children with EEC, nonbacterial gastroenteritis, Shigella flexneri, and Shigella sonnei was 4.6, 2.4, 5.1, and 2.5 days, respectively. The average duration of fever in these four groups was 1.4, 1.2, 2.1, and 1.2 days, respectively. The difference in duration of diarrhea between children with EEC and those with nonbacterial gastroenteritis was significant (P less than 0.001), even when age and rural/urban origin were controlled by analysis of variance. Nevertheless, the EEC group tended to be younger and to have a higher proportion of infants of rural origin. Although it appears that EEC serotypes rarely identify invasive or enterotoxin-producing organisms, clinical features of infants with EEC-associated gastroenteritis suggest that these infants may represent a distinctive and clinically important group with gastroenteritis of greater severity than nonbacterial gastroenteritis.

Reiter's syndrome following Shigella flexneri 2a: a sequel to traveler's diarrhea. Report of a case with hepatitis

Shigella flexneri 2a was isolated from a patient with Reiter's syndrome (RS) following a family outbreak of traveler's diarrhea. Among 3 members at risk, only the patient was positive for HLA-B27. Data from 3 similar families support the hypothesis that susceptibility to RS is genetically transmitted. It is urged that every effort be made to culture and subtype Shigella and other enteric pathogens in RS following diarrhea. Concurrently, the patient had hepatitis, interpreted as a parallel enteric infection.

Shigellosis in the United States: ten-year review of nationwide surveillance, 1964-1973

In the 10 years 1964-1973, 105,832 isolations of shigellae were reported to the Center for Disease Control through a nationwide surveillance system. The number reported increased by approximately 13% annually, from 5852 in 1964, when only 17 centers reported all 4 quarters; to 16,797 in 1973, when 52 centers reported each quarter. The rate of reported isolations varied from 4.6 per 100,000 persons in 1965 to 9.1 per 100,000 in 1973. Shigella sonnei accounted for 64% of all these isolates and for more than 80% of isolates in 1973. The majority of reported cases of shigellosis occurred in young children and in women of childbearing age. During the 10-year surveillance period, 35 epidemics in 25 states were investigated. Two-thirds of these outbreaks were the result of person-to-person spread; investigations of common-source outbreaks showed the importance of both water and foodstuffs, especially salads, as potential vehicles of contamination. Indian reservations, custodial institutions, and day-care centers were identified as special high-risk settings for the transmission of shigellosis. The emergence of R-factor-mediated antimicrobial-resistance patterns in recent years has necessitated antibiotic sensitivity testing to determine the drug of choice for treatment of individual cases. Initial testing of oral vaccines suggests these vaccines will have only limited usefulness in protecting certain high-risk populations. Public health education coupled with improvements in water and sewerage systems remains the most satisfactory means of control.

[ 771 Shigella strains isolated in a 15-year period from Americans living in Ankara. Comparisons with Shigella strains isolated from Turkish natives]

The author had worked as a bacteriologist in Ankara American Air Force Hospital from 1958 to 1972. During this period of time he was able to isolate 771 shigella strains from the American patients of the hospital. The amounts and the percentages of the subgroups are listed below together with the two other Ankara City Pediatric hospital results (see article). american community lived in Ankara for 15 years and shared many aspects which were important in shigella epidemiology like using city's tap water, shopping from the same green groceries to by fruits and vegetables so on. For shigella cases Ankara had seasonal alterations in July and August being the peak months. Americans, disease followed that course exactly. The big difference was being the local people of the city had those epidemics with the flexneri strains but Americans had them with the sonnei strains. To show the possible sources which could infect the community time to time and make sonnei predominant yielded negative result. All the patients stools were cultured. Sensitivity studies employing "plate disk diffusion" techniques were done. All patients treated accordingly. Stools checked for routine carriership exams. None become a chronic carrier. American installations had their shops, clubs, mess halls. The food handlers of these places had checked routinely by the preventive medicine office. None found infected. Only at 1963 the amount of flexneri isolations were higher than sonnei. All the remaining years sonnei were predominant. Antibiotic sensitivity studies showed no differences between subtypes. Except streptomycin and sulphamide strains stayed fairly sensitive to other antibiotics. Resistance factors contained maximum 6 markers. The little Americans community in Ankara consisted a unique and highly socioeconomic-wise developed group of the city. Many attempts to find the answer for the question is "who is infecting who" was always fruitless. That gives the impression as if the Americans were more sensitive to the shigella infections caused by sonnei strains for some reason. In another words Americans were more resistant to the infections other than sonnei.

Shigellosis transmitted by nurses

Twelve cases of Shigella sonnei infection, with two deaths, occurred at a custodial institution in Donelson, Tennessee, in April and May 1973. Nine of the cases and both deaths were in patients hospitalized at the institution's infirmary. The patients with nosocomial shigellosis were significantly younger and had been hospitalized significantly longer than controls. Epidemiologic investigation implicated staff members in the transmission of illness from one patient to another and identified the previous use of broad-spectrum antibiotics as a significant factor in placing patients at risk of acquiring shigellosis.

Recurrent urinary tract infection due to Shigella flexneri--case report

A case of urinary tract infection due to Shigella Flexneri is reported. The case presented suggests that in persistent and recurrent urinary tract infection in topical countries, investigations for organisms such as Shigella Flexneri should be considered. Urinary tract infection due to Shigella Flexneri is unknown and as far as we known has not been reported in the literature. A case report is presented in whom recurrent urinary tract infection was due to Shigella Flexneri and was treated effectively with antibiotics.

Shigellosis in custodial institutions. V. Effect of intervention with streptomycin-dependent Shigella sonnei vaccine in an institution with endemic disease

A double-blind controlled field trial of live, oral, streptomycin-dependent Shigella sonnei vaccine was begun in an institution with endemic S. sonnei disease. Considerable unexpected child-to-child transmission of the vaccine strains inadvertantly caused the field trial to resemble a mass vaccination campaign. Although S. sonnei accounted for 90% of shigella infections from 1968 to 1971 and three-fourths of the cases occurred in the seven study cottages, S. sonnei disease disappeared following vaccination; epidemiologic features suggest a causal relationship. Clinical S. sonnei disease did not occur despite the detection by bacteriologic surveillance of carriers of virulent S. sonnei. Levels of hygiene remained compatible with transmission of shigella since 43 cases of S. flexneri 6 were seen. If the interpretation is correct, the disappearance of S. sonnei disease resulted from inadvertent "mass vaccination" and oral shigella vaccines may prove useful for control of endemic shigellosis institutions. Nevertheless, a properly designed controlled field trial, taking into account transmissibility of vaccine, in an institutional setting similar to Sunland is necessary to substantiate the role of oral shigella vaccines in control of institutional shigellosis.

[Use of the VShS elective-differential medium in the diagnosis of dysentery and other acute intestinal infections]

Results of trial of the VShS medium under conditions of direct seeding feces of patients suffering from dysentery and other acute intestinal disturbances demonstrated that by the efficacy of Sh. sonnei isolation it failed to differ from Ploskirev's bactoagar, was less effective in comparison with Levin's medium with levomycetin (the incidence of Shigella isolation was 49.7, 52.6 and 60.3%, respectively) and was the most effective in Sh. newcastle isolation. In seeding feces after their enrichment in selenite broth the VShS medium proved to be much more effective than Ploskirev's bactoagar by the incidence of isolation of Shigellae (90 and 65.7%).

[Use of lincomycin, methicillin and ristomycin in the nutrient media for isolating pathogenic intestinal microorganisms]

Elective-differentiating solid nutrient media for simultaneous isolation of Vibrioes, Salmonella and Shigella were developed. Antibiotics active against grampostive microflora and dry bile salts inhibiting the growth of Proteus were used as the inhibitors of the growth of the accompanying microflora. The medium was lincomycin and the bile salts may be prepared in a dry form.

Superiority of MacConkey's agar over salmonella-shigella agar for isolation of Shigella dysenteriae type 1

The efficiency of MacConkey's agar in the isolation of various types of Shigella was compared with that of salmonella-shigella (SS) agar during an extensive 18-month outbreak of disease caused by Shigella. In all, 1,580 isolates of Shigella were obtained from 12,307 rectal swab and fecal samples of patients with diarrhea and their contacts by direct plating onto MacConkey's and SS agars. Shigella dysenteriae type 1 and Shigella flexneri constituted 55 percent and 33 percent of all isolates, respectively, with a smaller number of Shigella boydii and Shigella sonnei. MacConkey's agar was superior to SS agar in the detection of S. dysenteriae type 1; 83 percent of the isolates were detectable on MacConkey's agar, compared with 40 percent on SS agar. In contrast, 84 percent of S. flexneri isolates were detectable on SS agar, compared with 51 percent on MacConkey's agar alone. These findings confirm that, for the culture of fecal specimens thought to contain S. dysenteriae type 1, one of the media used should be noninhibitory. Shigella was isolated at a consistently and significantly higher rate from fecal samples than from rectal swabs.

Epidemiologic investigation of an outbreak of Shiga bacillus dysentery in an island population

An epidemic of dysentery broke out in St. Martin island during May through July 1973. The epidemic was caused by Shigella dysenteriae type 1. The dysentery could not be controlled by conventional antibiotics and other antidysenteric drugs. The average attack rate was 32.9%. The age specific attack rate was highest in the age group 1-4 years (52.2%). The attack rates were higher in smaller families. The rates were not greatly different amongst people using different sources of water. The overall death rate was 2.1%. The overall infection-to-death rate was 6.4% but amongst children less than a year old, it was 41.1%. A common source outbreak was unlikely. The higher attack rate in smaller families suggested limited possibility of person to person spread. No particular water source could be implicated with higher attack rate. Flies may have played an active role in transmission.

[Prodigiosin in the overall therapy of dysentery and in the prevention of intrahospital viral respiratory infection in children]

Prodigiozan was tested in complex therapy of children with acute dysentery. Comparison of clinical symptoms, specific immunogenesis and child sanation periods from Shigella in the child groups treated (80) and non-treated (74) with prodigiozan showed that prodigiozan lowered the rate of intrahospital acute respiratory virus infection, provided more favourable dysentery progression, more tensed specific immunity and the patient clearance from Shigella.

[Characteristics of the Salmonella and Shigella strains isolated from diarrhea patients during antibiotic therapy]

Drug resistant strains of Salmonella and Shigella were isolated from diarrhoeic children during antibiotic treatment. Two strains of Sh. flexneri serotype 2a, resistant to sulfonamides, streptomycin,chloramphenicol, and tetracyclines, were able to transfer "en bloc" their resistances to E. coli K12.

Shigellosis at sea: an outbreak aboard a passenger cruise ship

Between June 23 and June 30, 1973, 90% of 650 passengers and at least 35% of 299 crew members experienced a diarrheal illness during a 7-day Caribbean cruise aboard a passenger cruise liner. Symptoms were consistent with shigellosis, and Shigella flexneri 6, Boyd 88 biotype, was isolated from rectal swabs taken from 8 to 35 ill passengers and 33 of 294 crew members. Epidemiologic evidence incriminated the ship's water, including ice, as the probable vehicle of transmission, and elevated coliform counts were found in potable water samples obtained aboard the vessel at the peak of the outbreak. Potential sources of contamination of the vessel's potable water supply were investigated, and improvements in the loading and chlorination of potable water were recommended.

Transmissible drug resistance in Shigella and Salmonella isolated from pet monkeys and their owners

During two dysentery outbreaks in primate pet owners, Shigella and Salmonella strains were isolated from the enteric flora. In both outbreaks the source of infection was traced to asymptomatic spider monkeys (Ateles geoffroyi). The spider monkeys and their owners shed multiply drug-resistant Shigella and Salmonella serotypes. Six of the nine bacterial strains isolated from the animals were multiply drug-resistant and capable of transferring antibiotic resistance patterns.

[Sensitivity of different strains of E. coli and Shigella to the inhibitory action of Ploskirev's bactoagar]

A study was made of the sensitivity of 190 strains of E. coli and 107 strains of Shigellae of different serological types to the inhibitory action of Ploskirev's bactoagar on the capacity of these bacteria to form colonies. The strains under study proved to be nonhomogenous in this respect: between different strains of E. coli there were revealed 10-, 100- and even 1000-fold differences by this property; the differences between Shigellae strains were less marked--in over 90% of Shigellae strains the capacity to form colonies was depressed less than 4-fold. Only with the aid of some of E. coli and Shigellae strains was it possible to detect differences between the tested 20 commercial Ploskirev's bactoagar batches. Apparently, the use in practical bacteriological laboratories of accidental strains of local origin for control of Ploskirev's bactoagar could not aid in improving the quality of the medium, and consequently bacteriological diagnosis of infections.