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Muzembo BA, Kitahara K, Mitra D, Ohno A, Khatiwada J, Dutta S, Miyoshi SI. Burden of Shigella in South Asia: a systematic review and meta-analysis. J Travel Med 2023; 30:6798401. [PMID: 36331282 DOI: 10.1093/jtm/taac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Shigella remains one of the most common causes of diarrhoea in South Asia. Current estimates of the prevalence of Shigella are critical for guiding control measures. We estimated the prevalence of Shigella species and serogroups in South Asia. METHODS We performed a systematic review using PubMed, EMBASE, Google Scholar and Web of Science for peer-reviewed studies published between 2000 and 19 June 2022. We also manually searched the reference lists of the reviewed studies to identify additional studies. We included studies that detected the presence of Shigella in stool by culture or polymerase chain reaction (PCR). Studies associated with outbreaks were excluded. Two investigators independently reviewed the studies, extracted the data and performed quality assessment. A random-effects meta-analysis was performed to determine the pooled prevalence of Shigella. RESULTS Our search yielded 5707 studies, of which 91 studies from five South Asian countries were included in the systematic review, 79 in the meta-analysis of Shigella prevalence and 63 in the meta-analysis of Shigella serogroups prevalence. The pooled prevalence of Shigella was 7% [95% confidence interval (CI): 6-7%], with heterogeneity (I2 = 98.7; P < 0.01). The prevalence of Shigella was higher in children aged <5 years (10%; 95% CI: 8-11%), in rural areas (12%; 95% CI: 10-14%) and in studies using PCR (15%; 95% CI: 11-19%). Shigella flexneri (58%) was the most abundant serogroup, followed by Shigella sonnei (19%), Shigella boydii (10%) and Shigella dysenteriae (9%). Shigella flexneri 2a was the most frequently isolated serotype (36%), followed by serotype 3a (12%), serotype 6 (12%) and serotype 1b (6%). The prevalence of non-typeable Shigella was 10.0%. CONCLUSIONS Although the prevalence of Shigella in South Asia remains generally high, it varies by age group and geographical area, with data lacking in some countries. Effective Shigella vaccines would be advantageous for both endemic communities and travellers.
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Affiliation(s)
- Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kei Kitahara
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Collaborative Research Centre of Okayama University for Infectious Diseases at ICMR-NICED, Kolkata, India
| | - Debmalya Mitra
- Collaborative Research Centre of Okayama University for Infectious Diseases at ICMR-NICED, Kolkata, India
| | - Ayumu Ohno
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Collaborative Research Centre of Okayama University for Infectious Diseases at ICMR-NICED, Kolkata, India
| | | | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Liu Y, Shen W, Sun Y, Lv N, Sun K, Hu L, Ye Y, Gao Y, Li J. Virulence-Related Gene Distribution Among Shigella Isolates in Anhui, China: The Association with Antimicrobial Resistance. Infect Drug Resist 2020; 13:3637-3647. [PMID: 33116683 PMCID: PMC7585282 DOI: 10.2147/idr.s274862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The aim of this study was to investigate the antimicrobial resistance profiles and distribution of virulence-related genes (VRGs) among Shigella isolates in Anhui, China, and to identify the correlation between the VRGs and antimicrobial resistance. Materials and Methods A total of 525 non-duplicate Shigella isolates (449 S. flexneri, 68 S. sonnei, 3 S. boydii, and 5 S. dysenteriae) were collected in Anhui Province, China between September 2011 and September 2015. The antimicrobial resistance of the strains was determined by the agar dilution method according to CLSI guidelines. The presence of 16 VRGs, including ipaH, ipaA-D, ial, virB, virF, set, sen, icsA, icsB, sigA, sat, pic, and sepA, was evaluated using PCR amplification and sequencing. Results Shigella flexneri was the most abundant (85.5%), followed by S. sonnei (13.0%). The proportion of males with S. flexneri was higher than that of females (57% vs 43%; P<0.0001). The most common resistance pattern was the combination of ampicillin, nalidixic acid, and tetracycline for S. flexneri (90.2%) and S. sonnei (94.1%). Resistance to ciprofloxacin and levofloxacin was more common among S. flexneri than among S. sonnei (49.7% vs.19.1%, P<0.0001; 30.5% vs 10.3%, P=0.001, respectively). All the isolates were positive for the ipaH gene, while the set, sat, pic, and sepA genes were not detected among the S. sonnei isolates. Except for sigA and sen, resistance to chloramphenicol and ciprofloxacin was more common among VRG-positive S. flexneri than among VRG-negative S. flexneri (P<0.05). Furthermore, resistance to ceftriaxone and ceftazidime was more frequently detected among sat- and set-positive S. flexneri than among sat- and set-negative S. flexneri (P<0.05). However, gentamicin resistance was more prevalent among VRG-negative (ial, virF, set, sat, pic, and sepA) S. flexneri than among VRG-positive S. flexneri (P<0.05). Conclusion Shigella flexneri remains the predominant species in Anhui, China, and the resistance to fluoroquinolones was more widespread among S. flexneri than among S. sonnei. Shigella flexneri strains harboring specific VRGs were associated with antimicrobial resistance. To the best of our knowledge, this is the first report of the correlation between the VRGs and antimicrobial resistance in Anhui, China.
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Affiliation(s)
- Yanyan Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People's Republic of China.,Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Weihua Shen
- Department of Special Clinic, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yating Sun
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Na Lv
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Kaili Sun
- Department of Infectious Diseases, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Lifen Hu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Ying Ye
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People's Republic of China.,Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yufeng Gao
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People's Republic of China.,Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People's Republic of China.,Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People's Republic of China.,Department of Infectious Diseases, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Nisa I, Qasim M, Driessen A, Nijland J, Bari F, Haroon M, Rahman H, Yasin N, Khan TA, Hussain M, Ullah W. Molecular epidemiology of Shigella flexneri isolated from pediatrics in a diarrhea-endemic area of Khyber Pakhtunkhwa, Pakistan. Eur J Clin Microbiol Infect Dis 2020; 39:971-985. [PMID: 31938959 DOI: 10.1007/s10096-020-03811-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
Shigella flexneri is considered as an important causative agent of Shigellosis causing diarrhea in the countries with a low socioeconomic status. No study has been carried out on the molecular prevalence of S. flexneri in Khyber Pakhtunkhwa, Pakistan. So this study was designed to evaluate the molecular prevalence of S. flexneri and their associated risk factors. A total of 2014 diarrheal stool samples were collected from January 2016 to May 2017 from pediatrics patients of Khyber Pakhtunkhwa followed by identification of S. flexneri through biochemical, serological, and molecular methods. The overall prevalence of Shigella species was found to be 7.9% (n = 160). The predominant Shigella specie was S. flexneri (n = 155, 96.8%) followed by S. boydii (n = 5, 3.1%). Interestingly, no sample was found positive for S. sonnei and S. dysenteriae. The majority of Shigellosis cases occurred from June to September. Potential risk factors related with Shigellosis were unhygienic latrine usage, bad hand washing, and consumption of unhygienic food and water, and pipe leakage in the sewage system. In this study, we have observed a high number of Shigellosis cases especially those caused by S. flexneri. It is suggested that effective health awareness programs should be organized by the regional health authorities to minimize the magnitude of pediatrics Shigellosis.
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Affiliation(s)
- Iqbal Nisa
- Department of Microbiology, Kohat University of Science and Technology, Kohat, 26000, Pakistan
| | - Muhammad Qasim
- Department of Microbiology, Kohat University of Science and Technology, Kohat, 26000, Pakistan.
| | - Arnold Driessen
- Department of Molecular Microbiology, Groningen Biomolecular Sciences, and Biotechnology Institute, Faculty of Science and Engineering, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Jeroen Nijland
- Department of Molecular Microbiology, Groningen Biomolecular Sciences, and Biotechnology Institute, Faculty of Science and Engineering, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Fazli Bari
- Department of Pathology, Lady Reading Hospital, Peshawar, Pakistan.,Department of Microbiology, Nowshera Medical College, Nowshera, Pakistan
| | - Mohammad Haroon
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Hazir Rahman
- Department of Microbiology, Abdul Wali Khan University, Mardan, Pakistan
| | - Nusrat Yasin
- Department of Microbiology, Kohat University of Science and Technology, Kohat, 26000, Pakistan
| | - Taj Ali Khan
- Department of Microbiology, Kohat University of Science and Technology, Kohat, 26000, Pakistan
| | - Mubbashir Hussain
- Department of Microbiology, Kohat University of Science and Technology, Kohat, 26000, Pakistan
| | - Waheed Ullah
- Department of Microbiology, Kohat University of Science and Technology, Kohat, 26000, Pakistan
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Sah SK, Basnet S, Shrestha S, Ghale K, Tamang S, Mandal DK, Pun SB. Burden of Shigella spp and Vibrio spp, and their antibiotic sensitivity pattern in the patients with acute gastroenteritis in tertiary care hospital in Nepal. BMC Res Notes 2019; 12:699. [PMID: 31655628 PMCID: PMC6815351 DOI: 10.1186/s13104-019-4722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/12/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives The present study aims to investigate the etiology, clinical profile and resistance pattern of the isolated pathogens in Nepalese adults with acute gastroenteritis. This cross-sectional study was conducted at Sukraraj Tropical and Infectious Disease Hospital, from April 2016 to Sep 2017. Subjects’ ages 14 or above, presenting with gastroenteritis with positive stool culture were enrolled for analysis. Results Of total 153 patients, 47.72% subjects confirmed the presence of bacterial infection. Vibrio cholerae spp and Shigella spp were detected in 36.6% and 23.28% respectively. The most common resistance among Vibrio cholerae was to nitrofurantoin (92.8%), cotrimoxazole (92.8%) and nalidixic acid (92.8%). Among 17 isolates of Shigella spp, the most frequent drug resistant was observed in ampicillin (64.7%), nalidixic acid (58.8%), ceftriaxone (47%). Chloramphenicol (94.1%), tetracycline (88.2%), and cotrimoxazole (82.3%) were found to be the most sensitive towards this pathogen. High rate of diarrhea due to bacterial infection, especially Shigella spp and Vibrio spp and their high rate of drug resistance emphasize an urgent need of designing a surveillance system for antimicrobial resistance in Nepalese setting.
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Azmuda N, Fakruddin M, Khan SI, Birkeland NK. Bacterial Community Profiling of Tropical Freshwaters in Bangladesh. Front Public Health 2019; 7:115. [PMID: 31214556 PMCID: PMC6554655 DOI: 10.3389/fpubh.2019.00115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/24/2019] [Indexed: 01/25/2023] Open
Abstract
Seasonal and spatial variations in the bacterial communities of two tropical freshwater sources in Bangladesh, Lake Dhanmondi in central Dhaka, and a pond in the outskirts of Dhaka, were assessed and compared using PCR-DGGE and deep sequencing of 16S rRNA genes, as well as heterotrophic enrichments using water samples collected at nine different time points during 1 year. Temporal and spatial variations of common aquatic bacterial genera were observed, but no clear seasonal variations could be depicted. The major bacterial genera identified from these two sites were members of the Proteobacteria, Cyanobacteria, Actinobacteria, Bacteroidetes, Chlorobi, Chloroflexi, Verrucomicrobia, and Firmicutes. Among the proteobacterial groups, members of the α-, β-, and γ- Proteobacteria predominated. γ- Proteobacteria belonging to the Escherichia coli/Shigella group even the diarrheagenic pathotypes of E. coli e.g., EPEC and ETEC were detected in most samples throughout the year, with no apparent correlations with other microbial groups. The other pathotypes, EHEC, EAEC, and EIEC/Shigella spp. were also detected occasionally. This study represents the first thorough analysis of the microbial diversity of tropical freshwater systems in Bangladesh.
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Affiliation(s)
- Nafisa Azmuda
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.,Department of Biological Sciences, University of Bergen, Bergen, Norway.,Department of Microbiology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md Fakruddin
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
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Moosavian M, Seyed-Mohammadi S, Sheikh AF, Khoshnood S, Dezfuli AA, Saki M, Ghaderian G, Shahi F, Abdi M, Abbasi F. Prevalence of enterotoxin-encoding genes among diverse Shigella strains isolated from patients with diarrhea, southwest Iran. Acta Microbiol Immunol Hung 2019; 66:91-101. [PMID: 30203689 DOI: 10.1556/030.65.2018.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Shigella spp. are a major cause of bacillary dysentery, particularly among children in developing countries such as Iran. This study aimed to investigate the presence of two important Shigella enterotoxins (ShET-1 and ShET-2), encoded by the set and sen genes, respectively, by polymerase chain reaction (PCR) assay among Shigella species isolated from children affected by shigellosis in Ahvaz, southwest of Iran. In this cross-sectional study, from June 2016 to April 2017, altogether 117 Shigella isolates were collected from fecal specimens of children aged <15 years with diarrhea in Ahvaz, southwest Iran. All isolates were identified by standard microbiological and molecular methods. The presence of enterotoxin genes was determined by PCR. The most prevalent isolate was Shigella flexneri (47.9%), followed by Shigella sonnei (41%) and Shigella boydii (11.1%), respectively. Shigella dysenteriae was not detected in patients' samples. The frequencies of set1A, set1B, and sen genes were 5.1% (6/117), 15.4% (18/117), and 76.9% (90/117), respectively. This study provides initial background on the prevalence and distribution of the Shigella enterotoxin genes in Shigella isolates in southwest of Iran. In addition, this study revealed a high prevalence of sen enterotoxin gene in Shigella species.
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Affiliation(s)
- Mojtaba Moosavian
- 1 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sakineh Seyed-Mohammadi
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 3 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Farajzadeh Sheikh
- 1 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Khoshnood
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 3 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Aram Asarehzadegan Dezfuli
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 3 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamreza Ghaderian
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Shahi
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 3 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahtab Abdi
- 2 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fariba Abbasi
- 4 Department of Laboratory Sciences, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Sarker AR, Sultana M, Mahumud RA, Ali N, Huda TM, Salim uzzaman M, Haider S, Rahman H, Islam Z, Khan JAM, Van Der Meer R, Morton A. Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective. Glob Health Res Policy 2018; 3:1. [PMID: 29318195 PMCID: PMC5755417 DOI: 10.1186/s41256-017-0056-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. METHODS This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. RESULTS The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. CONCLUSIONS Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, UK
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir M Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - M. Salim uzzaman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sabbir Haider
- Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hafizur Rahman
- Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chang Z, Zhang J, Ran L, Sun J, Liu F, Luo L, Zeng L, Wang L, Li Z, Yu H, Liao Q. The changing epidemiology of bacillary dysentery and characteristics of antimicrobial resistance of Shigella isolated in China from 2004-2014. BMC Infect Dis 2016; 16:685. [PMID: 27863468 PMCID: PMC5116132 DOI: 10.1186/s12879-016-1977-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 10/26/2016] [Indexed: 12/05/2022] Open
Abstract
Background Bacillary dysentery caused by bacteria of the genus Shigella is a significant public health problem in developing countries such as China. The objective of this study was to analyze the epidemiological pattern of bacillary dysentery, the diversity of the causative agent, and the antimicrobial resistance patterns of Shigella spp. for the purpose of determining the most effective allocation of resources and prioritization of interventions. Methods Surveillance data were acquired from the National Infectious Disease Information Reporting System (2004–2014) and from the sentinel hospital-based surveillance system (2005–2014). We analyzed the spatial and temporal distribution of bacillary dysentery, age and sex distribution, species diversity, and antimicrobial resistance patterns of Shigella spp. Results The surveillance registry included over 3 million probable cases of bacillary dysentery during the period 2004–2014. The annual incidence rate of bacillary dysentery decreased from 38.03 cases per 100,000 person-years in 2004 to 11.24 cases per 100,000 person-years in 2014. The case-fatality rate decreased from 0.028% in 2004 to 0.003% in 2014. Children aged <1 year and 1–4 years were most affected, with higher incidence rates (228.59 cases per 100,000 person-years and 92.58 cases per 100,000 person-years respectively). The annual epidemic season occurred between June and September. A higher incidence rate of bacillary dysentery was found in the Northwest region, Beijing and Tianjin during the study period. Shigella flexneri was the most prevalent species that caused bacillary dysentery in China (63.86%), followed by Shigella sonnei (34.89%). Shigella isolates were highly resistant to nalidixic acid (89.13%), ampicillin (88.90%), tetracycline (88.43%), and sulfamethoxazole (82.92%). During the study period, isolates resistant to ciprofloxacin and cefotaxime increased from 8.53 and 7.87% in 2005 to 44.65 and 29.94% in 2014, respectively. Conclusions The incidence rate of bacillary dysentery has undergone an obvious decrease from 2004 to 2014. Priority interventions should be delivered to populations in northwest China and to individuals aged <5 years. Antimicrobial resistance of Shigella is a serious public health problem and it is important to consider the susceptibility profile of isolates before determining treatment.
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Affiliation(s)
- Zhaorui Chang
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Jing Zhang
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Lu Ran
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Junling Sun
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Fengfeng Liu
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Li Luo
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Lingjia Zeng
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Liping Wang
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Zhongjie Li
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Hongjie Yu
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Qiaohong Liao
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
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Casabonne C, González A, Aquili V, Balagué C. Prevalence and Virulence Genes of Shigella spp. Isolated from Patients with Diarrhea in Rosario, Argentina. Jpn J Infect Dis 2016; 69:477-481. [PMID: 26902216 DOI: 10.7883/yoken.jjid.2015.459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the prevalence and virulence factors of Shigella species isolated from patients with diarrhea. Shigella species were isolated from 1,022 stool samples collected from different hospitals in Rosario, Argentina. The isolates were characterized using phenotypic tests, serotyping, and detection of virulence genes by PCR. One hundred strains (9.8% of samples collected) of Shigella were isolated. Shigella flexneri was the most frequently identified species (74%), followed by S. sonnei (26%). S. flexneri was also the predominant species isolated from children aged 6-14 years. These clinical strains of Shigella were then tested for the presence of ipaH, virA, ial, sen, and set using specific primers. virA was present in all strains, whereas ipaH was detected in 98% of strains and ial in 83%. sen was found in 71.6% of S. flexneri and 42.3% of S. sonnei isolates, and 41.9% of S. flexneri isolates were positive for set. Furthermore, 32.4% of S. flexneri isolates were positive for both set and sen. This study provides data on the prevalence and distribution of diverse Shigella strains.
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Affiliation(s)
- Cecilia Casabonne
- Bacteriology Area, College of Biochemical and Pharmaceutical Sciences, National University of Rosario
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Colombara DV, Faruque ASG, Cowgill KD, Mayer JD. Risk factors for diarrhea hospitalization in Bangladesh, 2000-2008: a case-case study of cholera and shigellosis. BMC Infect Dis 2014; 14:440. [PMID: 25127553 PMCID: PMC4141120 DOI: 10.1186/1471-2334-14-440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 08/12/2014] [Indexed: 02/05/2023] Open
Abstract
Background Cholera and shigellosis are endemic on the Indian subcontinent. Our objective was to identify cholera-specific risk factors distinct from shigellosis risk factors. Methods We conducted a case-case study among hospitalized diarrheal patients, comparing those with cholera and shigellosis in International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospitals in Matlab (rural) and Dhaka (urban) between January 1, 2000 and December 31, 2008. Results Multivariable Poisson regression models revealed that having more than nine years of education, compared to no education, was associated with a 39% (adjusted Risk Ratio [aRR] = 0.61, 95% confidence interval [CI]: 0.40-0.93) decreased risk for cholera hospitalization in Matlab and a 16% (aRR = 0.84, 95% CI: 0.75-0.94) decreased risk in Dhaka. Having a family member with diarrhea in the past seven days increased cholera hospitalization risk by 17% (aRR = 1.17, 95% CI: 1.09-1.26) in Matlab. Conclusions Further studies are needed to elucidate the pathway through which education impacts cholera risk in order to create targeted interventions in cholera-endemic areas. Interventions seeking to reduce transmission and facilitate hygienic practices among family members of index cases with diarrhea should be considered, especially in rural cholera endemic settings.
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Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Burkart K, Khan MMH, Schneider A, Breitner S, Langner M, Krämer A, Endlicher W. The effects of season and meteorology on human mortality in tropical climates: a systematic review. Trans R Soc Trop Med Hyg 2014; 108:393-401. [DOI: 10.1093/trstmh/tru055] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mardaneh J, Abbas Poor S, Afrugh P. Prevalence of Shigella species and Antimicrobial Resistance Patterns of Isolated Strains from Infected Pediatrics in Tehran. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2013. [DOI: 10.17795/ijep10705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Akhtar S, Sarker MR, Hossain A. Microbiological food safety: a dilemma of developing societies. Crit Rev Microbiol 2012; 40:348-59. [DOI: 10.3109/1040841x.2012.742036] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Shamsizadeh A, Nikfar R, Bavarsadian E. Neurological manifestations of shigellosis in children in southwestern Iran. Pediatr Int 2012; 54:127-30. [PMID: 22115119 DOI: 10.1111/j.1442-200x.2011.03522.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shigella spp. are important causative agents of acute diarrhea and dysentery. Neurological signs are among the most common extraintestinal manifestation of shigellosis. The aim of this study was to determine the relative frequency of neurological signs in children with shigellosis in southwestern Iran. METHODS In a retrospective study, the medical records of all children suffering from shigellosis who had been admitted to Abuzar Children's Hospital in Ahvaz, southwestern Iran, from March 2006 to March 2009 were reviewed. The epidemiological characteristics, clinical findings, and laboratory data of the patients with shigellosis were analyzed. The statistical analysis was performed using SPSS version 13.0 software. RESULTS During the study period, 154 children suffering from shigellosis were admitted. Of the patients studied, 85 (55.2%) were male and 69 (44.8%) female. The majority of patients were in the age group of 1-4 years. A total of 129 children (83.3%) had fever; dysentery was the presenting complaint of 43 (27.9%) of the patients. Shigella sonnei was isolated from 77 cases (50%), Shigella flexneri from 59 (38.2%), Shigella boydii from 11 (7.1%), and Shigella dysenteriae from seven (4.5%). Neurological manifestations were observed in 106 (68.8%) of the children. There were no statistically significant associations between the presences of neurological manifestations and sex, age, leukocytosis, bandemia, electrolyte imbalance or species of Shigella. The associations between neurological manifestations and the presence of fever and dysentery were statistically significant. CONCLUSIONS Shigella sonnei was the most common species of Shigella in southwestern Iran. Neurological manifestations were common in the children with shigellosis. Fever and dysentery were significant risk factors for the development of neurological signs.
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Affiliation(s)
- Ahmad Shamsizadeh
- Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Burkart K, Khan MH, Krämer A, Breitner S, Schneider A, Endlicher WR. Seasonal variations of all-cause and cause-specific mortality by age, gender, and socioeconomic condition in urban and rural areas of Bangladesh. Int J Equity Health 2011; 10:32. [PMID: 21816075 PMCID: PMC3167758 DOI: 10.1186/1475-9276-10-32] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 08/04/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to long-term influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. The pressures of climate change make an understanding of the interdependencies between season, climate and health especially important. METHODS This study investigated daily death counts collected within the Sample Vital Registration System (VSRS) established by the Bangladesh Bureau of Statistics (BBS). The sample was stratified by location (urban vs. rural), gender and socioeconomic status. Furthermore, seasonality was analyzed for all-cause mortality, and several cause-specific mortalities. Daily deviation from average mortality was calculated and seasonal fluctuations were elaborated using non parametric spline smoothing. A seasonality index for each year of life was calculated in order to assess the age-dependency of seasonal effects. RESULTS We found distinctive seasonal variations of mortality with generally higher levels during the cold season. To some extent, a rudimentary secondary summer maximum could be observed. The degree and shape of seasonality changed with the cause of death as well as with location, gender, and SES and was strongly age-dependent. Urban areas were seen to be facing an increased summer mortality peak, particularly in terms of cardiovascular mortality. Generally, children and the elderly faced stronger seasonal effects than youths and young adults. CONCLUSION This study clearly demonstrated the complex and dynamic nature of seasonal impacts on mortality. The modifying effect of spatial and population characteristics were highlighted. While tropical regions have been, and still are, associated with a marked excess of mortality in summer, only a weakly pronounced secondary summer peak could be observed for Bangladesh, possibly due to the reduced incidence of diarrhoea-related fatalities. These findings suggest that Bangladesh is undergoing an epidemiological transition from summer to winter excess mortality, as a consequence of changes in socioeconomic conditions and health care provision.
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Affiliation(s)
- Katrin Burkart
- Humboldt-Universität zu Berlin, Department of Geography, Berlin, German
| | - Mobarak H Khan
- Universität Bielefeld, School of Public Health, Bielefeld, Germany
- Department of Statistics, Jahangirnagar Universtity, Savar, Bangladesh
| | - Alexander Krämer
- Universität Bielefeld, School of Public Health, Bielefeld, Germany
| | - Susanne Breitner
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology II, München, Germany
| | - Alexandra Schneider
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology II, München, Germany
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Fischer Walker CL, Sack D, Black RE. Etiology of diarrhea in older children, adolescents and adults: a systematic review. PLoS Negl Trop Dis 2010; 4:e768. [PMID: 20689809 PMCID: PMC2914743 DOI: 10.1371/journal.pntd.0000768] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 06/16/2010] [Indexed: 01/04/2023] Open
Abstract
Background Diarrhea is an important cause of morbidity and mortality in all regions of the world and among all ages, yet little is known about the fraction of diarrhea episodes and deaths due to each pathogen. Methodology/Principal Findings We conducted a systematic literature review to identify all papers reporting the proportion of diarrhea episodes with positive laboratory tests for at least one pathogen in inpatient, outpatient and community settings that met our inclusion and exclusion criteria. We identified a total of 25,701 papers with possible etiology data and after final screening included 22 papers that met all inclusion and exclusion criteria. Enterotoxigenic Escherichia coli and V. cholerae O1/O139 were the leading causes of hospitalizations. In outpatient settings, Salmonella spp., Shigella spp., and E. histolytica were the most frequently isolated pathogens. Conclusions/Significance This is the first systematic review which has considered the relative importance of multiple diarrhea pathogens. The few studies identified suggest that there is a great need for additional prospective studies around the world in these age groups to better understand the burden of disease and the variation by region. Diarrhea is an important cause of illness and death around the world and among people of all ages, but unfortunately we often do not know what specific bacterium or virus causes the illness. We conducted a review of the scientific literature with the goal of finding published studies that identified bacteria and viruses among patients with diarrhea in the community and in hospital settings. We initially found nearly 26,000 papers on this topic but narrowed the list to 22 studies that met all of our specific criteria for inclusion in our review. Among patients hospitalized for diarrhea, E coli and Vibrio cholerae were found in more than 49% of people living in middle income and poor countries. Among patients who sought care from their doctor on an outpatient basis, Salmonella spp., Shigella spp., and E. histolytica were most often found. In our review we focused on the differences in the distribution of pathogens between patients in inpatient vs. outpatient settings because these estimates may best approximate what we would expect to see if the distribution were applied to global estimates of diarrhea deaths vs. uncomplicated illnesses.
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Affiliation(s)
- Christa L Fischer Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Orrett FA. Prevalence of Shigella serogroups and their antimicrobial resistance patterns in southern Trinidad. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2008; 26:456-462. [PMID: 19069625 PMCID: PMC2740689 DOI: 10.3329/jhpn.v26i4.1889] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The serogroup distribution and antimicrobial susceptibility patterns of Shigella isolates obtained from stool specimens of persons with acute diarrhoea in community-based studies from southern Trinidad during 1997-2006 were reviewed. Of the 5,187 stool specimens, 392 (8%) were positive for Shigella organisms. From these 392 isolates, 88.8% were recovered from children aged >0-10 year(s). Shigella sonnei was the most frequently-isolated serogroup (75%), followed by S. flexneri (19%), S. boydii (4.1%), and S. dysenteriae (1.8%). S. flexneri was the major isolate among the >20-30 years age-group. The most common drug resistance among all age-groups was to ampicillin. All strains of S. flexneri, S. boydii, and S. dysenteriae were fully susceptible to aztreonam, gentamicin, and ciprofloxacin. S. sonnei, the most common species isolated, showed resistance to all antibiotics tested. The data showed that, throughout the study period, the resistance to commonly-used drugs was relatively low. Since resistance to several drugs seems to be emerging, continuous monitoring of resistance patterns is mandatory for the appropriate selection of empiric antimicrobial drugs in the therapy of suspected cases of shigellosis.
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Affiliation(s)
- Fitzroy A Orrett
- Department of Paraclinical Sciences, Unit of Pathology and Microbiology, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago.
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Emch M, Ali M, Yunus M. Risk areas and neighborhood-level risk factors for Shigella dysenteriae 1 and Shigella flexneri. Health Place 2008; 14:96-105. [PMID: 17602851 DOI: 10.1016/j.healthplace.2007.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 04/27/2007] [Accepted: 05/15/2007] [Indexed: 10/23/2022]
Abstract
Annually, there are 165 million cases of shigellosis resulting in 1.1 million deaths in the developing world. Two species of the causative agent, Shigella dysenteriae 1 and Shigella flexneri, are responsible for acute diarrheal illness. Vaccines are being developed against both but many questions remain about the disease burden, distribution of species in space and time, and community-level risk factors. This study answers two questions. What are the differences in neighborhood-level risk factors between S. dysenteriae 1 and S. flexneri? Does shigellosis caused by the two different species occur in the same neighborhoods and are those high-risk neighborhoods persistent in time? Cases from a hospital in rural Bangladesh were assigned to one of the two shigellosis types and age-matched individuals were randomly chosen from the community to be controls. Information was collected for neighborhood-level variables hypothesized to be related to shigellosis. During the 3-year study period, there were 161 cases of S. dysenteriae 1 and 225 cases of S. flexneri. Incidence of both types was highest in children under 2 followed by children from 2 to 5. The location of S. dysenteriae 1 risk varies in time but S. flexneri risk areas were persistent in time. Neighborhoods near bazaars with many non-septic latrines were at highest risk for S. dysenteriae 1. S. flexneri was most common in flood-controlled areas. S. dysenteriae 1 risk is more related to hygiene and sanitation and S. flexneri is more related to the environment.
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Affiliation(s)
- Michael Emch
- University of North Carolina at Chapel Hill, Geography & CPC 308 Saunders Hall, Campus Box 3220, Chapel Hill, NC 27599, USA.
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Fluoroquinolone-resistant Shigella dysenteriae type 1 in northeastern Bangladesh. THE LANCET. INFECTIOUS DISEASES 2004; 4:607-8. [PMID: 15451486 DOI: 10.1016/s1473-3099(04)01143-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bhattacharya SK, Sarkar K, Balakrish Nair G, Faruque ASG, Sack DA. Multidrug-resistant Shigella dysenteriae type 1 in south Asia. THE LANCET. INFECTIOUS DISEASES 2004; 3:755. [PMID: 14652200 DOI: 10.1016/s1473-3099(03)00829-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S K Bhattacharya
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
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Talukder KA, Islam MA, Khajanchi BK, Dutta DK, Islam Z, Safa A, Alam K, Hossain A, Nair GB, Sack DA. Temporal shifts in the dominance of serotypes of Shigella dysenteriae from 1999 to 2002 in Dhaka, Bangladesh. J Clin Microbiol 2003; 41:5053-8. [PMID: 14605138 PMCID: PMC262501 DOI: 10.1128/jcm.41.11.5053-5058.2003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Revised: 07/03/2003] [Accepted: 08/12/2003] [Indexed: 11/20/2022] Open
Abstract
A total of 358 Shigella dysenteriae strains isolated from patients attending the Dhaka treatment center of the International Centre for Diarrheal Disease Research, Bangladesh, between the years 1999 and 2002 were included in this study. S. dysenteriae type 1, the dominant serotype in 1999 (76.4%), declined to 6.5% in 2002. On the other hand, S. dysenteriae types 2 to 12 were isolated with increasing frequencies of 19, 67, 73.5, and 87% in 1999, 2000, 2001, and 2002, respectively. Of these, types 2 and 4 were the most dominant serotypes, accounting for more than 18.7 and 28.5% of the total isolates, respectively. There was no isolation of serotypes 5, 7, 8, and 13 during this period. Twenty-eight (7.8%) of the isolates were atypical and agglutinated only with the polyvalent antiserum of S. dysenteriae. More than 98% of type 1 strains isolated between 1999 and 2001 were resistant to ampicillin, sulfamethoxazole-trimethoprim, and nalidixic acid. Among other serotypes of S. dysenteriae, Nal(r) type 2 strains were isolated in 2001 and 2002. Although heterogeneous plasmid profiles were obtained depending on the presence or absence of a single plasmid, core plasmids were defined for particular serotypes. On the other hand, the same plasmid profile was found to be shared by different serotypes. Interestingly, plasmid patterns of types 2 and 4 were almost identical except that a middle-range plasmid of 70 to 60 MDa was present in type 4 in addition to the core plasmids. All the strains harboring the 140-MDa plasmid were positive for the ipaH gene, had Congo red binding abilities, and were positive by the Sereny test, demonstrating their invasive properties.
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Affiliation(s)
- Kaisar A Talukder
- ICDDR, B: Centre for Health and Population Research, Dhaka 1000, Bangladesh.
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. IS, . RMM, . SHB, . MMR. Survivality and Virulence of Shigella sonnei and Shigella boydii in Different Physico-Chemical Stress Conditions. ACTA ACUST UNITED AC 2002. [DOI: 10.3923/jbs.2002.196.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Birmingham ME, Lee LA, Ntakibirora M, Bizimana F, Deming MS. A household survey of dysentery in Burundi: implications for the current pandemic in sub-Saharan Africa. Bull World Health Organ 1997; 75:45-53. [PMID: 9141750 PMCID: PMC2486987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
To characterize the epidemiology of dysentery (defined as bloody diarrhoea) in Burundi, we reviewed national surveillance data and conducted a household cluster survey including two case--control studies: one at the household, the other at the individual level. We estimated that community incidences for dysentery (per 1000 residents) in Kibuye Sector were 15.3 and 27.3, and that dysentery accounted for 6% and 12% of all deaths, in 1991 and 1992, respectively. Factors associated (P < or = 0.05) with contracting dysentery were being female, using a cloth rag after defecation, a history of recent weight loss, and not washing hands before preparing food. The attributable risk, at the household level, of not washing hands before preparing food was 30%. Secondary household transmission accounted for at most 11% of dysentery cases. This study suggests that Shigella dysenteriae type 1 may be one of the leading causes of preventable mortality in Burundi and other African countries where effective antimicrobial agents are no longer affordable. Since hands were the most important mode of transmission of S. dysenteriae in this study, community-based interventions aimed at increasing hand washing with soap and water, particularly after defecation and before food preparation, may be effective for controlling dysentery epidemics caused by S. dysenteriae type 1 in Africa.
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Affiliation(s)
- M E Birmingham
- International Health Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Shigella dysentery is a major public-health problem in many tropical areas. Despite improvements in water supplies and sanitation, it continues to be a disease of poor rural and urban communities and in populations affected by migration and crowding following disasters. Pathogenesis is due to colonic invasion, endotoxin, and, in Shigella dysenteriae 1, shiga toxin. As well as the local manifestations of dysentery, systemic complications include convulsions, haemolytic-uraemic syndrome, hyponatraemia and hypoglycaemia. The spread of shigella infection is most commonly person-person, although water and food-borne outbreaks have been reported. Since 1970, multiple antimicrobial resistance, particularly in Sh. dysenteriae 1, has complicated strategies for management. Multiply resistant strains have occurred in Latin America, Central Africa and southern and south-eastern Asia. No vaccines are currently available, and prevention and control will depend on public-health improvements and improved case management.
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Affiliation(s)
- P Shears
- Centre for Tropical Medical Microbiology, Liverpool School of Tropical Medicine, U.K
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Lima AA, Lima NL, Pinho MC, Barros Juñior EA, Teixeira MJ, Martins MC, Guerrant RL. High frequency of strains multiply resistant to ampicillin, trimethoprim-sulfamethoxazole, streptomycin, chloramphenicol, and tetracycline isolated from patients with shigellosis in northeastern Brazil during the period 1988 to 1993. Antimicrob Agents Chemother 1995; 39:256-9. [PMID: 7695319 PMCID: PMC162521 DOI: 10.1128/aac.39.1.256] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The occurrence and antimicrobial resistance pattern of Shigella isolates obtained from persons in community and hospital-based studies of diarrhea and matched controls in northeastern Brazil were studied. The isolation rate of Shigella spp. from patients with diarrhea during 1988 to 1993 varied from 4.5% (26 of 575) for the urban community of Gonçalves Dias to 6.7% (12 of 179) and 5.9% (7 of 119) for Hospital Infantil and Hospital Universitário, respectively. Of the 55 Shigella isolates (45 from patients with diarrhea, 8 from controls, and 2 undetermined) 73% (40 of 55) were Shigella flexneri, 16% (9 of 55) were S. sonnei, 7% (4 of 55) were S. boydii, and 4% (2 of 55) were S. dysenteriae. Of 39 S. flexneri strains, over half were resistant to ampicillin, trimethoprim-sulfamethoxazole, or both. Over 64% were resistant to streptomycin, chloramphenicol, and tetracycline. Overall, 82% of all S. flexneri isolates were resistant to four or more antimicrobial agents tested. As elsewhere, in the northeast of Brazil, ampicillin and trimethoprim-sulfamethoxazole are no longer reliable for treatment of S. flexneri infection. Most Shigella strains were resistant to four or more antimicrobial agents. Nalidixic acid was still useful for treatment of infections due to S. flexneri.
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Affiliation(s)
- A A Lima
- Clinical Research Unit/Clinical Pharmacology, Federal University of Ceará, Fortaleza, Brazil
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Islam MS, Hasan MK, Miah MA, Sur GC, Felsenstein A, Venkatesan M, Sack RB, Albert MJ. Use of the polymerase chain reaction and fluorescent-antibody methods for detecting viable but nonculturable Shigella dysenteriae type 1 in laboratory microcosms. Appl Environ Microbiol 1993; 59:536-40. [PMID: 8434918 PMCID: PMC202139 DOI: 10.1128/aem.59.2.536-540.1993] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Epidemiological studies of shigellosis in Bangladesh have demonstrated that surface-water sources can act as foci of infection. Studies of laboratory microcosms have shown that shigellae become nonculturable but remain viable when exposed to environmental samples of water. The present study was carried out to detect viable but nonculturable Shigella dysenteriae 1 from laboratory microcosms by the polymerase chain reaction and the fluorescent-antibody techniques. S. dysenteriae 1 was inoculated into laboratory microcosms consisting of water samples collected from ponds, lakes, rivers, and drains in Bangladesh. The survival of S. dysenteriae in microcosms was assessed by viable counting on MacConkey agar. After 2 to 3 weeks, S. dysenteriae 1 became nonculturable but remained viable. After 6 weeks, this nonculturable but viable S. dysenteriae 1 was detected by both the polymerase chain reaction and the fluorescent-antibody methods. The viable but nonculturable state of S. dysenteriae 1 demonstrated in this study may be important for understanding the epidemiology of shigellosis.
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Affiliation(s)
- M S Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Islam MS, Hasan MK, Khan SI. Growth and survival of Shigella flexneri in common Bangladeshi foods under various conditions of time and temperature. Appl Environ Microbiol 1993; 59:652-4. [PMID: 8434933 PMCID: PMC202164 DOI: 10.1128/aem.59.2.652-654.1993] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Survival and growth of Shigella flexneri were assessed in various foods, including boiled rice, lentil soup, milk, cooked beef, cooked fish, mashed potato, mashed brinjal, and raw cucumber. Growth at 25 and 37 degrees C and survival at 5 degrees C were observed by viable counts on MacConkey agar. The organism grew well in all tested foods and growth increased from 10(5) to 10(8) to 10(10) cells per ml or g within 6 to 18 h after inoculation at 25 and 37 degrees C.
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Affiliation(s)
- M S Islam
- Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Hossain MA, Albert MJ. Effect of duration of diarrhoea and predictive values of stool leucocytes and red blood cells in the isolation of different serogroups or serotypes of Shigella. Trans R Soc Trop Med Hyg 1991; 85:664-6. [PMID: 1781003 DOI: 10.1016/0035-9203(91)90388-f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Diarrhoeal stools from 11,358 patients were microscopically examined for the presence of white and red blood cells (WBC and RBC) and cultured for enteric pathogens. Of the 3895 patients who had Shigella as sole pathogens, 2681 (72.3%) showed the presence of both WBC and RBC and the remainder had only WBC (P less than 0.001). The presence of both WBC and RBC was as good a predictor of shigellosis as the presence of greater than 25 WBC per high power field (hpf) of the microscope with or without RBC. However, the best predictor of shigellosis (positive predictive value 85%, negative predictive value 83%) was the presence of greater than 25 WBC/hpf and the presence of RBC regardless of their number. More patients infected with S. dysenteriae 1, S. flexneri and S. boydii shed both WBC and RBC than those infected with S. sonnei, most of whom shed WBC only (P less than 0.001). A greater number of patients infected with S. dysenteriae 1 shed more WBC and RBC than those infected with S. flexneri (P less than 0.001). The same trend was found when patients infected with S. flexneri were compared with those infected with S. boydii (though the difference was not statistically significant) and when patients infected with S. boydii were compared with patients infected with S. sonnei (P less than 0.001). There was a progressive decline in the isolation rate of Shigella as the duration of dysentery, before stool culture, increased.
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Affiliation(s)
- M A Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, (ICDDR,B), Dhaka
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