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Tufon KA, Fokam DPY, Kouanou YS, Meriki HD. Case report on a swift shift in uropathogens from Shigella flexneri to Escherichia coli: a thin line between bacterial persistence and reinfection. Ann Clin Microbiol Antimicrob 2020; 19:31. [PMID: 32727466 PMCID: PMC7392695 DOI: 10.1186/s12941-020-00374-y] [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: 01/15/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Urinary tract infections (UTI) are mostly caused by bacteria. Urine cultures are usually a definitive measure to select the appropriate antibiotics for the elimination of a uropathogen and subsequent recovery from the infection. However, the preferred antibiotics as determined by urine culture and sensitivity may still not eliminate the infection and would require further examination to ascertain the cause of treatment failure which could be unresolved bacteriuria, bacterial persistence, immediate reinfection with a different uropathogen or misdiagnosis. Case presentation A 2-years 7 months-old female was admitted in the Regional hospital of Buea following persistent fever. An auto medication with amoxicillin was reported. Urinalysis was done on the first day and the sediment of the cloudy urine revealed many bacteria and few pus cells. Ceftriaxone was prescribed as empirical treatment and a request for urine and blood culture was made. Three days after admission, the temperature and CRP were 39.0 °C and 96 mg/l, respectively. The urine culture results (> 105 CFU/ml of Shigella flexneri sensitive to ofloxacin) were presented to the doctor on the 4th day of admission. Patient was put on ofloxacin. Three days after, the temperature (38.5 °C) and CRP (24 mg/l) were still elevated. The blood culture result came out negative. A second urine culture was requested which came back positive (> 105 CFU/ml of Escherichia coli resistant to ofloxacin and sensitive to meropenem and amikacin). Ofloxacin was discontinued and the patient put on meropenem and amikacin. The third urine culture recorded no significant growth after 48 h of incubation. The patient was discharged looking healthy once more with a normal body temperature. Conclusion Antibiotics tailored towards the elimination of a particular bacterial species may as well provide a favorable environment for other bacterial species that are resistant to it in the course of treating a UTI episode. This apparent treatment failure may first of all require a second urine culture for confirmation rather than considering the possibilities of a misdiagnosis.
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Affiliation(s)
- Kukwah Anthony Tufon
- Buea Regional Hospital, Southwest Region, Buea, Cameroon. .,Department of Allied Health, Faculty of Health Science, Biaka University, Buea, Cameroon. .,Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.
| | - Djike Puepi Yolande Fokam
- Buea Regional Hospital, Southwest Region, Buea, Cameroon.,Department of Internal Medicine and Paediatrics, Faculty of Health Science, University of Buea, Buea, Cameroon
| | | | - Henry Dilonga Meriki
- Buea Regional Hospital, Southwest Region, Buea, Cameroon.,Department of Allied Health, Faculty of Health Science, Biaka University, Buea, Cameroon.,Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
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Lamba K, Nelson JA, Kimura AC, Poe A, Collins J, Kao AS, Cruz L, Inami G, Vaishampayan J, Garza A, Chaturvedi V, Vugia DJ. Shiga Toxin 1-Producing Shigella sonnei Infections, California, United States, 2014-2015. Emerg Infect Dis 2016; 22:679-86. [PMID: 26982255 PMCID: PMC4806944 DOI: 10.3201/eid2204.151825] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Shiga toxins (Stx) are primarily associated with Shiga toxin–producing Escherichia coli and Shigella dysenteriae serotype 1. Stx production by other shigellae is uncommon, but in 2014, Stx1-producing S. sonnei infections were detected in California. Surveillance was enhanced to test S. sonnei isolates for the presence and expression of stx genes, perform DNA subtyping, describe clinical and epidemiologic characteristics of case-patients, and investigate for sources of infection. During June 2014–April 2015, we identified 56 cases of Stx1-producing S. sonnei, in 2 clusters. All isolates encoded stx1 and produced active Stx1. Multiple pulsed-field gel electrophoresis patterns were identified. Bloody diarrhea was reported by 71% of case-patients; none had hemolytic uremic syndrome. Some initial cases were epidemiologically linked to travel to Mexico, but subsequent infections were transmitted domestically. Continued surveillance of Stx1-producing S. sonnei in California is necessary to characterize its features and plan for reduction of its spread in the United States.
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Ashkenazi S, Cohen D. An update on vaccines against Shigella. THERAPEUTIC ADVANCES IN VACCINES 2013; 1:113-23. [PMID: 24757519 PMCID: PMC3967666 DOI: 10.1177/2051013613500428] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite intensive research efforts for more than 60 years, utilizing diverse vaccine strategies, a safe and efficacious vaccine against shigellosis is not available yet. We are currently witnessing innovative approaches based on elucidation of the virulence mechanisms of Shigella, understanding the immune response to the pathogen and progress in molecular technology for developing Shigella vaccines. It is hoped that these will lead to a licensed effective Shigella vaccine to protect humans against the significant worldwide morbidity and mortality caused by this microorganism.
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Affiliation(s)
- Shai Ashkenazi
- Department of Pediatrics A, Schneider Children's Medical Center, 14 Kaplan Street, Petach Tikva 49202, Israel
| | - Dani Cohen
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Hutton T, Goldstein R, Njaa B, Atwater D, Chang YF, Simpson K. Search forBorrelia burgdorferiin Kidneys of Dogs with Suspected “Lyme Nephritis”. J Vet Intern Med 2008; 22:860-5. [DOI: 10.1111/j.1939-1676.2008.0131.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Anatoliotaki M, Galanakis E, Schinaki A, Stefanaki S, Mavrokosta M, Tsilimigaki A. Antimicrobial resistance of urinary tract pathogens in children in Crete, Greece. ACTA ACUST UNITED AC 2007; 39:671-5. [PMID: 17654342 DOI: 10.1080/00365540701199899] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to identify the organisms responsible for community acquired febrile UTI in children and to investigate their susceptibility to commonly used antibiotics. A 5-y prospective analysis was performed in children hospitalized for a first episode of UTI, in Crete, Greece. A total of 262 children, 40.1% males and 59.9% females, aged 0.08 to 13 y, were enrolled in the study. Escherichia coli (E. coli) was the leading uropathogen. Antimicrobial resistance of E. coli isolates was most commonly to ampicillin (56.4%) followed by trimethoprim-sulfamethoxazole (TMP-SMX) (27.3%), cefaclor (22.5%), amoxicillin-clavulanate (15.5%), gentamicin (4.9%), cefuroxime (3.1%), nitrofurantoin (2.6%), and ceftriaxone (1.6%). Interestingly, a significant decrease in E. coli resistance to TMP-SMX was observed during the study period. Resistance to ampicillin, TMP-SMX and cefaclor was noted for 61%, 28% and 27% of the total uropathogens, respectively, making these agents inappropriate for empirical treatment of febrile UTI in our region. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate. More than 90% of the uropathogens are susceptible to cefuroxime, ceftriaxone, gentamicin, and nitrofurantoin. In conclusion, several of the first-line agents for empirical treatment of childhood UTI seem to have become ineffective in the area of this study.
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Affiliation(s)
- Maria Anatoliotaki
- Department of Paediatrics, Venizelion General Hospital, Heraklion, Crete, Greece
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Abstract
Shigellosis , the acute enteric infection caused by bacteria of the genus Shigella , has a worldwide distribution with an estimated annual incidence of 164.7 million cases, of which 163.2 million occur in developing countries, and 1.1 million deaths. Sixty-nine percent of all episodes and 61 percent of all Shigella -related deaths involve children younger than 5 years old. In the United States, 10,000 to 15,000 cases of shigellosis are reported each year. Although usually confined to the colonic mucosa, shigellosis sometimes can cause extraintestinal complications. Recent publications have shed light on the clinical characteristics of Shigella -induced bacteremia, surgical complications, urogenital symptoms, and neurologic manifestations, and on the unique manifestations in the neonatal period. The mainstay of treatment of shigellosis in children is correction of the fluid and electrolyte loss, which often is achieved by the administration of oral rehydration solutions. Appropriate antibiotic therapy shortens the duration of both clinical symptoms and fecal excretion of the pathogen. However, the increasing antimicrobial resistance of shigellae worldwide constitutes a major problem. Regarding the pathophysiology of shigellosis and its complications, recent data not only elucidated the molecular mechanisms involved but also linked manifestations of disease to the interplay of bacterial virulence factors and host responses. The improved understanding of the pathophysiology is hoped to lead to innovative therapeutic approaches against shigellosis and new generations of vaccine candidates.
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Affiliation(s)
- Shai Ashkenazi
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petah Tikva 49202, Israel.
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Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Laboratory-Confirmed Shigellosis in the United States, 1989-2002: Epidemiologic Trends and Patterns. Clin Infect Dis 2004; 38:1372-7. [PMID: 15156473 DOI: 10.1086/386326] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2003] [Accepted: 01/14/2004] [Indexed: 11/04/2022] Open
Abstract
During 1989-2002, a total of 208,368 laboratory-confirmed Shigella infections were reported to the Centers for Disease Control and Prevention. Shigella sonnei accounted for 71.7%, Shigella flexneri accounted for 18.4%, Shigella boydii accounted for 1.6%, and Shigella dysenteriae accounted for 0.7% of infections; for 7.6%, no serogroup was reported. National incidence rates ranged from 7.6 cases per 100,000 persons in 1993 to 3.7 cases per 100,000 persons in 1999. Incidence rates for S. boydii, S. dysenteriae, and S. flexneri decreased over the 14-year period by 81%, 83%, and 64%, respectively; S. sonnei rates only decreased by 8%. The highest rates were reported from western states (10.0 cases per 100,000 persons) and among children 1-4 years of age (20.6 cases per 100,000 persons). The female-male S. sonnei incidence rate ratio among 20-39-year-old adults decreased from 2.3 during 1989-1999 to 1.4 during 2000-2002. Approximately 1% of isolates were from extraenteric sources; 0.25% were from blood. S. sonnei remains an important cause of diarrhea in the United States. Prevention efforts that target high-risk groups are needed.
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Affiliation(s)
- Amita Gupta
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office,National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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