1
|
Torok M, Hewitson I, Hutton A, Scallan Walter E, Jervis R. Collecting a Sexual History During Shigellosis Case Investigations: Nationwide Practices and an Assessment of Data Quality. Foodborne Pathog Dis 2024; 21:353-359. [PMID: 38265447 DOI: 10.1089/fpd.2023.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Shigellosis is spread through the fecal-oral route, including sexual activity. The Centers for Disease Control and Prevention recommends collecting a sexual history from people diagnosed with shigellosis to enhance the understanding of its epidemiology and outbreak detection and the design of disease prevention messaging, although individual jurisdictions decide if and how this is done. Moreover, enteric disease interviewers typically receive in-depth general interviewing training, but often not sexual history question training. The goal of this project was to inform national practices around sexual history questions asked during shigellosis interviews by collecting information from U.S. state health agencies and evaluating sexual history data from people diagnosed with shigellosis in Colorado. From November 2021 to January 2022, information on sexual history questions asked of persons with reported shigellosis and accompanying training resources were collected from U.S. state health departments. Data completeness and quality of shigellosis sexual history questions from Colorado's notifiable disease database from 2018 to 2022 were also evaluated. Of 48 states, 54% reported routinely asking all adults about their sexual history during shigellosis interviews. Of 44 states, 18% indicated having accompanying training materials for interviewers. In Colorado, the proportion of unknown/missing responses to questions about recent sexual contact with male and female partners was lower for males (3.3% unknown and 3.3% missing) than females (5.4% and 6.2%) and highest among those 66 years and older (6.7% and 10%). Among those reporting new sexual partners, 93.5% indicated how they met. The evaluation of Colorado data demonstrates that routine collection of complete, high-quality, actionable sexual history data from all adults with reported shigellosis is feasible. Nearly half of the responding states indicated not doing so, and few had training resources. We recommend training enteric disease interviewers to routinely ask all adults with reported shigellosis about their sexual history, including new partner meeting location.
Collapse
Affiliation(s)
- Michelle Torok
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Ingrid Hewitson
- Disease Control and Public Health Response Division, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Abbey Hutton
- Disease Control and Public Health Response Division, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Elaine Scallan Walter
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Rachel Jervis
- Disease Control and Public Health Response Division, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| |
Collapse
|
2
|
Català A, Hernández DG. AEDV Expert Recommendations on the Management of Suppurative Sexually Transmitted Infections. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00340-5. [PMID: 38663731 DOI: 10.1016/j.ad.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of sexually transmitted infections (STIs) is increasing in Spain. Suppurative STIs are one of the most frequent reasons for consultation in specialized centers. The reason for suppurative STIs is multiple and their empirical treatment varies with the currently growing problem of antimicrobial resistance. Dermatologists are trained and prepared to treat these diseases, but their correct management requires active knowledge of national and international guidelines. The present document updates, reviews and summarizes the main expert recommendations on the management and treatment of these STIs.
Collapse
Affiliation(s)
- A Català
- Servicio de Dermatología y Venereología, Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología, España; Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña.
| | - D García Hernández
- Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña
| |
Collapse
|
3
|
Haugan I, Husby MG, Skjøtskift B, Aamnes Mostue D, Brun A, Olsen LC, Simpson MR, Lange H, Afset JE. Enteroaggregative Escherichia coli in mid-Norway: A prospective, case control study. PLoS One 2024; 19:e0301625. [PMID: 38635516 PMCID: PMC11025732 DOI: 10.1371/journal.pone.0301625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The use of molecular methods has led to increased detection of Enteroaggregative Escherichia coli (EAEC) in faecal samples. Studies have yielded conflicting results regarding the clinical relevance of this finding. The objective of this study was to investigate the prevalence of EAEC in faecal samples from patients with diarrhoea and healthy controls and describe characteristics of EAEC positive persons. METHODS From March 1st, 2017 to February 28th, 2019, we investigated all consecutive faecal samples from patients with diarrhoea received at the laboratory and collected faecal samples from randomly invited healthy controls from mid-Norway. Real-time multiplex PCR was used for detection of bacterial, viral, and parasitic pathogens. We registered sex, age, urban versus non-urban residency, and travel history for all participants. Statistical analyses were performed with Pearson chi-squared test, Kruskal-Wallis test, and Mann-Whitney U test. RESULTS We identified EAEC in 440 of 9487 (4.6%) patients with diarrhoea and 8 of 375 (2.2%) healthy controls. The EAEC prevalence was 19.1% among those with diarrhoea and recent foreign travel and 2.2% in those without travel history independent of diarrhoea. Concomitant pathogens were detected in 64.3% of EAEC-positive patients with diarrhoea. The median age was 28.5 in those with EAEC-positive diarrhoea and 38 in those with EAEC-negative diarrhoea (p <0.01). In patients with diarrhoea, travel was reported in 72% of those with EAEC and concomitant pathogens, and 54% and 12% in those with only EAEC and no EAEC, respectively (p <0.01). CONCLUSIONS EAEC was a common detection, particularly in patients with diarrhoea and recent international travel, and was found together with other intestinal pathogens in the majority of cases. Our results suggest that domestically acquired EAEC is not associated with diarrhoea. Patients with EAEC-positive diarrhoea and concomitant pathogens were young and often reported recent travel history compared to other patients with diarrhoea.
Collapse
Affiliation(s)
- Ingvild Haugan
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Gudrun Husby
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørg Skjøtskift
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Dorothea Aamnes Mostue
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Andreas Brun
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lene Christin Olsen
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Melanie Rae Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Research Unit Central Norway, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heidi Lange
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Egil Afset
- Department of Medical Microbiology, Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
4
|
Miller TI, Banning S, Lieberman JA. Risk factors and provider awareness of sexually transmitted enteric pathogens among men who have sex with men. Microbiol Spectr 2024; 12:e0357723. [PMID: 38391230 PMCID: PMC10986602 DOI: 10.1128/spectrum.03577-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Sexual transmission of enteric pathogens among men who have sex with men (MSM) is well documented, although whether providers are cognizant of this risk when MSM patients present with gastrointestinal symptoms has not been studied. Over 34 months at a major tertiary metropolitan medical system, this study retrospectively analyzed 436 BioFire FilmArray Gastrointestinal results from 361 patients documented as MSM. An extensive chart review was performed, including specific sexual behaviors, socioeconomic risk factors, and whether providers charted a sexual history when a patient presented for care. Overall BioFire positivity rate was 62% with no significant difference in positivity between persons living with HIV and those without. Patients charted as sexually active had a significantly increased odds ratio (OR) of a positive result compared to those who were not. Anilingus had the highest OR. Providers charted any type of sexual history in 40.6% of cases, and HIV/infectious disease providers were significantly more likely to do this compared to other subspecialties. Sexual transmission of enteric pathogens within MSM is ongoing, and patients are at risk regardless of living with HIV. Not all sexual behaviors have the same associated risk, highlighting opportunities to decrease transmission. Increased provider vigilance and better patient education on sexual transmission of enteric pathogens are needed to reduce the disease burden. IMPORTANCE Our work adds several key findings to the growing body of literature describing the epidemiology of enteric pathogens as sexually transmitted infections among men who have sex with men (MSM). We analyzed clinical test results, housing status, provider awareness, sexual behaviors, and symptoms for 361 patients. We found that any sexual activity was associated with an increased risk of diarrheal pathogen detection, whereas being unhoused was not a risk factor. These findings suggest separate transmission networks between unhoused persons, who are also at risk of infectious diarrhea, and MSM. Moreover, our study suggested low awareness among patient-facing clinicians that diarrheal pathogens can be sexually transmitted. Together, our findings indicate an important opportunity to disrupt transmission cycles by educating clinicians on how to assess and counsel MSM patients.
Collapse
Affiliation(s)
- Timothy Isaac Miller
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Stephanie Banning
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joshua A. Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
5
|
Hausdorff WP, Anderson JD, Bagamian KH, Bourgeois AL, Mills M, Sawe F, Scheele S, Talaat K, Giersing BK. Vaccine value profile for Shigella. Vaccine 2023; 41 Suppl 2:S76-S94. [PMID: 37827969 DOI: 10.1016/j.vaccine.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/14/2022] [Accepted: 12/16/2022] [Indexed: 10/14/2023]
Abstract
Shigella is the leading bacterial cause of diarrhoea and the second leading cause of diarrhoeal mortality among all ages. It also exhibits increasing levels of antibiotic resistance. The greatest burden is among children under five in low- and middle-income countries (LMICs). As such, a priority strategic goal of the World Health Organization (WHO) is the development of a safe, effective and affordable vaccine to reduce morbidity and mortality from Shigella-attributable dysentery and diarrhea, including long term outcomes associated with chronic inflammation and growth faltering, in children under 5 years of age in LMICs. In addition, a safe and effective Shigella vaccine is of potential interest to travellers and military both to prevent acute disease and rarer, long-term sequelae. An effective Shigella vaccine is also anticipated to reduce antibiotic use and thereby help diminish further emergence of enteric pathogens resistant to antimicrobials. The most advanced vaccine candidates are multivalent, parenteral formulations in Phase 2 and Phase 3 clinical studies. They rely on O-antigen-polysaccharide protein conjugate technologies or, alternatively, outer membrane vesicles expressing penta-acylated lipopolysaccharide that has been detoxified. Other parenteral and oral formulations, many delivering a broader array of Shigella antigens, are at earlier stages of clinical development. These formulations are being assessed in alignment with the WHO Preferred Product Characteristics, which call for a 1 to 2 dose primary immunization series given during the first 12 months of life, ideally starting at 6 months of age. This 'Vaccine Value Profile' (VVP) for Shigella is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, government agencies and multi-lateral organizations. All contributors have extensive expertise on various elements of the Shigella VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
Collapse
Affiliation(s)
- William P Hausdorff
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Ave NW, Washington, DC 20001, USA; Faculty of Medicine, Université de Bruxelles, Brussels 1070, Belgium.
| | - John D Anderson
- Office of Health Affairs, West Virginia University, Morgantown, WV 26505, USA; Bagamian Scientific Consulting, LLC, Gainesville, FL 32601, USA
| | - Karoun H Bagamian
- Bagamian Scientific Consulting, LLC, Gainesville, FL 32601, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL 32603, USA
| | - A Louis Bourgeois
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Ave NW, Washington, DC 20001, USA
| | - Melody Mills
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892 USA
| | - Frederick Sawe
- Kenya Medical Research Institute/U.S. Army Medical Research Directorate-Africa/Kenya-Henry Jackson Foundation MRI, Kericho, Kenya
| | - Suzanne Scheele
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Ave NW, Washington, DC 20001, USA
| | - Kawsar Talaat
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Birgitte K Giersing
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), Geneva, Switzerland
| |
Collapse
|
6
|
Tsai CS, Wang JL, Liao YS, Fukushige M, Chiou CS, Ko WC. Shigellosis in Taiwan: An old enteric pathogen with changing epidemiology and increasing antimicrobial resistance. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023:S1684-1182(23)00206-2. [PMID: 37951802 DOI: 10.1016/j.jmii.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/07/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
While the incidence of shigellosis has decreased in developed nations due to improved living conditions and healthcare systems, it remains prevalent in economically developing regions. In recent years, a resurgence of shigellosis has been observed in the United States, Europe, and Taiwan, primarily among men having sex with men and people living with human immunodeficiency virus, along with a rise in antimicrobial resistance. This study aims to review the historical epidemiological trends and drug resistance in shigellosis, with a focus on Taiwan. A comprehensive search was conducted using various databases and sources, including non-English literature in Japanese and Chinese. In developed countries, Shigella sonnei and Shigella flexneri are the most common species, while Shigella dysenteriae infections are sporadic. In Taiwan, the classification and prevalence of Shigella species have evolved over time, with S. flexneri and S. sonnei being the predominant strains. Fluoroquinolone resistance and azithromycin non-susceptibility are the ongoing threat. In conclusion, shigellosis remains a significant global health concern, with recent increases in certain populations and antimicrobial resistance. Further research is necessary to understand the clinical significance and risk factors associated with asymptomatic carriers and to assess the impact of behavioral modifications and interventions in high-risk populations.
Collapse
Affiliation(s)
- Chin-Shiang Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Shu Liao
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Mizuho Fukushige
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Chien-Shun Chiou
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan.
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
7
|
Mogaka FO, Stewart J, Omollo V, Bukusi E. Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis. Curr HIV/AIDS Rep 2023; 20:312-319. [PMID: 37751130 PMCID: PMC10805125 DOI: 10.1007/s11904-023-00666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs. RECENT FINDINGS The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited. STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.
Collapse
Affiliation(s)
- Felix Ong'era Mogaka
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Jenell Stewart
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Victor Omollo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| |
Collapse
|
8
|
Tansarli GS, Long DR, Waalkes A, Bourassa LA, Libby SJ, Penewit K, Almazan J, Matsumoto J, Bryson-Cahn C, Rietberg K, Dell BM, Hatley NV, Salipante SJ, Fang FC. Genomic reconstruction and directed interventions in a multidrug-resistant Shigellosis outbreak in Seattle, WA, USA: a genomic surveillance study. THE LANCET. INFECTIOUS DISEASES 2023; 23:740-750. [PMID: 36731480 PMCID: PMC10726761 DOI: 10.1016/s1473-3099(22)00879-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/09/2022] [Accepted: 12/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shigella spp have been associated with community-wide outbreaks in urban settings. We analysed a sustained shigellosis outbreak in Seattle, WA, USA, to understand its origins and mechanisms of antimicrobial resistance, define ongoing transmission patterns, and optimise strategies for treatment and infection control. METHODS We did a retrospective study of all Shigella isolates identified from stool samples at the clinical laboratories at Harborview Medical Center and University of Washington Medical Center (Seattle, WA, USA) from May 1, 2017, to Feb 28, 2022. We characterised isolates by species identification, phenotypic susceptibility testing, and whole-genome sequencing. Demographic characteristics and clinical outcomes of the patients were retrospectively examined. FINDINGS 171 cases of shigellosis were included. 78 (46%) patients were men who have sex with men (MSM), and 88 (52%) were people experiencing homelessness (PEH). Although 84 (51%) isolates were multidrug resistant, 100 (70%) of 143 patients with data on antimicrobial therapy received appropriate empirical therapy. Phylogenomic analysis identified sequential outbreaks of multiple distinct lineages of Shigella flexneri and Shigella sonnei. Discrete clonal lineages (ten in S flexneri and nine in S sonnei) and resistance traits were responsible for infection in different at-risk populations (ie, MSM, PEH), enabling development of effective guidelines for empirical treatment. The most prevalent lineage in Seattle was probably introduced to Washington State via international travel, with subsequent domestic transmission between at-risk groups. INTERPRETATION An outbreak in Seattle was driven by parallel emergence of multidrug-resistant strains involving international transmission networks and domestic transmission between at-risk populations. Genomic analysis elucidated not only outbreak origin, but directed optimal approaches to testing, treatment, and public health response. Rapid diagnostics combined with detailed knowledge of local epidemiology can enable high rates of appropriate empirical therapy even in multidrug-resistant infection. FUNDING None.
Collapse
Affiliation(s)
- Giannoula S Tansarli
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Dustin R Long
- Division of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Adam Waalkes
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Lori A Bourassa
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephen J Libby
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Kelsi Penewit
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jared Almazan
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jason Matsumoto
- Clinical Microbiology Laboratory, Harborview Medical Center, Seattle, WA, USA
| | - Chloe Bryson-Cahn
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Infection Prevention and Control, Harborview Medical Center, Seattle, WA, USA
| | - Krista Rietberg
- Infection Prevention and Control, Harborview Medical Center, Seattle, WA, USA
| | - BreeAnna M Dell
- Public Health-Seattle & King County, Communicable Diseases, Epidemiology, and Immunizations, Seattle, WA, USA
| | - Noël V Hatley
- Public Health-Seattle & King County, Communicable Diseases, Epidemiology, and Immunizations, Seattle, WA, USA
| | - Stephen J Salipante
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ferric C Fang
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA; Department of Microbiology, University of Washington School of Medicine, Seattle, WA, USA; Clinical Microbiology Laboratory, Harborview Medical Center, Seattle, WA, USA.
| |
Collapse
|
9
|
Richardson D, Pakianathan M, Ewens M, Mitchell H, Mohammed H, Wiseman E, Tweed M, Nichols K, Rawdah W, Cooper R, Macrowan R, Irish M, Evans A, Godbole G. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS 2023:9564624231168217. [PMID: 37247427 DOI: 10.1177/09564624231168217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
Collapse
Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | | | | | | | - Waseem Rawdah
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Amy Evans
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | |
Collapse
|
10
|
Tsai CS, Chen PL, Lee NY, Tsai HP, Huang SH, Chen SY, Tang YW, Lin YC, Tsai PF, Mao LW, Su SL, Wang JL, Ko WC. Characteristics of rectal chlamydia among men who have sex with men in southern Taiwan, 2020-2022: An emerging threat of rectal lymphogranuloma venereum L2b. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:408-415. [PMID: 36682913 DOI: 10.1016/j.jmii.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/13/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East. MATERIAL AND METHODS From January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample. RESULTS Among 341 MSM during 2020-2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44-31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002-1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline. CONCLUSIONS Rectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.
Collapse
Affiliation(s)
- Chin-Shiang Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huey-Pin Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Szu-Ying Chen
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Tang
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Chun Lin
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lin-Wen Mao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Li Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
11
|
O'Flanagan H, Siddiq M, Llewellyn C, Richardson D. Antimicrobial resistance in sexually transmitted Shigella in men who have sex with men: A systematic review. Int J STD AIDS 2023; 34:374-384. [PMID: 36786731 DOI: 10.1177/09564624231154942] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Outbreaks of sexually transmitted Shigella flexneri and Shigella sonnei in men who have sex with men (MSM) are a major public health issue. While most cases can be managed conservatively, a minority require antimicrobial treatment. Recent reports have highlighted increasing antimicrobial resistant (AMR) strains of Shigella spp. in men who have sex with men. We aimed to systematically review antimicrobial resistance (and decreased antimicrobial sensitivity) in sexually transmitted shigella in men who have sex with men, focussing on macrolides, quinolones, and third generation cephalosporins. METHODS We systematically searched 4 bibliographical databases (EMBASE, medline, EMCARE and CINAHL) from January 2011 to November 2021. We used a 2-stage process to assess eligibility: the primary author conducted an initial screen and then 3 authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts in English which included men who have sex with men with sexually transmitted shigella where data on antimicrobial resistance was available. RESULTS Thirty-nine manuscripts met the inclusion criteria. A majority of the manuscripts (N = 34) described reduced susceptibility or antimicrobial resistant to macrolides, quinolones and third generation cephalosporins in circulating strains of shigella within sexual networks of men who have sex with men. Extensively drug resistant outbreaks of shigella in men who have sex with men have been reported containing genetic markers of ceftriaxone resistance (e.g. BlaCTX-M27) where isolates also contained markers of reduced susceptibility, and antimicrobial resistant to macrolides and quinolones. CONCLUSION There is little role for macrolides, quinolones or third generation cephalosporins in the management of sexually transmitted shigella in men who have sex with men. More research is needed to develop novel strategies for shigella control in men who have sex with men, as antimicrobial options are diminishing.
Collapse
Affiliation(s)
| | | | | | - Daniel Richardson
- 12190Brighton and Sussex Medical School, Brighton, UK.,8721University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| |
Collapse
|
12
|
Braam JF, Bruisten SM, Hoogeland M, de Vries HJC, Schim van der Loeff MF, van Dam AP. Shigella is common in symptomatic and asymptomatic men who have sex with men visiting a sexual health clinic in Amsterdam. Sex Transm Infect 2022; 98:564-569. [PMID: 35149579 DOI: 10.1136/sextrans-2021-055274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Shigellosis is a reportable infectious disease. It can present as a severe bloody diarrhoea but is often asymptomatic. Shigella can be sexually transmissible. We performed a study among symptomatic and asymptomatic men who have sex with men (MSM) to assess the prevalence of Shigella, Salmonella and Campylobacter. METHODS From March to June 2020, MSM attending the Amsterdam centre for sexual health were consecutively included. Predefined minimal numbers of inclusion of 150, 100 and 50 were determined, respectively, for MSM who reported no diarrhoea, diarrhoea during last month or diarrhoea on the day of visit to clinic. Anal samples were tested for the presence of Shigella, Salmonella and Campylobacter. During the same period, the frequency of these bacteria was assessed in routinely tested samples requested by general physicians or nursing home physicians. Characteristics of included MSM were compared between the men with different diarrhoea anamnesis, and the prevalence of shigellosis was estimated in each group. RESULTS We included 212 MSM without diarrhoea, 109 MSM who recently had diarrhoea and 68 MSM who reported diarrhoea on the day of clinic visit. Thirteen (3.3%, 95% CI 1.7% to 5.6%) MSM were infected with Shigella, none with Salmonella and 7 (1.8%, 95% CI 0.7% to 3.7%) with Campylobacter. Shigella prevalence was 2.8% (95% CI 1.0% to 6.1%) in asymptomatic men, 3.7% (95% CI 1.0% to 9.1%) in men who recently had diarrhoea and 4.4% (95% CI 0.9% to 12.4%) in men with current diarrhoea (p=0.799). Shigella was more frequently found in MSM who had used pre-exposure prophylaxis (PrEP) in the preceding 3 months (10/151), compared with those not having used PrEP (2/146) or being HIV positive (1/75) (p=0.038). Shigella was significantly more often detected among MSM compared with routinely obtained faecal samples being 11/770 (1.4%) (p=0.031). CONCLUSION Shigella infections are relatively common in both symptomatic and asymptomatic MSM. Future studies should focus on the risk of onward transmission via asymptomatic persons. Samenvatting Introductie Shigellose is een meldingsplichtige infectieziekte. Het kan zich presenteren als een ernstige bloederige diarree, maar is vaak asymptomatisch. Shigella kan seksueel overdraagbaar zijn. We hebben een onderzoek uitgevoerd onder symptomatische en asymptomatische mannen die seks hebben met mannen (MSM) om de prevalentie van Shigella, Salmonella en Campylobacter te bepalen. Methoden Van maart tot juni 2020 werden achtereenvolgens MSM van het Amsterdamse centrum voor seksuele gezondheid opgenomen. Vooraf gedefinieerde minimale aantallen van inclusie van respectievelijk 150, 100 en 50 waren bepaald voor MSM die geen diarree, diarree in de afgelopen maand of diarree op de dag van bezoek aan de kliniek meldden. Anale monsters werden getest op de aanwezigheid van Shigella, Salmonella en Campylobacter. In dezelfde periode werd de frequentie van deze bacteriën bepaald in routinematig geteste monsters aangevraagd door huisartsen of verpleeghuisartsen. Kenmerken van geïncludeerde MSM werden vergeleken tussen mannen met verschillende diarree anamnese, en de prevalentie van shigellose werd in elke groep geschat. Resultaten We includeerden 212 MSM zonder diarree, 109 MSM die onlangs diarree hadden en 68 MSM die diarree meldden op de dag van het bezoek aan de kliniek. Dertien (3,3%, 95% CI 1,7-5,6%) MSM waren geïnfecteerd met Shigella, geen enkele met Salmonella, en 7 (1,8%, 95% CI 0,7-3,7%) met Campylobacter. De prevalentie van Shigella was 2,8% (95%CI 1,0-6,1%) bij asymptomatische mannen, 3,7% (95%CI 1,0-9,1%) bij mannen die recent diarree hadden en 4,4% (95%CI 0,9-12,4%) bij mannen met huidige diarree (P=0,799). Shigella werd vaker gevonden bij MSM die in de voorgaande drie maanden (10/151) PrEP hadden gebruikt dan bij mensen die geen PrEP hadden gebruikt (2/146) of hiv-positief waren (1/75) (p=0,038). Shigella werd significant vaker gedetecteerd bij MSM in vergelijking met routinematig verkregen fecale monsters, namelijk 11/770 (1,4%) (p=0,031). Conclusie Shigella infecties komen relatief vaak voor bij zowel symptomatische als asymptomatische MSM. Toekomstige studies moeten zich richten op het risico van verdere overdracht via asymptomatische personen.
Collapse
Affiliation(s)
- Joyce F Braam
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Microbiology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Mariska Hoogeland
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Alje P van Dam
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Microbiology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| |
Collapse
|
13
|
Russotto Y, Micali C, Pellicanò GF, Nunnari G, Venanzi Rullo E. HIV and Mediterranean Zoonoses: A Review of the Literature. Infect Dis Rep 2022; 14:694-709. [PMID: 36136825 PMCID: PMC9498920 DOI: 10.3390/idr14050075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/21/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
A zoonosis is an infectious disease that has jumped from a non-human animal to humans. Some zoonoses are very common in the Mediterranean area and endemic in specific regions, so they represent an important problem for public health. Human Immunodeficiency Virus (HIV) is a virus that has originated as a zoonosis and is now diffused globally, with the most significant numbers of infected people among the infectious diseases. Since the introduction of antiretroviral therapy (ART), the history for people living with HIV (PLWH) has changed drastically, and many diseases are now no different in epidemiology and prognosis as they are in not-HIV-infected people. Still, the underlying inflammatory state that is correlated with HIV and other alterations related to the infection itself can be a risk factor when infected with other bacteria, parasites or viruses. We reviewed the literature for infection by the most common Mediterranean zoonoses, such as Campylobacter, Salmonella, Brucella, Rickettsia, Borrelia, Listeria and Echinococcus, and a possible correlation with HIV. We included Monkeypox, since the outbreak of cases is becoming a concern lately. We found that HIV may be related with alterations of the microbiome, as for campylobacteriosis, and that there are some zoonoses with a significant prevalence in PLWH, as for salmonellosis.
Collapse
Affiliation(s)
- Ylenia Russotto
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Cristina Micali
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
- Correspondence: ; Tel.: +39-09-0221-2032
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age “G. Barresi”, University of Messina, 98124 Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| |
Collapse
|
14
|
Verma A, Hine AM, Joelson A, Mei R, Pitts RA, Lebwohl B, Axelrad JE. The influence of hospitalization and HIV severity on gastrointestinal PCR panel evaluation of HIV-related acute diarrhea in New York City: a retrospective, cross-sectional study. Therap Adv Gastroenterol 2022; 15:17562848221092593. [PMID: 35509422 PMCID: PMC9058368 DOI: 10.1177/17562848221092593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Diarrhea is common in persons living with HIV (PLWH)/AIDS. With the increasing utilization of multiplex gastrointestinal PCR panel (GI panel) testing, we aimed to characterize the roles of CD4 count and hospitalization in GI panel assessments of PLWH with acute diarrhea. METHODS We performed a cross-sectional study of adult PLWH with acute diarrhea who underwent GI panel testing at two urban academic centers. Demographic, HIV disease, GI panel result, and hospitalization data were collected, and patients were cohorted by CD4 count (CD4 < 200, CD4 200-499, CD4 > = 500). The primary outcome was enteric infection as detected by GI panel, and hospitalization. RESULTS Of 298 PLWH, 119 (39.9%) had a CD4 count below 200, 195 (65.4%) were hospitalized, and 137 (46.0%) had enteric infection. Bacterial infection correlated with higher CD4 count (41.9% (CD4 > = 500) vs 31.2% (CD4 200-499) vs 25.2% (CD4 < 200), p = 0.041). Hospitalization correlated with poorly controlled HIV and fewer enteric infections (34.4% vs 68.0%, p < 0.001). After adjusting for HIV disease severity, a negative GI panel remained independently associated with hospitalization (adjusted odds ratio (aOR) 5.32, 95% confidence interval (CI) 2.72-10.9), even in patients tested within 72 hours of hospitalization. Despite better HIV control, men who have sex with men (MSM) had more frequent infectious diarrhea, including from E. coli, giardiasis, and multiple pathogens. MSM status independently predicted enteric infection (aOR 1.93, 95% CI: 1.02-3.67). CONCLUSIONS GI panel results vary by HIV disease severity and hospitalization in PLWH. Clinicians - especially in the inpatient setting - should carefully consider these factors when interpreting GI panel results. Further characterization of diarrheal etiology in PLWH with a negative GI panel is needed. PLAIN LANGUAGE SUMMARY PCR stool test results are affected by certain factors in HIV-related diarrhea Diarrhea is common in people living with HIV (PLWH) and has a variety of causes, including infections, medications, and HIV itself. Multiplex polymerase chain reaction (PCR) stool testing simultaneously evaluates for a variety of common viral, bacterial, and parasitic infections of the gastrointestinal tract, and is increasingly being used in patients with diarrhea. However, patients with HIV and diarrheal illness may have uncommon infections not typically present in those with normal immune function - and thus not routinely evaluated for in stool testing. It is not known what factors, if any, might affect the results of PCR testing in HIV-related diarrhea.In this study, we examined all PLWH who underwent stool PCR testing for diarrhea over a 4-year period. We separated the patients into groups based on HIV disease severity as measured by CD4 T-cell count, or the count of the immune cells affected by HIV. We examined whether there were differences among groups in infection rates as detected by PCR stool testing. Separately, we studied the role of hospitalization in stool PCR test results.Of 298 PLWH who underwent stool PCR testing for diarrhea, 119 had a CD4 count less than 200 (low CD4 count), 195 were hospitalized at time of testing, and 137 had a positive stool PCR test. Compared to those with a low CD4 count, subjects with less severe HIV disease were more likely to have a bacterial infection on stool PCR testing and less likely to be hospitalized. Hospitalized patients were more likely to have a negative PCR stool test, regardless of CD4 count. Many patients with a low CD4 count had diarrheal etiologies not evaluated by multiplex stool PCR. In PLWH who experience diarrhea, stool PCR testing results vary by CD4 count and hospitalization. Providers should be mindful of these factors when interpreting stool PCR test results.
Collapse
Affiliation(s)
- Abhishek Verma
- Department of Medicine, NYU Grossman School of Medicine, New York, NY USA
| | - Ashley M. Hine
- University of Connecticut School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Andrew Joelson
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Rena Mei
- Department of Medicine, NewYork-Presbyterian and Columbia University Irving Medical Center, New York, NY, USA
| | - Robert A. Pitts
- Division of Infectious Diseases, NYU Langone Health, New York, NY, USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | |
Collapse
|
15
|
Krumrie S, Capewell P, Smith-Palmer A, Mellor D, Weir W, Alexander CL. A scoping review of risk factors and transmission routes associated with human giardiasis outbreaks in high-income settings. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100084. [PMID: 36589877 PMCID: PMC9795371 DOI: 10.1016/j.crpvbd.2022.100084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/04/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023]
Abstract
The flagellated pathogen Giardia duodenalis is one of the leading causes of parasitic gastrointestinal illness worldwide. In many higher income countries, such as the United Kingdom, the disease is often perceived as being travel-related, likely leading to the under-reporting of sporadic cases and outbreaks. A summary of the literature describing outbreaks and risk factors in higher income countries is necessary to improve our understanding of this pathogen and identify existing knowledge gaps. Initial literature searches were carried out in September 2016 and updated at regular intervals until November 2021, using appropriate search terms in Medline, Embase and PubMed databases. A total of 75 papers met the inclusion criteria, revealing that the consumption of contaminated water and contact with young children of diaper-wearing age were the most common transmission routes leading to outbreaks of giardiasis. Of the ten studies where food was primarily associated with outbreaks, food handlers accounted for eight of these. Another reported transmission route was direct contact with fecal material, which was reported in six studies as the primary transmission route. Travel-associated giardiasis was considered the sole transmission route in two studies, whereas multiple transmission routes contributed to giardiasis outbreaks in eleven studies. The evidence around zoonotic transmission was less clear and hampered by the lack of robust and regularly applied parasite molecular typing techniques. This literature review summarizes the findings of Giardia outbreak investigations and epidemiological studies in high-income countries. Transmission routes are identified and discussed to highlight the associated risk factors. These data also indicate gaps in our current knowledge that include the need for robust, in-depth molecular studies and have underscored the importance of water as a transmission route for Giardia cysts. These future molecular studies will improve our understanding of Giardia epidemiology and transmission pathways in higher income countries to prevent spread of this significantly under-reported pathogen.
Collapse
Affiliation(s)
- Sarah Krumrie
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
- Corresponding author. University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK.
| | - Paul Capewell
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
- BioClavis Ltd, Queen Elizabeth Teaching and Learning Centre, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Alison Smith-Palmer
- Gastrointestinal and Zoonoses Team, Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Dominic Mellor
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
- Gastrointestinal and Zoonoses Team, Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Willie Weir
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Claire L. Alexander
- Scottish Microbiology Reference Laboratories, New Lister Building, 10-16 Alexandria Parade, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| |
Collapse
|
16
|
Purpura L, Zucker J, LaSota E, Lopez M, Spicehandler R, Carnevale C, Perez E, Richards P, Chang J, Cohall A, Uhlemann AC, Whittier S, Sobieszczyk ME, Green DA. Prevalence of Gastrointestinal Pathogens Detected by Multiplex Polymerase Chain Reaction in a Prospective Cohort of Men Who Have Sex With Men Taking Human Immunodeficiency Virus Preexposure Prophylaxis-New York City, 2019-2020. Open Forum Infect Dis 2021; 8:ofab411. [PMID: 34430675 PMCID: PMC8379716 DOI: 10.1093/ofid/ofab411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Multiplex polymerase chain reaction testing for gastrointestinal pathogens was performed on a longitudinal cohort of 110 men who have sex with men taking human immunodeficiency virus preexposure prophylaxis. At least 1 pathogen was detected among 50 (45%) participants, with some participants testing positive for the same pathogen on multiple consecutive visits over a period of months.
Collapse
Affiliation(s)
- Lawrence Purpura
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.,ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elijah LaSota
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Mabel Lopez
- Clinical Microbiology, Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca Spicehandler
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Edward Perez
- New York Presbyterian-Columbia Hospital, New York, New York, USA
| | - Paul Richards
- New York Presbyterian-Columbia Hospital, New York, New York, USA
| | - Jennifer Chang
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Al Cohall
- New York Presbyterian-Columbia Hospital, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Whittier
- Clinical Microbiology, Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel A Green
- Clinical Microbiology, Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
17
|
Kuhn KG, Hvass AK, Christiansen AH, Ethelberg S, Cowan SA. Sexual Contact as Risk Factor for Campylobacter Infection, Denmark. Emerg Infect Dis 2021; 27:1133-1140. [PMID: 33754996 PMCID: PMC8007285 DOI: 10.3201/eid2704.202337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Campylobacteriosis is a disease of worldwide importance, but aspects of its transmission dynamics, particularly risk factors, are still poorly understood. We used data from a matched case-control study of 4,269 men who have sex with men (MSM) and 26,215 controls, combined with national surveillance data on Campylobacter spp., Salmonella spp., and Shigella spp., to calculate matched odds ratios (mORs) for infection among MSM and controls. MSM had higher odds of Campylobacter (mOR 14, 95% CI 10–21) and Shigella (mOR 74, 95% CI 27–203) infections, but not Salmonella (mOR 0.2, 95% CI 0–13), and were less likely than controls to have acquired Campylobacter infection abroad (χ2 = 21; p<0.001). Our results confirm that sexual contact is a risk factor for campylobacteriosis and also suggest explanations for unique features of Campylobacter epidemiology. These findings provide a baseline for updating infection risk guidelines to the general population.
Collapse
|
18
|
Shehi E, Ghazanfar H, Fortuzi K, Shaikh D, Dev A. An Unusual Case of Polymicrobial Bacteremia From Methicillin-Resistant Staphylococcus Aureus and Shigella. Cureus 2020; 12:e12011. [PMID: 33457119 PMCID: PMC7797462 DOI: 10.7759/cureus.12011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bloodstream infections (BSIs) are a significant cause of morbidity and mortality worldwide. Patients with polymicrobial BSI have a two-fold risk of hospital mortality as compared with patients with monomicrobial BSI. We present a case of a 53-year-old African American male with a medical history significant for hyperlipidemia, coronary artery disease, hypertension, anxiety, depression, and human immunodeficiency virus non-adherent to antiretroviral therapy who presented to the hospital with complaints of shoulder pain and diarrhea. The physical exam was significant for multiple skin abscesses, the largest being 5x6 cm. Blood culture grew Shigella and methicillin-resistant Staphylococcus aureus (MRSA), stool culture grew Shigella, and wound culture after incision and drainage grew MRSA. Transthoracic echocardiogram showed no vegetations. He was treated with vancomycin and ceftriaxone. The patient's clinical condition improved, and diarrhea resolved. Patient repeat cultures showed no growth. As polymicrobial bacteremia is associated with higher morbidity and mortality, early initiation of antibiotics and appropriate antibiotic therapy are pivotal.
Collapse
Affiliation(s)
- Elona Shehi
- Medicine/Gastroenterology, BronxCare Health System, Bronx, USA
| | | | - Ked Fortuzi
- Internal Medicine, BronxCare Hospital, Bronx, USA
| | - Danial Shaikh
- Medicine/Gastroenterology, BronxCare Health System, Bronx, USA.,Internal Medicine, BronxCare Health System, Bronx, USA
| | - Anil Dev
- Gastroenterology, BronxCare Health System, Bronx, USA
| |
Collapse
|
19
|
Abdelmaksoud A, Vestita M, Goldust M. Sexually transmitted COVID-19. Dermatol Ther 2020; 33:e13982. [PMID: 32638489 PMCID: PMC7361805 DOI: 10.1111/dth.13982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Ayman Abdelmaksoud
- Department of Dermatology, Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
| | - Michelangelo Vestita
- Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamad Goldust
- Department of Dermatology, University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
20
|
Affiliation(s)
- Deborah A Williamson
- From the Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, and the Department of Microbiology, Royal Melbourne Hospital (D.A.W.), and Melbourne Sexual Health Centre, Alfred Health, and Central Clinical School, Monash University (M.Y.C.) - all in Melbourne, VIC, Australia
| | - Marcus Y Chen
- From the Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, and the Department of Microbiology, Royal Melbourne Hospital (D.A.W.), and Melbourne Sexual Health Centre, Alfred Health, and Central Clinical School, Monash University (M.Y.C.) - all in Melbourne, VIC, Australia
| |
Collapse
|