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Miti S, Chilyabanyama ON, Chisenga CC, Chibuye M, Bosomprah S, Mumba C, Chitondo S, Siziya S, Cohen D, Chilengi R, Simuyandi M. Sensitivity and predictive value of dysentery in diagnosing shigellosis among under five children in Zambia. PLoS One 2023; 18:e0279012. [PMID: 36827347 PMCID: PMC9955635 DOI: 10.1371/journal.pone.0279012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/28/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Shigella is a leading cause of bacterial diarrhea morbidity and mortality affecting mainly children under five in the developing world. In Zambia, Shigella has a high prevalence of 34.7% in children with diarrhea and an attributable fraction of 6.7% in Zambian children with moderate to severe diarrhea. Zambian diarrhea management guidelines and the health ministry reporting tool Health Management Information System (HMIS) heavily rely on the WHO clinical classification of dysentery to potentially identify and estimate the burden of Shigella in children. This reliance on clinical dysentery as a proxy to shigellosis in under five children may be resulting in gross under-estimation of shigella disease burden in Zambia. METHODS We used existing laboratory and clinical data to examine the sensitivity and predictive value of dysentery to correctly identify Shigella infection in under five children with PCR confirmed Shigella infection in Lusaka and Ndola districts, Zambia. RESULTS Clinical dysentery had a sensitivity of 8.5% (34/401) in identifying under five children with Shigella by stool PCR. Dysentery was able to correctly classify Shigella in 34 of 68 bloody stool samples giving a corresponding positive predictive value of 50%. Of the 1087 with non-bloody diarrhea, 720 did not have Shigella giving a negative predictive value of 66.2%. CONCLUSIONS Use of clinical dysentery as a screening symptom for Shigella infection in children under five presenting with moderate to severe diarrhea has low sensitivity and low positive predictive value respectively. Clinical dysentery as a screening symptom for Shigella contributes to gross under diagnosis and reporting of Shigella infection among under five children in Zambia. Further research is required to better inform practice on more accurate methods or tools to use in support of routine diagnosis, particularly in low middle-income settings where laboratory diagnosis remains a challenge.
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Affiliation(s)
- Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia,Center for Infectious Disease Research in Zambia, Lusaka, Zambia,School of Medicine, Copperbelt University, Ndola, Zambia,Tropical Diseases Research Center, Ndola, Zambia,* E-mail:
| | | | | | - Mwelwa Chibuye
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Samuel Bosomprah
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia,Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Seter Siziya
- School of Medicine, Copperbelt University, Ndola, Zambia
| | - Dani Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
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Nipa NJ, Aktar N, Hira HM, Akter F, Jahan D, Islam S, Etando A, Abdullah A, Chowdhury K, Ahmad R, Haq A, Haque M. Intestinal Parasitic Infections Among Pediatric Patients in a Metropolitan City of Bangladesh With Emphasis on Cryptosporidiosis. Cureus 2022; 14:e26927. [PMID: 35865179 PMCID: PMC9293268 DOI: 10.7759/cureus.26927] [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] [Accepted: 07/16/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Gastrointestinal parasitic infections are one of the global health concerns in developing countries like Bangladesh. Among them, Cryptosporidium spp. plays an essential role in causing diarrhea, malnutrition, and poor cognitive function, especially in children. This study was conducted to identify the frequency of Cryptosporidium cases and other parasitic agents. Methods A cross-sectional observational study was conducted among 219 hospitalized children with diarrhea. The conventional microscopic technique was applied for parasitic detection. Particular staining (modified Ziehl-Neelsen) procedure was performed to identify oocysts of Cryptosporidium spp. A polymerase chain reaction (PCR) was performed to determine the SSU rRNA and gp60 gene of Cryptosporidium. Results Cysts of Giardia duodenalis (2.3%), ova of Ascaris lumbricoides (1.4%,), Trichuris trichiura (0.5%), and both A. lumbricoides and T. trichiura (0.9%) were identified in samples through wet mount preparation. The distribution of Cryptosporidium spp. as detected by the staining method and nested PCR was 1.4% and 4.1%, respectively. Conclusion Factors independently associated with Cryptosporidium infection are unsafe water, lack of regular hand washing, and insufficiency of exclusive breastfeeding. This study reports, presumably for the first time, the detection of Cryptosporidium oocysts in Chattogram metropolitan city of Bangladesh.
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Affiliation(s)
| | - Nasima Aktar
- Microbiology, Chittagong Medical College, Chattogram, BGD
| | - Hasina M Hira
- Community Medicine, Chittagong Medical College, Chattogram, BGD
| | - Farhana Akter
- Endocrinology and Diabetes, Chittagong Medical College, Chattogram, BGD
| | | | | | - Ayukafangha Etando
- Medical Laboratory Sciences, Faculty of Health Sciences, Eswatini Medical Christian University, Mbabane, SWZ
| | - Adnan Abdullah
- Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Kona Chowdhury
- Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Savar, BGD
| | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Ahsanul Haq
- Statistics, Gonoshasthaya - RNA Biotech Limited, Savar, BGD
| | - Mainul Haque
- Pharmacology and Therapeutics, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
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Jarquin C, Morales O, McCracken JP, Lopez MR, Lopez B, Reyes L, Gómez GA, Bryan JP, Peruski LF, Pattabiraman V, Parsons MB. Burden of Diarrheagenic
Escherichia coli
in Santa Rosa, Guatemala in active health‐services surveillance during 2008‐2009 and 2014‐2015. Trop Med Int Health 2022; 27:408-417. [DOI: 10.1111/tmi.13735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claudia Jarquin
- Center for Health Studies Universidad del Valle de Guatemala Guatemala City Guatemala
| | - Oneida Morales
- Center for Health Studies Universidad del Valle de Guatemala Guatemala City Guatemala
| | - John P. McCracken
- Center for Health Studies Universidad del Valle de Guatemala Guatemala City Guatemala
| | - Maria R. Lopez
- Center for Health Studies Universidad del Valle de Guatemala Guatemala City Guatemala
| | - Beatriz Lopez
- US Centers for Disease Control and Prevention Central America Regional Office Center for Global Health Guatemala
| | - Lisette Reyes
- Guatemalan Ministry of Public Health and Social Welfare Guatemala
| | - Gerardo A. Gómez
- National Center for Emerging and Zoonotic Infectious Diseases US Centers for Disease Control and Prevention Atlanta USA
| | - Joe P. Bryan
- US Centers for Disease Control and Prevention Central America Regional Office Center for Global Health Guatemala
| | - Leonard F. Peruski
- US Centers for Disease Control and Prevention Central America Regional Office Center for Global Health Guatemala
| | - Vaishnavi Pattabiraman
- National Center for Emerging and Zoonotic Infectious Diseases US Centers for Disease Control and Prevention Atlanta USA
| | - Michele B. Parsons
- National Center for Emerging and Zoonotic Infectious Diseases US Centers for Disease Control and Prevention Atlanta USA
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Phiri AF, Abia ALK, Amoako DG, Mkakosya R, Sundsfjord A, Essack SY, Simonsen GS. Burden, Antibiotic Resistance, and Clonality of Shigella spp. Implicated in Community-Acquired Acute Diarrhoea in Lilongwe, Malawi. Trop Med Infect Dis 2021; 6:tropicalmed6020063. [PMID: 33925030 PMCID: PMC8167763 DOI: 10.3390/tropicalmed6020063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Although numerous studies have investigated diarrhoea aetiology in many sub-Saharan African countries, recent data on Shigella species’ involvement in community-acquired acute diarrhoea (CA-AD) in Malawi are scarce. This study investigated the incidence, antibiotic susceptibility profile, genotypic characteristics, and clonal relationships of Shigella flexneri among 243 patients presenting with acute diarrhoea at a District Hospital in Lilongwe, Malawi. Shigella spp. were isolated and identified using standard microbiological and serological methods and confirmed by identifying the ipaH gene using real-time polymerase chain reaction. The isolates’ antibiotic susceptibility to 20 antibiotics was determined using the VITEK 2 system according to EUCAST guidelines. Genes conferring resistance to sulfamethoxazole (sul1, sul2 and sul3), trimethoprim (dfrA1, dfrA12 and dfrA17) and ampicillin (oxa-1 and oxa-2), and virulence genes (ipaBCD, sat, ial, virA, sen, set1A and set1B) were detected by real-time PCR. Clonal relatedness was assessed using ERIC-PCR. Thirty-four Shigella flexneri isolates were isolated (an overall incidence of 14.0%). All the isolates were fully resistant to sulfamethoxazole/trimethoprim (100%) and ampicillin (100%) but susceptible to the other antibiotics tested. The sul1 (79%), sul2 (79%), sul3 (47%), dfrA12 (71%) and dfrA17 (56%) sulfonamide and trimethoprim resistance genes were identified; Oxa-1, oxa-2 and dfrA1 were not detected. The virulence genes ipaBCD (85%), sat (85%), ial (82%), virA (76%), sen (71%), stx (71%), set1A (26%) and set1B (18%) were detected. ERIC-PCR profiling revealed that the Shigella isolates were genetically distinct and clonally unrelated, indicating the potential involvement of genetically distinct S. flexneri in CA-AD in Malawi. The high percentage resistance to ampicillin and sulfamethoxazole/trimethoprim and the presence of several virulence determinants in these isolates emphasises a need for continuous molecular surveillance studies to inform preventive measures and management of Shigella-associated diarrhoeal infections in Malawi.
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Affiliation(s)
- Abel F.N.D. Phiri
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (A.F.N.D.P.); (D.G.A.); (S.Y.E.)
- National Microbiology Reference Laboratory, Ministry of Health, Lilongwe 3, Malawi
| | - Akebe Luther King Abia
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (A.F.N.D.P.); (D.G.A.); (S.Y.E.)
- Correspondence:
| | - Daniel Gyamfi Amoako
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (A.F.N.D.P.); (D.G.A.); (S.Y.E.)
| | - Rajab Mkakosya
- Department of Pathology, College of Medicine, University of Malawi, Blantyre 3, Malawi;
| | - Arnfinn Sundsfjord
- Department of Microbiology and Infection Control, University Hospital of North Norway, 9038 Tromsø, Norway; (A.S.); (G.S.S.)
- Faculty of Health Sciences, UiT—The Arctic University of Norway, N-9037 Tromsø, Norway
| | - Sabiha Y. Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (A.F.N.D.P.); (D.G.A.); (S.Y.E.)
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, 9038 Tromsø, Norway; (A.S.); (G.S.S.)
- Faculty of Health Sciences, UiT—The Arctic University of Norway, N-9037 Tromsø, Norway
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