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Muzembo BA, Kitahara K, Mitra D, Ohno A, Khatiwada J, Dutta S, Miyoshi SI. Shigellosis in Southeast Asia: A systematic review and meta-analysis. Travel Med Infect Dis 2023; 52:102554. [PMID: 36792021 DOI: 10.1016/j.tmaid.2023.102554] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Southeast Asia is attractive for tourism. Unfortunately, travelers to this region are at risk of becoming infected with Shigella. We conducted a meta-analysis to provide updates on Shigella prevalence in Southeast Asia, along with their serogroups and serotypes. METHODS We conducted a systematic search using PubMed, EMBASE, and Web of Science for peer-reviewed studies from 2000 to November 2022. We selected studies that detected Shigella in stools by culture or polymerase chain reaction (PCR). Two reviewers extracted the data using a standardized form and performed quality assessments using the Joanna Briggs Institute checklist. The random effects model was used to estimate the pooled prevalence of Shigella. RESULTS During our search, we identified 4376 studies. 29 studies (from six Southeast Asian countries) were included in the systematic review, 21 each in the meta-analysis of the prevalence of Shigella (Sample size: 109545) and the prevalence of Shigella serogroups. The pooled prevalence of Shigella was 4% (95% CI: 4-5%) among diarrhea cases. Shigella sonnei was the most abundant serogroup in Thailand (74%) and Vietnam (57%), whereas Shigella flexneri was dominant in Indonesia (72%) and Cambodia (71%). Shigella dysenteriae and Shigella boydii were uncommon (pooled prevalence of 1% each). The pooled prevalence of Shigella was 5% (95% CI: 4-6%) in children aged <5 years. The pooled prevalence showed a decreasing trend comparing data collected between 2000-2013 (5%; 95% CI: 4-6%) and between 2014-2022 (3%; 95% CI: 2-4%). Shigella prevalence was 6% in studies that included participants with mixed pathogens versus 3% in those without. Shigella flexneri serotype 2a was the most frequently isolated (33%), followed by 3a (21%), 1b (10%), 2b (3%), and 6 (3%). CONCLUSIONS This study provides compelling evidence for the development of effective Shigella vaccines for residents of endemic regions and travellers to these areas.
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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 in India at ICMR-NICED, Kolkata, India
| | - Debmalya Mitra
- Collaborative Research Centre of Okayama University for Infectious Diseases in India 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 in India 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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Antibiotic resistance and drug modification: Synthesis, characterization and bioactivity of newly modified potent ciprofloxacin derivatives. Bioorg Chem 2021; 108:104658. [PMID: 33517003 DOI: 10.1016/j.bioorg.2021.104658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/23/2022]
Abstract
Development of new derivatives of commercial antibiotics using different organic reagents and testing these derivatives against different microorganisms are the main goals of this article. Thus, the antibiotic ciprofloxacin, CF, was acylated via reaction with ethyl cyanoacetate and ethyl acetoacetate in basic medium to give the cyanoacetylpiprazinyl dihydroquinoline derivative 3, and oxobutanoylpiprazinyl dihydroquinoline derivative 5, respectively. On the other hand, N-alkylated derivatives 8-10, were prepared through the reaction of CF with chloroacetonitrile, chloroacetyl acetone and chloroacetone in the presence of carbonate salt. In basic medium, both 3 and 10 were coupled with benzenediazonium chloride to afford hydrazono derivatives, which were then cyclized to give 4-(dihydropyridazinecarbonyl)piperazinyl-1,4-dihydroquinoline. Furthermore, compounds 3 and 10 were reacted with benylidenemalononitrile to produce 4H-pyan and pyrido[1,2-a]pyrazine derivatives, respectively. Both 3 and 10 were reacted with DMFDMA to give enaminone derivatives. These enaminones were cyclized to aminopyrimidine derivatives by reacting with urea or thiourea. X-ray, elemental analysis and spectral data were used to illustrate and confirm the structures of the isolated compounds. The bioactivities of the novel compounds were investigated against different gram-positive and gram-negative bacteria. In addition, these novel antibiotic derivatives were tested against ciprofloxacin-resistant bacteria isolated from patients aged 65-74 years. This study reveals that most of the modified drugs show high to moderate antibacterial activity. Additionally, these drugs show good effects against ciprofloxacin-resistant bacteria.
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3
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Shigella sonnei: virulence and antibiotic resistance. Arch Microbiol 2020; 203:45-58. [PMID: 32929595 PMCID: PMC7489455 DOI: 10.1007/s00203-020-02034-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022]
Abstract
Shigella sonnei is the emerging pathogen globally, as it is the second common infectious species of shigellosis (bloody diarrhoea) in low- and middle-income countries (LMICs) and the leading one in developed world. The multifactorial processes and novel mechanisms have been identified in S. sonnei, that are collectively playing apart a substantial role in increasing its prevalence, while replacing the S. flexneri and other Gram-negative gut pathogens niche occupancy. Recently, studies suggest that due to improvement in sanitation S. sonnei has reduced cross-immunization from Plesiomonas shigelliodes (having same O-antigen as S. sonnei) and also found to outcompete the two major species of Enterobacteriaceae family (Shigella flexneri and Escherichia coli), due to encoding of type VI secretion system (T6SS). This review aimed to highlight S. sonnei as an emerging pathogen in the light of recent research with pondering aspects on its epidemiology, transmission, and pathogenic mechanisms. Additionally, this paper aimed to review S. sonnei disease pattern and related complications, symptoms, and laboratory diagnostic techniques. Furthermore, the available treatment reigns and antibiotic-resistance patterns of S. sonnei are also discussed, as the ciprofloxacin and fluoroquinolone-resistant S. sonnei has already intensified the global spread and burden of antimicrobial resistance. In last, prevention and controlling strategies are briefed to limit and tackle S. sonnei and possible future areas are also explored that needed more research to unravel the hidden mysteries surrounding S. sonnei.
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da Cruz Gouveia MA, Lins MTC, da Silva GAP. Acute diarrhea with blood: diagnosis and drug treatment. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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da Cruz Gouveia MA, Lins MTC, da Silva GAP. Acute diarrhea with blood: diagnosis and drug treatment. J Pediatr (Rio J) 2020; 96 Suppl 1:20-28. [PMID: 31604059 PMCID: PMC9432323 DOI: 10.1016/j.jped.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy. SOURCES OF DATA A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review. SYNTHESIS OF DATA Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines. CONCLUSIONS Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.
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Affiliation(s)
- Mara Alves da Cruz Gouveia
- Universidade Federal de Pernambuco (UFPE), Saúde da Criança e do Adolescente, Recife, PE, Brazil; Universidade Federal de Pernambuco (UFPE), Centro de Ciências Médicas, Pediatria, Recife, PE, Brazil
| | - Manuela Torres Camara Lins
- Universidade Federal de Pernambuco (UFPE), Saúde da Criança e do Adolescente, Recife, PE, Brazil; Universidade Federal de Pernambuco (UFPE), Centro de Ciências Médicas, Pediatria, Recife, PE, Brazil
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Commensal Escherichia coli are a reservoir for the transfer of XDR plasmids into epidemic fluoroquinolone-resistant Shigella sonnei. Nat Microbiol 2020; 5:256-264. [PMID: 31959970 PMCID: PMC6992430 DOI: 10.1038/s41564-019-0645-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
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Moed S, Hall M, Lee N, Prazeres da Costa C, Rødland EK, Shemirani AI, Clifford K, Desai D, Zaman MH. Quantitative assay for ciprofloxacin and enrofloxacin formulations. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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8
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Williams PCM, Berkley JA. Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence. Paediatr Int Child Health 2018; 38:S50-S65. [PMID: 29790845 PMCID: PMC6021764 DOI: 10.1080/20469047.2017.1409454] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Shigella remains the primary cause of diarrhoea in paediatric patients worldwide and accounts for up to 40,000 deaths per year. Current guidelines for the treatment of shigellosis are based on data which are over a decade old. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for shigellosis in children is necessary, taking into account susceptibility patterns, cost and the risk of adverse events. METHODS A systematic review of the current published literature on the treatment of shigella dysentery was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS The initial search produced 131 results, of which nine studies met the inclusion criteria. The quality of the studies was assessed as per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. International guidelines were also reviewed. There is a lack of current research regarding the clinical treatment of shigellosis in paediatric and adult patients, despite rising antimicrobial resistance worldwide. In particular, there is a lack of studies assessing the non-susceptibility of community-acquired strains, with almost all published research pertaining to microbiological data from hospital-based settings. DISCUSSION Current WHO guidelines support the use of fluoroquinolones (first-line), β-lactams (second-line) and cephalosporins (second-line) which accords with currently available evidence and other international guidelines, and there is no strong evidence for changing this guidance. Azithromycin is appropriate as a second-line therapy in regions where the rate of non-susceptibility of ciprofloxacin is known to be high, and research suggests that, from a cardiac point of view, azithromycin is safer than other macrolide antibiotics. Cefixime is also a reasonable alternative, although its use must be weighed against the risk of dissemination of extended-spectrum β-lactamase-producing organisms.
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Affiliation(s)
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford, UK
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9
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Xue C, Cai J, Kang H, Chen Y, Wang K, Qian H, Bao C, Li N, Guo Z, Zhang Z, Wang J, Ma P, Gu B. Two novel mutations in parE among Shigella flexneri isolated from Jiangsu Province of China, 2016. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:306. [PMID: 30211194 DOI: 10.21037/atm.2018.07.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background The study was conducted to assess the resistance capacity of quinolone against Shigella flexneri, and to investigate the involved quinolone resistance mechanism. The data were collected from Jiangsu Province, China in 2016. Methods The number of 81 S. flexneri was obtained from 12 cities in Jiangsu Province of China during 2016. Slide agglutination was taken for serotyping, and susceptibility test was identified by the disc diffusion method. PCR aimed to amplify the quinolone resistance-determining region (QRDR) genes and screen for plasmid-mediated quinolone resistance (PMQR) determinants. Chromosomal mutation was confirmed by sequencing and Blast comparison. Results 2a was the commonest serotype, accounting for 40.7% (33/81) of the 81 S. flexneri. 70.4% (57/81) isolates expressed resistance against nalidixic acid, and the resistance against ciprofloxacin even reached up to a high proportion of 58.0% (47/81). A total of 8 point mutations were identified, including 2 novel mutations discovered in parE (Ser458Leu and Gly408Asp). The common mutation Ser83Leu in gyrA was still the most prevalent here with a percentage of 70.4% (57/81), followed by the approximate mutation of 69.1% (56/81) in parC (Ser80Ile) and His211Tyr in gyrA. Meanwhile, 35.8% (29/81) isolates were confirmed with mutation of Gln517Arg in gyrB. In addition, qnrS positive isolates occupied a proportion of 7.4% (6/81), but only 1 strain was observed with aac(6')-Ib-cr. All PMQR positive isolates were resistant to nalidixic acid. However, 5 of them didn't stay susceptible to ciprofloxacin any more. Conclusions This is the first time that a study researches the occurrence of mutations in parE among S. flexneri, Ser458Leu and Gly408Asp included. The study indicates that the high resistance to fluoroquinolone remains a serious problem in Jiangsu, China. Thus, the prevention and control of current infection urge for a comprehensive and systematic surveillance based on persistent surveys.
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Affiliation(s)
- Cun Xue
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China
| | - Jinchi Cai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Haiquan Kang
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Ying Chen
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China
| | - Kaixuan Wang
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China
| | - Huimin Qian
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Changjun Bao
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Na Li
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China
| | - Zhen Guo
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China
| | - Zheng Zhang
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China
| | - Jing Wang
- School of Foreign Languages, Shaanxi Normal University, Xi'an 710062, China
| | - Ping Ma
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China.,Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Bing Gu
- Medical Technology School, Xuzhou Medical University, Xuzhou 221004, China.,Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
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Sadouki Z, Day MR, Doumith M, Chattaway MA, Dallman TJ, Hopkins KL, Elson R, Woodford N, Godbole G, Jenkins C. Comparison of phenotypic and WGS-derived antimicrobial resistance profiles of Shigella sonnei isolated from cases of diarrhoeal disease in England and Wales, 2015. J Antimicrob Chemother 2018; 72:2496-2502. [PMID: 28591819 DOI: 10.1093/jac/dkx170] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/02/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives Phenotypic and genotypic methods for the detection of antimicrobial resistance (AMR) in Shigella sonnei in England and Wales were compared and evaluated. Methods WGS data from 341 isolates of S. sonnei isolated between June 2015 and January 2016 were mapped to genes known to be associated with phenotypic AMR. Antimicrobial susceptibility testing was performed on all viable isolates (n = 335). Results Fifteen of 335 isolates had a discrepancy between phenotypic and genotypic testing for 1 of the 10 antimicrobial classes tested, equating to 15 (0.45%) discordant results out of a possible 3350 isolate/antimicrobial combinations. All 15 mismatched results were genotypically resistant but phenotypically susceptible. Eleven of the 15 discrepancies were observed in streptomycin resistance profiles. The most common resistance profile was trimethoprim, sulphonamides, tetracyclines and streptomycin, occurring in 97 (28.4%) isolates. Resistances to ciprofloxacin and the third-generation cephalosporins, not detected in England and Wales prior to 2002, were identified in 18.2% and 12% of isolates, respectively. Three hundred and four (89.1%) isolates were MDR. There was no significant association between any of the AMR determinants tested and recent foreign travel in male or female cases. The number of isolates of S. sonnei harbouring blaTEM-1 and ermB/mphA was significantly higher in men who reported no recent travel outside the UK. Conclusions The use of WGS for routine public health surveillance is a reliable method for rapid detection of emerging AMR in isolates of S. sonnei.
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Affiliation(s)
- Zahra Sadouki
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.,Division of Infection & Immunity, University College London, Gower Street, London WC1E 6BT, UK
| | - Martin R Day
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Michel Doumith
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Marie A Chattaway
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Timothy J Dallman
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Katie L Hopkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Richard Elson
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Neil Woodford
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
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Chung The H, Baker S. Out of Asia: the independent rise and global spread of fluoroquinolone-resistant Shigella. Microb Genom 2018; 4. [PMID: 29595412 PMCID: PMC5989582 DOI: 10.1099/mgen.0.000171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Shigella are ranked among the most prevalent aetiologies of diarrhoeal disease worldwide, disproportionately affecting young children in developing countries and high-risk communities in developed settings. Antimicrobial treatment, most commonly with fluoroquinolones, is currently recommended for Shigella infections to alleviate symptoms and control disease transmission. Resistance to fluoroquinolones has emerged in differing Shigella species (S. dysenteriae, flexneri and sonnei) since the turn of the 21st century, originating in endemic areas, and latterly spreading into non-endemic regions. Despite occurring independently, the emergence of fluoroquinolone resistance in these different Shigella species shares striking similarities regarding their epidemiology and resistance mechanisms. Here, we review and discuss the current epidemiology of fluoroquinolone-resistant Shigella species, particularly in the light of recent genomic insights.
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Affiliation(s)
- Hao Chung The
- Enteric Infections, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- Enteric Infections, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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12
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Nüesch-Inderbinen M, Heini N, Zurfluh K, Althaus D, Hächler H, Stephan R. Shigella Antimicrobial Drug Resistance Mechanisms, 2004-2014. Emerg Infect Dis 2018; 22:1083-5. [PMID: 27191035 PMCID: PMC4880098 DOI: 10.3201/eid2206.152088] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
To determine antimicrobial drug resistance mechanisms of Shigella spp., we analyzed 344 isolates collected in Switzerland during 2004–2014. Overall, 78.5% of isolates were multidrug resistant; 10.5% were ciprofloxacin resistant; and 2% harbored mph(A), a plasmid-mediated gene that confers reduced susceptibility to azithromycin, a last-resort antimicrobial agent for shigellosis.
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Anandan S, Muthuirulandi Sethuvel DP, Gajendiren R, Verghese VP, Walia K, Veeraraghavan B. Molecular characterization of antimicrobial resistance in clinical Shigella isolates during 2014 and 2015: trends in South India. Germs 2017; 7:115-122. [PMID: 28932711 DOI: 10.18683/germs.2017.1116] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/27/2017] [Accepted: 05/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shigella species are an important cause of acute diarrheal disease worldwide. This study describes the prevalence of Shigella spp. serotypes and their resistance profile in Vellore, South India from 2014 to 2015. METHODS From 2014 to 2015, 338 Shigella strains were isolated from stool samples at Christian Medical College, Vellore, India. Identification and serotyping was carried out using standard protocols. Antimicrobial susceptibility testing was done against commonly used antibiotics. Multidrug resistance was detected in 157 isolates. A subset of 73 isolates was randomly characterized further for acquired antimicrobial resistance genes in this study. RESULTS The resistance profile of the study isolates varied by species and year. S. sonnei isolates were 100% resistant to all tested antibiotics in 2014, whereas in 2015, resistance was found for AMP-NAL-TAX-SXT-FIX. The resistance phenotypes among S. flexneri isolates for the year 2014 and 2015 were AMP-SXT-NAL-NOR-FIX-TAX and AMP-NAL-SXT-TAX-NOR-FIX respectively. Screening for antimicrobial resistance genes in S. flexneri found dhfr1A, sulII, blaOXA, blaTEM, blaCTX-M-1,qnrB, qnrS and AmpC genes while S. sonnei were found to have only dhfr1A, sulII, blaCTX-M-1 and qnrS genes respectively. Antimicrobial resistance genes were predominantly seen in AMP-SXT-NAL and AMP-SXT-NAL-NOR resistance phenotypes. CONCLUSION Shigella prevalence of 4.8% to 4.6% was documented between the years 2014 to 2015 in this study. We show evidence that resistance to commonly used antibiotics continues to increase among Shigella spp. in South India. The presence of qnrS and blaCTX-M-15 in the study isolates further indicates the threat of spreading resistance to quinolones and third-generation cephalosporins.
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Affiliation(s)
- Shalini Anandan
- MD, Department of Clinical Microbiology, Asha building, Christian Medical College, Ida scudder road, Vellore, 632004, India
| | | | - Revathi Gajendiren
- MSc, Department of Clinical Microbiology, Asha building, Christian Medical College, Ida scudder road, Vellore, 632004, India
| | - Valsan Philip Verghese
- MD, Department of Child Health, ISSCC building, Christian Medical College, Ida scudder road, Vellore, 632004, India
| | - Kamini Walia
- PhD, Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Balaji Veeraraghavan
- PhD, Department of Clinical Microbiology, Asha building, Christian Medical College, Ida scudder road, Vellore, 632004, India
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14
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Sharma D, Patel RP, Zaidi STR, Sarker MMR, Lean QY, Ming LC. Interplay of the Quality of Ciprofloxacin and Antibiotic Resistance in Developing Countries. Front Pharmacol 2017; 8:546. [PMID: 28871228 PMCID: PMC5566961 DOI: 10.3389/fphar.2017.00546] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/04/2017] [Indexed: 12/01/2022] Open
Abstract
Ciprofloxacin, a second generation broad spectrum fluoroquinolone, is active against both Gram-positive and Gram-negative bacteria. Ciprofloxacin has a high oral bioavailability and a large volume of distribution. It is used for the treatment of a wide range of infections including urinary tract infections caused by susceptible bacteria. However, the availability and use of substandard and spurious quality of oral ciprofloxacin formulations in the developing countries has been thought to have contributed toward increased risk of treatment failure and bacterial resistance. Therefore, quality control and bioequivalence studies of the commercially available oral ciprofloxacin formulations should be monitored. Appropriate actions should be taken against offending manufacturers in order to prevent the sale of substandard and spurious quality of ciprofloxacin formulations.
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Affiliation(s)
- Deepali Sharma
- Pharmacy, School of Medicine, University of Tasmania, HobartTAS, Australia
| | - Rahul P Patel
- Pharmacy, School of Medicine, University of Tasmania, HobartTAS, Australia
| | | | | | - Qi Ying Lean
- Vector borne Diseases Research Group, Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARAShah Alam, Malaysia.,Faculty of Pharmacy, Universiti Teknologi MARABertam, Malaysia
| | - Long C Ming
- Pharmacy, School of Medicine, University of Tasmania, HobartTAS, Australia.,School of Pharmacy, KPJ Healthcare University CollegeNegeri Sembilan, Malaysia
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Taylor DN, Hamer DH, Shlim DR. Medications for the prevention and treatment of travellers' diarrhea. J Travel Med 2017; 24:S17-S22. [PMID: 28520998 DOI: 10.1093/jtm/taw097] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/13/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND . Travellers' diarrhea (TD) remains one of the most common illnesses encountered by travellers to less developed areas of the world. Because bacterial pathogens such as enterotoxigenic Escherichia coli (ETEC), enteroaggregative E. coli , Campylobacter spp. and Shigella spp. are the most frequent causes, antibiotics have been useful in both prevention and treatment of TD. METHODS. Results of trials that assessed the use of medications for the prevention and treatment of TD were identified through PubMed and MEDLINE searches using search terms 'travellers' diarrhea', 'prevention' and 'treatment'. References of articles were also screened for additional relevant studies. RESULTS. Prevention of TD with antibiotics has been recommended only under special circumstances. Doxycycline, trimethoprim-sulfamethoxazole, fluoroquinolones and rifaximin have been used for prevention, but at present the first three antibiotics may have limited use secondary to increasing resistance, leaving rifaximin as the only current option. Bismuth subsalicylate (BSS) (Pepto-Bismol tablets) is also an option for prophylaxis. Treatment with antibiotics has been recommended for moderate to severe TD. Azithromycin is the drug of choice, especially in Asia where Campylobacter is common. Fluoroquinolone antibiotics continue to be effectively used in Latin America and Africa where ETEC is predominant. BSS and loperamide (LOP) also are effective as standalone treatments. LOP may be used alone for treatment of mild TD or in conjunction with antibiotics for treatment of TD. CONCLUSIONS . Historically, antibiotic prophylaxis has not been routinely recommended and has been reserved for special circumstances such as when a traveller with an underlying illness cannot tolerate TD. Antibiotics with or without LOP have been useful in shortening the duration and severity of TD. Emerging antibiotic resistance, limited new antibiotic alternatives and faecal carriage of antibiotic-resistant bacteria by travellers may prompt a re-evaluation of classic recommendations for treatment and prevention of TD with antibiotics.
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Affiliation(s)
- David N Taylor
- Vaccine Development Global Program, PATH, Seattle, WA, USA
| | - Davidson H Hamer
- Section of Infectious Diseases, Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David R Shlim
- Jackson Hole Travel and Tropical Medicine, Jackson Hole, WY, USA
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16
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Chung The H, Rabaa MA, Pham Thanh D, De Lappe N, Cormican M, Valcanis M, Howden BP, Wangchuk S, Bodhidatta L, Mason CJ, Nguyen Thi Nguyen T, Vu Thuy D, Thompson CN, Phu Huong Lan N, Voong Vinh P, Ha Thanh T, Turner P, Sar P, Thwaites G, Thomson NR, Holt KE, Baker S. South Asia as a Reservoir for the Global Spread of Ciprofloxacin-Resistant Shigella sonnei: A Cross-Sectional Study. PLoS Med 2016; 13:e1002055. [PMID: 27483136 PMCID: PMC4970813 DOI: 10.1371/journal.pmed.1002055] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a major issue in the Shigellae, particularly as a specific multidrug-resistant (MDR) lineage of Shigella sonnei (lineage III) is becoming globally dominant. Ciprofloxacin is a recommended treatment for Shigella infections. However, ciprofloxacin-resistant S. sonnei are being increasingly isolated in Asia and sporadically reported on other continents. We hypothesized that Asia is a primary hub for the recent international spread of ciprofloxacin-resistant S. sonnei. METHODS AND FINDINGS We performed whole-genome sequencing on a collection of 60 contemporaneous ciprofloxacin-resistant S. sonnei isolated in four countries within Asia (Vietnam, n = 11; Bhutan, n = 12; Thailand, n = 1; Cambodia, n = 1) and two outside of Asia (Australia, n = 19; Ireland, n = 16). We reconstructed the recent evolutionary history of these organisms and combined these data with their geographical location of isolation. Placing these sequences into a global phylogeny, we found that all ciprofloxacin-resistant S. sonnei formed a single clade within a Central Asian expansion of lineage III. Furthermore, our data show that resistance to ciprofloxacin within S. sonnei may be globally attributed to a single clonal emergence event, encompassing sequential gyrA-S83L, parC-S80I, and gyrA-D87G mutations. Geographical data predict that South Asia is the likely primary source of these organisms, which are being regularly exported across Asia and intercontinentally into Australia, the United States and Europe. Our analysis was limited by the number of S. sonnei sequences available from diverse geographical areas and time periods, and we cannot discount the potential existence of other unsampled reservoir populations of antimicrobial-resistant S. sonnei. CONCLUSIONS This study suggests that a single clone, which is widespread in South Asia, is likely driving the current intercontinental surge of ciprofloxacin-resistant S. sonnei and is capable of establishing endemic transmission in new locations. Despite being limited in geographical scope, our work has major implications for understanding the international transfer of antimicrobial-resistant pathogens, with S. sonnei acting as a tractable model for studying how antimicrobial-resistant Gram-negative bacteria spread globally.
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Affiliation(s)
- Hao Chung The
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Maia A. Rabaa
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Duy Pham Thanh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Niall De Lappe
- National Salmonella, Shigella, and Listeria monocytogenes Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Martin Cormican
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Ladaporn Bodhidatta
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Carl J. Mason
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - To Nguyen Thi Nguyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Duong Vu Thuy
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Corinne N. Thompson
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Nguyen Phu Huong Lan
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phat Voong Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuyen Ha Thanh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Poda Sar
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Guy Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Nicholas R. Thomson
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Kathryn E. Holt
- Centre for Systems Genomics, The University of Melbourne, Melbourne, Australia
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
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17
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Lääveri T, Sterne J, Rombo L, Kantele A. Systematic review of loperamide: No proof of antibiotics being superior to loperamide in treatment of mild/moderate travellers' diarrhoea. Travel Med Infect Dis 2016; 14:299-312. [PMID: 27363327 DOI: 10.1016/j.tmaid.2016.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 12/18/2022]
Abstract
Looking at the worldwide emergency of antimicrobial resistance, international travellers appear to have a central role in spreading the bacteria across the globe. Travellers' diarrhoea (TD) is the most common disease encountered by visitors to the (sub)tropics. Both TD and its treatment with antibiotics have proved significant independent risk factors of colonization by resistant intestinal bacteria while travelling. Travellers should therefore be given preventive advice regarding TD and cautioned about taking antibiotics: mild or moderate TD does not require antibiotics. Logical alternatives are medications with effects on gastrointestinal function, such as loperamide. The present review explores literature on loperamide in treating TD. Adhering to manufacturer's dosage recommendations, loperamide offers a safe and effective alternative for relieving mild and moderate symptoms. Moreover, loperamide taken singly does no predispose to contracting MDR bacteria. Most importantly, we found no proof that would show antibiotics to be significantly more effective than loperamide in treating mild/moderate TD.
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Affiliation(s)
- Tinja Lääveri
- Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, POB 348, FIN-00029 HUS, Finland.
| | - Jesper Sterne
- Centre for Clinical Research, Sörmland County Council, Eskilstuna and University of Uppsala, SE 631 88 Eskilstuna, Sweden.
| | - Lars Rombo
- Centre for Clinical Research, Sörmland County Council, Eskilstuna and University of Uppsala, SE 631 88 Eskilstuna, Sweden; Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, SE 17176 Stockholm, Sweden.
| | - Anu Kantele
- Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, POB 348, FIN-00029 HUS, Finland; Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, SE 17176 Stockholm, Sweden; Department of Medicine, University of Helsinki, Finland.
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18
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Anderson M, Sansonetti PJ, Marteyn BS. Shigella Diversity and Changing Landscape: Insights for the Twenty-First Century. Front Cell Infect Microbiol 2016; 6:45. [PMID: 27148494 PMCID: PMC4835486 DOI: 10.3389/fcimb.2016.00045] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/28/2016] [Indexed: 12/17/2022] Open
Abstract
Shigella is a pathovar of Escherichia coli comprising four groups, Shigella flexneri, Shigella sonnei, Shigella dysenteriae, and Shigella boydii, each of them, with the exception of S.sonnei, comprising several serotypes. Shigella accounts for the majority of dysentery causing infections occurring world-wide each year. Recent advancements in the Shigella field have led to a better understanding of the molecular mechanisms underlying host epithelial cell invasion and immune cell function manipulation, mainly using S. flexneri as a model. Host-cell invasion is the final step of the infection process, as Shigella's virulence strategy relies also on its ability to survive hostile conditions during its journey through the gastro-intestinal tract, to compete with the host microbiota and to cross the intestinal mucus layer. Hence, the diversity of the virulence strategies among the different Shigella species has not yet been deeply investigated, which might be an important step to understand the epidemiological spreading of Shigella species worldwide and a key aspect for the validation of novel vaccine candidates. The recent development of high-throughput screening and sequencing methods will facilitate these complex comparison studies. In this review we discuss several of the major avenues that the Shigella research field has taken over the past few years and hopefully gain some insights into the questions that remain surrounding this important human pathogen.
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Affiliation(s)
- Mark Anderson
- Institut Pasteur, Unité de Pathogénie Microbienne MoléculaireParis, France; Institut National de la Santé et de la Recherche Médicale, Unité 786Paris, France
| | - Philippe J Sansonetti
- Institut Pasteur, Unité de Pathogénie Microbienne MoléculaireParis, France; Institut National de la Santé et de la Recherche Médicale, Unité 786Paris, France; Collège de FranceParis, France
| | - Benoit S Marteyn
- Institut Pasteur, Unité de Pathogénie Microbienne MoléculaireParis, France; Institut National de la Santé et de la Recherche Médicale, Unité 786Paris, France
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19
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Cabello FC, Godfrey HP, Buschmann AH, Dölz HJ. Aquaculture as yet another environmental gateway to the development and globalisation of antimicrobial resistance. THE LANCET. INFECTIOUS DISEASES 2016; 16:e127-e133. [PMID: 27083976 DOI: 10.1016/s1473-3099(16)00100-6] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/28/2015] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
Aquaculture uses hundreds of tonnes of antimicrobials annually to prevent and treat bacterial infection. The passage of these antimicrobials into the aquatic environment selects for resistant bacteria and resistance genes and stimulates bacterial mutation, recombination, and horizontal gene transfer. The potential bridging of aquatic and human pathogen resistomes leads to emergence of new antimicrobial-resistant bacteria and global dissemination of them and their antimicrobial resistance genes into animal and human populations. Efforts to prevent antimicrobial overuse in aquaculture must include education of all stakeholders about its detrimental effects on the health of fish, human beings, and the aquatic ecosystem (the notion of One Health), and encouragement of environmentally friendly measures of disease prevention, including vaccines, probiotics, and bacteriophages. Adoption of these measures is a crucial supplement to efforts dealing with antimicrobial resistance by developing new therapeutic agents, if headway is to be made against the increasing problem of antimicrobial resistance in human and veterinary medicine.
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Affiliation(s)
- Felipe C Cabello
- Department of Microbiology and Immunology and Department of Pathology, New York Medical College, Valhalla, New York, NY, USA.
| | - Henry P Godfrey
- Department of Microbiology and Immunology and Department of Pathology, New York Medical College, Valhalla, New York, NY, USA
| | | | - Humberto J Dölz
- Instituto de Farmacia, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
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20
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Chiou CS, Izumiya H, Kawamura M, Liao YS, Su YS, Wu HH, Chen WC, Lo YC. The worldwide spread of ciprofloxacin-resistant Shigella sonnei among HIV-infected men who have sex with men, Taiwan. Clin Microbiol Infect 2016; 22:383.e11-383.e16. [DOI: 10.1016/j.cmi.2015.12.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/25/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
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21
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Thompson CN, Le TPT, Anders KL, Nguyen TH, Lu LV, Nguyen VVC, Vu TD, Nguyen NMC, Tran THC, Ha TT, Tran VTN, Pham VM, Tran DHN, Le TQN, Saul A, Martin LB, Podda A, Gerke C, Thwaites G, Simmons CP, Baker S. The transfer and decay of maternal antibody against Shigella sonnei in a longitudinal cohort of Vietnamese infants. Vaccine 2015; 34:783-90. [PMID: 26742945 PMCID: PMC4742520 DOI: 10.1016/j.vaccine.2015.12.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/27/2015] [Accepted: 12/18/2015] [Indexed: 11/16/2022]
Abstract
Shigella sonnei is an emergent and highly drug resistant diarrheal pathogen. The half-life of maternal S. sonnei IgG in infants is 43 days. Maternal titer, antibody transfer ratio and gestational age influence birth titer. Incidence of seroconversion in infants in southern Vietnam is 4/100 infant years. Children should be vaccinated after 5 months of age if a candidate is licensed.
Background Shigella sonnei is an emergent and major diarrheal pathogen for which there is currently no vaccine. We aimed to quantify duration of maternal antibody against S. sonnei and investigate transplacental IgG transfer in a birth cohort in southern Vietnam. Methods and results Over 500-paired maternal/infant plasma samples were evaluated for presence of anti-S. sonnei-O IgG and IgM. Longitudinal plasma samples allowed for the estimation of the median half-life of maternal anti-S. sonnei-O IgG, which was 43 days (95% confidence interval: 41–45 days). Additionally, half of infants lacked a detectable titer by 19 weeks of age. Lower cord titers were associated with greater increases in S. sonnei IgG over the first year of life, and the incidence of S. sonnei seroconversion was estimated to be 4/100 infant years. Maternal IgG titer, the ratio of antibody transfer, the season of birth and gestational age were significantly associated with cord titer. Conclusions Maternal anti-S. sonnei-O IgG is efficiently transferred across the placenta and anti-S. sonnei-O maternal IgG declines rapidly after birth and is undetectable after 5 months in the majority of children. Preterm neonates and children born to mothers with low IgG titers have lower cord titers and therefore may be at greater risk of seroconversion in infancy.
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Affiliation(s)
- Corinne N Thompson
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Thi Phuong Tu Le
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | | | | | - Lan Vi Lu
- The Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | | | - Thuy Duong Vu
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Ngoc Minh Chau Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Thi Hong Chau Tran
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Thanh Tuyen Ha
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Vu Thieu Nga Tran
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Van Minh Pham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Do Hoang Nhu Tran
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Thi Quynh Nhi Le
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Allan Saul
- Novartis Vaccines Institute for Global Health(2), A GSK Company, Siena, Italy
| | - Laura B Martin
- Novartis Vaccines Institute for Global Health(2), A GSK Company, Siena, Italy
| | - Audino Podda
- Novartis Vaccines Institute for Global Health(2), A GSK Company, Siena, Italy
| | - Christiane Gerke
- Novartis Vaccines Institute for Global Health(2), A GSK Company, Siena, Italy
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Cameron P Simmons
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK; Department of Microbiology and Immunology, University of Melbourne, Australia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK; London School of Hygiene and Tropical Medicine, London, UK.
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22
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Chung The H, Rabaa MA, Thanh DP, Ruekit S, Wangchuk S, Dorji T, Tshering KP, Nguyen TNT, Vinh PV, Thanh TH, Minh CNN, Turner P, Sar P, Thwaites G, Holt KE, Thomson NR, Bodhidatta L, Jeffries Mason C, Baker S. Introduction and establishment of fluoroquinolone-resistant Shigella sonnei into Bhutan. Microb Genom 2015; 1:e000042. [PMID: 28348825 PMCID: PMC5320628 DOI: 10.1099/mgen.0.000042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022] Open
Abstract
Shigella sonnei is a major contributor to the global burden of diarrhoeal disease, generally associated with dysenteric diarrhoea in developed countries but also emerging in developing countries. The reason for the recent success of S. sonnei is unknown, but is likely catalysed by its ability to acquire resistance against multiple antimicrobials. Between 2011 and 2013, S. sonnei exhibiting resistance to fluoroquinolones, the first-line treatment recommended for shigellosis, emerged in Bhutan. Aiming to reconstruct the introduction and establishment of fluoroquinolone-resistant S. sonnei populations in Bhutan, we performed whole-genome sequencing on 71 S. sonnei samples isolated in Bhutan between 2011 and 2013.We found that these strains represented an expansion of a clade within the previously described lineage III, found specifically in Central Asia. Temporal phylogenetic reconstruction demonstrated that all of the sequenced Bhutanese S. sonnei diverged from a single ancestor that was introduced into Bhutan around 2006. Our data additionally predicted that fluoroquinolone resistance, conferred by mutations in gyrA and parC, arose prior to the introduction of the founder strain into Bhutan. Once established in Bhutan, these S. sonnei had access to a broad gene pool, as indicated by the acquisition of extended-spectrum β-lactamase-encoding plasmids and genes encoding type IV pili. The data presented here outline a model for the introduction and maintenance of fluoroquinolone-resistant S. sonnei in a new setting. Given the current circulation of fluoroquinolone-resistant S. sonnei in Asia, we speculate that this pattern of introduction is being recapitulated across the region and beyond.
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Affiliation(s)
- Hao Chung The
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam
| | - Maia A Rabaa
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Oxford University, Oxford, UK
| | - Duy Pham Thanh
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam
| | | | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Tshering Dorji
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Kinzang Pem Tshering
- Department of Pediatrics, Jigme Dorji Wangchuk Referral Hospital, Kawa Jangsa, Thimphu, Bhutan
| | | | - Phat Voong Vinh
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam
| | - Tuyen Ha Thanh
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam
| | | | - Paul Turner
- Centre for Tropical Medicine, Oxford University, Oxford, UK.,Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Poda Sar
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Guy Thwaites
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Oxford University, Oxford, UK
| | - Kathryn E Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Nicholas R Thomson
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, UK.,The London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Stephen Baker
- The Hospital for Tropical Diseases, OUCRU, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Oxford University, Oxford, UK.,The London School of Hygiene and Tropical Medicine, London, UK
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23
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Thompson CN, Thieu NTV, Vinh PV, Duc AN, Wolbers M, Vinh H, Campbell JI, Ngoc DTT, Hoang NVM, Thanh TH, The HC, Nguyen TNT, Lan NPH, Parry CM, Chau NVV, Thwaites G, Thanh DP, Baker S. Clinical implications of reduced susceptibility to fluoroquinolones in paediatric Shigella sonnei and Shigella flexneri infections. J Antimicrob Chemother 2015; 71:807-15. [PMID: 26679253 PMCID: PMC4743702 DOI: 10.1093/jac/dkv400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/26/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives We aimed to quantify the impact of fluoroquinolone resistance on the clinical outcome of paediatric shigellosis patients treated with fluoroquinolones in southern Vietnam. Such information is important to inform therapeutic management for infections caused by this increasingly drug-resistant pathogen, responsible for high morbidity and mortality in young children globally. Methods Clinical information and bacterial isolates were derived from a randomized controlled trial comparing gatifloxacin with ciprofloxacin for the treatment of paediatric shigellosis. Time–kill experiments were performed to evaluate the impact of MIC on the in vitro growth of Shigella and Cox regression modelling was used to compare clinical outcome between treatments and Shigella species. Results Shigella flexneri patients treated with gatifloxacin had significantly worse outcomes than those treated with ciprofloxacin. However, the MICs of fluoroquinolones were not significantly associated with poorer outcome. The presence of S83L and A87T mutations in the gyrA gene significantly increased MICs of fluoroquinolones. Finally, elevated MICs and the presence of the qnrS gene allowed Shigella to replicate efficiently in vitro in high concentrations of ciprofloxacin. Conclusions We found that below the CLSI breakpoint, there was no association between MIC and clinical outcome in paediatric shigellosis infections. However, S. flexneri patients had worse clinical outcomes when treated with gatifloxacin in this study regardless of MIC. Additionally, Shigella harbouring the qnrS gene are able to replicate efficiently in high concentrations of ciprofloxacin and we hypothesize that such strains possess a competitive advantage against fluoroquinolone-susceptible strains due to enhanced shedding and transmission.
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Affiliation(s)
- Corinne N Thompson
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Oxford University, Oxford, UK The London School of Hygiene and Tropical Medicine, London, UK
| | - Nga Tran Vu Thieu
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phat Voong Vinh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Anh Nguyen Duc
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Oxford University, Oxford, UK
| | - Ha Vinh
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Oxford University, Oxford, UK
| | - Dung Tran Thi Ngoc
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Van Minh Hoang
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tuyen Ha Thanh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hao Chung The
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - To Nguyen Thi Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Phu Huong Lan
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Christopher M Parry
- The London School of Hygiene and Tropical Medicine, London, UK School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Guy Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Oxford University, Oxford, UK
| | - Duy Pham Thanh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Oxford University, Oxford, UK The London School of Hygiene and Tropical Medicine, London, UK
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24
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Gray MD, Leonard SR, Lacher DW, Lampel KA, Alam MT, Morris JG, Ali A, LaBreck PT, Maurelli AT. Stx-Producing Shigella Species From Patients in Haiti: An Emerging Pathogen With the Potential for Global Spread. Open Forum Infect Dis 2015; 2:ofv134. [PMID: 26484357 PMCID: PMC4606844 DOI: 10.1093/ofid/ofv134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/04/2015] [Indexed: 11/14/2022] Open
Abstract
Shiga toxins (Stx) are commonly produced by Shigella dysenteriae serotype 1 and Stx-producing Escherichia coli. However, the toxin genes have been detected in additional Shigella species. We recently reported the emergence of Stx-producing Shigella in travelers in the United States and France who had recently visited Hispaniola (Haiti and the Dominican Republic). In this study, we confirm this epidemiological link by identifying Stx-producing Shigella from Haitian patients attending clinics near Port-au-Prince. We also demonstrate that the bacteriophage encoding Stx is capable of dissemination to stx-negative Shigella species found in Haiti, suggesting that Stx-producing Shigella may become more widespread within that region.
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Affiliation(s)
- Miranda D. Gray
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda
| | - Susan R. Leonard
- US Food and Drug Administration, Center for Food Safety and Nutrition, Laurel, Maryland
| | - David W. Lacher
- US Food and Drug Administration, Center for Food Safety and Nutrition, Laurel, Maryland
| | - Keith A. Lampel
- US Food and Drug Administration, Center for Food Safety and Nutrition, Laurel, Maryland
| | - Meer T. Alam
- University of Florida, Emerging Pathogens Institute,
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville
| | | | - Afsar Ali
- University of Florida, Emerging Pathogens Institute,
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Patrick T. LaBreck
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda
| | - Anthony T. Maurelli
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda
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