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BACKGROUND Shigellosis, an acute diarrheal disease, is the third most common bacterial infection in the United States. Shigellosis most commonly affects children under the age of 5; however, clusters and outbreaks of shigellosis have been reported among gay, bisexual, and other men who have sex with men (MSM). Evidence suggests that knowledge of shigellosis among MSM is low, indicating health promotion outreach is needed for this population. METHODS To inform the development of shigellosis-related health communication materials and strategies, six focus groups were conducted in 2017, in Atlanta, Georgia among 24 self-identified gay and bisexual men. Participants were asked about their preferences and recommendations for health communication materials. RESULTS Participants indicated they would prefer a range of physical and virtual materials placed in diverse locations where the community would see them. Respondents recommended health messages be simple, quick to read, and concise and have limited word counts. Participants also advised the use of diverse images that were inclusive of couples of varying sexual orientations to reduce stigma. Participants advocated for the use of humor and provocative images to increase user engagement. CONCLUSIONS The results emphasize the potential benefits of conducting formative research when designing health communication materials. Incorporating messaging preferences of MSM in the development of shigellosis-related health communication materials could enhance their relevance for the target population, while also avoiding unintended consequences associated with stigmatizing MSM.

No doubts that shigellosis severity directly depends on the spread of the gut specific lesion. There are some data published on the basis of autopsy records and pointing to shigella caused lesion spreading both to colon and ileum in adult cases especially in those older than 60 y.o. or with any immunosuppressive premorbid background. Obviously, the gut mucosa condition determines the local resistance potential and moreover it's shown that in shigellosis cases, the histologic pattern of gut mucosa depends on quantity and quality of neutrophils, extremely important to control the intensity of agent invasion. Viral infections with concomitant neutropenia are commonly considered as immune suppressive conditions. As to Herpes virus infection, it's well known as the large mucosa lesion disease that can subsequently lead to aggravation of any forthcoming acute bacterial infection. The paper suggests the description of shigellosis case confirmed with the use of PCR test (PCR kit Amplisens All-bacto-screen-FL Lab, Interlabservice) and developed by young woman with unfavorable premorbid condition. The disease course turned to be severe and complicated by the peritonitis development. The aggravating factors in the proposed case were likely such immune modulating concurrent conditions as Herpes virus infection and pregnancy. The clinical example demonstrates that young people can develop severe complicated shigellosis course given burdened premorbid background availability.

The ways of improving of diet management in children with Shigellosis infected with H. pylori were determined. The study involved 29 children with H. pylori infection aged from 1 to 10, who were hospitalized in the Regional Children’s Infectious Diseases Hospital (Kharkiv) and had a diagnosis of Shigellosis sonnei of moderate severity. The children were divided into two groups depending on the feeding mode. The first group was represented by 13 children, who were undergone standard treatment. The second group included 16 children who had two days prolonged gradual increase in the volume of food at each feeding, and decreased number of feedings per day. Children of the second group received aluminum phosphate from the first day and after discharge they were advised to keep on the regime of feeding «more frequently, but in small portions». A longer duration of the symptoms of bowel dysfunction and vomiting, pain in periumbilical area, bloating, changes in fecal examination in the form of the presence of undigested food in children of the first group were revealed. Patients of the second group regained their weight in much shorter period. Rational diet therapy makes it possible to prevent recrudescence of shi­gellosis in children at early stages of recovery. Studies have shown that early detection of H. pylori infection in children with shigellosis as well as timely correction of feeding have a positive effect on recovery of functional activity of digestive processes, faster normalization of clinical and laboratory parameters of patients, contribute to regression of clinical symptoms of the underlying disease.

Worldwide, foodborne illness is a significant public health issue in both developed and developing countries. Salmonellosis, campylobacteriosis and shigellosis are common foodborne gastrointestinal illnesses caused by the bacteria Salmonella spp., Campylobacter spp. and Shigella spp. respectively. These zoonotic diseases are frequently linked to eggs and poultry products. The aim of this study was to investigate the presence of these pathogens in Australian backyard poultry flocks and to determine risk factors for these pathogens. Poultry faeces samples were collected from 82 backyards and screened for Salmonella spp., Campylobacter spp. and Shigella spp. using qPCR. A questionnaire was administered to the backyard poultry owners to assess their knowledge regarding management of poultry and eggs and to identify potential risk factors that may contribute to the presence of zoonotic pathogens in the flocks. One composite faecal sample was collected from each backyard (82 samples). Composite sampling here means taking one or more grab samples from a backyard to make up approximately 10 grams. Four per cent of samples, that is 4% backyards tested, were positive for Salmonella spp., 10% were positive for Campylobacter spp. and none were positive for Shigella spp. A higher infection rate was seen in multi-aged flocks (24%) compared with the single-aged flocks (3%). The survey found that many participants were engaging in risky food safety behaviours with 46% of participants responding that they washed their eggs with running water or still water instead of wiping the dirt off with a damp cloth to clean the eggs and 19% stored their eggs at room temperature. This study demonstrated that backyard poultry may pose a potential risk for salmonellosis and campylobacteriosis. Additionally, Australian public health and food safety regulations should be modified and effectively implemented to address the risks associated with backyard poultry husbandry.

This cross-sectional, institutional-based study aimed to determine the prevalence of shigellosis and associated risk factors among Babcock University students in Ogun State, Nigeria. One hundred and twenty (120) undergraduate students, 80 females and 40 males, were asked to provide stool specimen in a sterile leak-proof single-use universal bottle with a screw-capped lid. Standard microbiological techniques were used to analyse the stool samples. A questionnaire was designed to collect demographic and clinical information from participants. The data obtained were statistically analysed using the SPSS Statistics software (version 18.0). The study showed that there was no occurrence of shigellosis among the study participants (0%), but other enteric pathogens infection were present in all participants (100%). The three most common mono-infections found among the study participants included Staphylococcus aureus (40%), followed by Escherichia coli (16.7%), and Salmonella typhi and Bacillus spp. (3.3%, each). While the most common prevalence of dual-infections included Staphylococcus aureus and Escherichia coli (33.3%), followed by Staphylococcus aureus and Salmonella typhi (3.3%). The proportion of participants who were asymptomatic (66.7%) was significantly higher than the symptomatic ones (33.3%). Identified risk factors of non-Shigella enteric infection included consumption of beef, vegetables, fruits, poultry/poultry products, as well as street foods, poor hand hygiene before eating, anal cleaning, and poor hand hygiene after toileting. Although shigellosis did not exist among undergraduate students of Babcock University, this study highlighted the existence of other enteric infections among the study participants. Therefore, the necessary preventive measures should be ensured and sustained.

Both Campylobacter- and Shigella-induced invasive enteritis are common in under-5 Bangladeshi children. Our study aimed to determine the factors associated with Campylobacter and Shigella enteritis among under-5 children, the post-infection worsening growth, and the household cost of invasive enteritis. Data of children having Shigella (591/803) and Campylobacter (246/1148) isolated from the fecal specimen in Bangladesh were extracted from the Global Enteric Multicenter Study (GEMS) for the period December 2007 to March 2011. In multiple logistic regression analysis, fever was observed more frequently among shigellosis cases [adjusted OR 2.21; (95% CI 1.58, 3.09)]. Breastfeeding [aOR 0.55; (95% CI 0.37, 0.81)] was found to be protective against Shigella. The generalized estimating equations multivariable model identified a negative association between Shigella and weight-for-height z score [aOR − 0.11; (95% CI − 0.21, − 0.001)]; a positive association between symptomatic Campylobacter and weight-for-age z score [aOR 0.22; (95% CI 0.06, 0.37)] and weight-for-height z score [aOR 0.22; (95% CI 0.08, 0.37)]. Total costs incurred by households were more in shigellosis children than Campylobacter-induced enteritis ($4.27 vs. $3.49). Households with low-level maternal education tended to incur less cost in case of their shigellosis children. Our findings underscore the need for preventive strategies targeting Shigella infection, which could potentially reduce the disease burden, associated household costs, and child growth faltering.

Foodborne diseases are considered a relevant issue in health around the world due to their incidence, mortality and negative effects on the economic and productive sector. Fish is considered a food of high nutritional quality, being of global production, distribution and commercialization mainly for human consumption. Among the fish worldwide obtained from capture fisheries and mainly aquaculture for human consumption is Tilapia, due to the adaptability of this fish under cultivation conditions in addition to the fact that its meat is of quality and accessible economic value. Fish due to its composition, is highly susceptible to deterioration and contamination by different hazards throughout the food chain, putting the safety of products and public health at risk. Shigellosis is among the diseases that may be contracted from the consumption of food contaminated by bacteria of the genus Shigella spp.; food contamination is mainly related to inadequate or non-hygienic conditions and practices in the production, processing and handling of food. Therefore, the purpose of this review is to provide a general perspective of foodborne diseases, especially shigellosis, causal agents, conditioning factors, related foods such as fish, as well as control and preventive actions in order to protect the food safety and public health. Key words: Food pathogens, food safety, food microbiology, enterobacteria, fisheries, aquaculture.

Background and aim: Shigella is one of the leading causes of acute diarrhea in children worldwide. Antibiotic resistance in this bacterium has increased due to the indiscriminate use of common antibiotics. Therefore, the aim of this study was to investigate the prevalence and pattern of antibiotic resistance in Shigella species isolated from children with acute diarrhea in Tabriz hospitals. Materials and methods: In this descriptive cross-sectional study, 321 samples suspected of Shigella were collected from children's diarrhea stool samples and identified using standard microbiological and biochemical tests. Antibiotic resistance was also determined using disk diffusion by the Kirby-Bauer method. Results: A total of 84 samples were positive for Shigella. Among them, S. flexneri species with 83.3% had the highest frequency and S. boydii with 13.1%, S. sonnei with 2.4% and S. dysanteriae with 1.2% had the lowest frequency. The highest resistance was related to the antibiotics cotrimoxazole (92.85%), tetracycline and ampicillin (67.86%) and the lowest resistance was related to imipenem antibiotics (2.38%) and ceftizoxime (9.52%). Conclusion: The present study showed that Shigella flexneri is the predominant species isolated from children with Shigellosis in hospitals in Tabriz city. Our results also indicate an increase in resistance to common antibiotics. Therefore, it is recommended that antimicrobial susceptibility testing be performed in the study area prior to antibiotic administration.

Enteric infection with Shigella spp. can lead to symptoms ranging from acute watery diarrhea to sudden, severe dysentery. Approximately 212 000 diarrheal deaths annually are attributed to Shigella with a disproportionate impact in low-resource countries. The impact in under-resourced countries was illustrated by a reanalysis of the Global Enteric Multicenter Study which found that Shigella was the leading pathogen associated with moderate-to severe diarrhea in children under 5 years old. While recent studies have highlighted the burden of the disease, there has been a concurrent reduction in therapeutic options for the treatment of shigellosis as drug resistant strains increase in prevalence. In addition, increasing reports of drug resistant shigellosis cases in the men who have sex with men community confirm that the impact is not limited to low-resource countries. Despite the urgent need for new treatments, a target product profile (TPP) has not been established, and there is no clear development path for antibacterial treatments. To address this troubling concern, this manuscript describes a TPP for antishigellosis small molecule therapeutics and a development path that integrates currently available preclinical and clinical models of Shigella infection.

Introduction: In the Karachay-Cherkess Republic (KCR), dysentery and salmonellosis rank high in the etiological structure of intestinal infections and arose interest in studying the incidence of shigellosis in the republic. Our objective was to analyze the incidence of bacillary dysentery, to study Shigella landscape in the territory of the KCR in 2005–2019, and to compare the findings with similar variables in other regions of the Russian Federation. Materials and methods: We analyzed data of the Center for Hygiene and Epidemiology in the Karachay-Cherkess Republic on the incidence of shigellosis and Shigella isolates obtained from human stool samples in the KCR in 2005–2019 and compared them with available results of similar studies conducted in other parts of the country. Results: When analyzing the curves of the incidence of dysentery in the KCR and the Russian Federation, we found that they were asynchronous. In the KCR, the curve rose twice (in 2005–2006 and 2011–2014), while in the Russian Federation, the incidence rates demonstrated a gradual decrease. Over the whole observation period, only in 2018–2019 the incidence of shigellosis in Karachay-Cherkessia was 1.3–1.8 times lower than in the country as a whole. We also established that, in contrast to the Russian Federation, Shigella sonnei represented by the biochemical variant IIg prevailed in the structure of shigellosis in the republic. The analysis of the relationship between the number of detected samples of dairy products of poor microbial quality and the incidence rate of Sonne dysentery showed that those two variables did not always correlate. Molecular genotyping of Shigella sonnei strains by pulsed-field gel electrophoresis (PFGE) allowed us to assume the imported nature of the pathogen. The import could have occurred during the Hajj to Mecca and Medina of KCR residents in 2012. Conclusion: Shigella sonnei strains differing in the presence of tetracycline and chloramphenicol (levomycetin) resistance determinants are circulating in Karachay-Cherkessia. No bacteria resistant to ciprofloxacin were isolated in the republic in 2005–2019.

The aim of this work is to study the etiological and epidemiological features of infectious hemocolites (IG) in hospitalized children of different ages.Materials and methods of research. An analysis of the results of a survey of 3103 children admitted to hospital treatment for acute intestinal infections (AII) from January to December 2018, among which patients with IG were identified. The etiology of the disease was determined based on the results of the bacteriological method, PCR studies of faeces with Amplicens ® OKI screen-FL reagents, serological and immunological methods. Microscopic examination of faeces was performed to identify protozoa. Patients were divided into age groups: infant (n=78; 30%); early (n=74; 28,5%); preschool (n=63; 24,2%), school (n=45; 17,3%).Results. The incidence of IG in hospitalized children with AII was 8,4%. Bacterial pathogens of IG were detected in 66,5% of children, IG of unspecified etiology was diagnosed in 24,2%. Viral and bacterial infections were rarely detected (9,2%). Among intestinal viruses, rotavirus (37,5%), norovirus (29,2%) and enterovirus (20,8%) were more frequently detected in hemocolitis of combined viral and bacterial etiology. In the IG age structure, infants (30%), young children (28,5%) and pre-school children (24,2%) made up the majority. The maximum number of IG patients was detected in the summer (10,9% of all cases of AII). Salmonellosis was more often detected in autumn (31,6%), campylobacteriosis – in summer (17.9%) and autumn (24,1%), escherichiosis and shigellosis – in summer (11,5% and 6,4%, respectively). The maximum detection of IG in infants was observed in June (14,1%) and October (12,8%), in young children – in July (17,6%), in preschoolers – in June (12,7%) and November (15,9%), in schoolchildren in May (13,3% of cases) and in October (15,6%).Conclusion. The incidence of infectious hemocolites in hospitalized children with acute intestinal infections was 8,4%. The bacterial etiology of the disease was detected in 66,5% of children. The age structure of the IG was dominated by children of infant, early and preschool age. The maximum detection of patients with IG was observed in the summer.

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

Availability of clean, safe drinking water is one of the primary needs of human beings. The present study focused on the quality of drinking water in Alappuzha district, in the state of Kerala, India. The harmful concentrations of water-soluble chemicals in drinking water can adversely affect human health. This investigation probed the influence of toxic chemical pollutants on human health. Although concentrations of chemical parameters in the water samples were found to be within the permissible limits, cases of humans infected by waterborne disease such as Leptospirosis, Hepatitis A, and Hepatitis E, Cholera, Shigellosis, and Amoebic meningoencephalitis were reported in the district, in the year 2016. This suggests that microorganisms play a vital role in contaminating water and spreading disease. As many of these diseases are lethal, expedient remedial measures must be undertaken to alleviate their incidence and severity.

In recent years, our group isolated the Escherichia albertii strain DM104 and characterized it as a vaccine strain against Shigella dysenteriae type 4 in the guinea pig eye model. Protective efficacy of different routes of immunization such as intranasal, oral, and intrarectal routes were also determined and compared by challenging immunized guinea pigs against live S. dysenteriae. In the current study, we compared the intranasal and intraperitoneal routes of immunizations with the DM104 vaccine strain in mice to understand the better route of administration of the DM104 vaccine and its immunogenicity as well as protective efficacy in mouse model. The results indicate that the immune response elicited by the DM104 strain is strongly dependent on the immunization route, with the intranasal route being more effective than the intraperitoneal route following intraperitoneal live S. dysenteriae challenge. Intranasal immunization yielded 80% protective efficacy in immunized mice whereas, intraperitoneal immunization could not provide any protection. Protection generated by intranasal immunization was accompanied by high titre of anti-whole cell lysate IgG and IgA in DM104 immunized sera compared to sera collected from mice of control group. All these data demonstrate the intranasal route of the vaccine DM104 strain in mouse model to be a better immunization route to protect the animals against live S. dysenteriae challenge. Bangladesh J Microbiol, Volume 37 Number 2 December 2020, pp 38-41

The relevance of the study of Shigellosis is due to the fact that the pathogen is capable of invasion and the production of cyto- and neurotoxins, which leads to the development of severe inflammation and toxicosis, and with massive infection — and neurotoxicosis. Purpose: to study the clinical and laboratory features of the course of Shigellosis in hospitalized patients at the present stage. Materials and Methods: a retrospective study of 17 case histories of children aged 9 month to 17 years old, hospitalized in the infectious diseases department of a Moscow hospital in 2019 with a confirmed diagnosis of Shigellosis, was carried out. Results: depending on the season, the frequency of hospitalizations of children with Shigellosis was practically the same in autumn, winter and spring, excluding summer (35%, 35%, 30% and 0%, respectively). Children with Shigellosis under the age of 1 year were 2, 1—3 years old — 4, 3—7 years old — 5, 7—14 years old — 3, over 14 years old — 3. The diagnosis of Shigellosis was confirmed in 13 patients according to the results of bacteriological research , in 4 — according to IHR (indirect hemagglutination reaction) data (without seeding). Shigella flexneri 2a was detected in 14 children, Shigella sonnei in 2, Shigella flexneri 2a together with Shigella sonnei in 1. Most of the patients 82.4% (14/17) were admitted to the hospital in the first three days of illness (by 2.8 ± 0.05 days). Intoxication symptoms were expressed in all patients, vomiting — in 76.5% of cases (13/17), fever — in 94% (16/17), abdominal pain — in 82.4% (14/17), inflammatory impurities in feces (cloudy mucus) — in all patients, hemocolitis (streaks of blood in feces) — in all but one — 94% (16/17). In one third of patients, Shigellosis was severe — in 35% (6/17). Conclusions. Shigellosis remains relevant due to the incidence of hemocolitis, severe forms, which requires hospitalization.

Introduction Shigellosis cases have decreased gradually in Japan in recent years, but indigenous shigellosis outbreaks sometimes occur in childcare facilities. From national surveillance data, we identified a shigellosis outbreak involving a kindergarten. Methods After detecting Shigella sonnei in Kitakyushu City, we conducted active case finding and epidemiological investigation in Kindergarten Z, including stool specimen collection and interviews. The stool specimens were cultured, and isolated strains were subjected to pulsed-field gel electrophoresis (PFGE) and multiple-locus variable-number tandem-repeat analysis (MLVA). Results Between September 1 and December 31, 2014, we identified 19 cases: 14 confirmed, 2 suspected, and 3 asymptomatic. Of the 19 cases, 16 were epidemiologically associated with Kindergarten Z (10 pupils, 5 family members, and 1 teacher). On October 19, a pupil with gastrointestinal illness participated in the kindergarten's sports festival, in which the pupils were split into “red” and “white” teams; the pupil in question belonged to the red team. Attack rates of the red and white teams were 8% (7/82) and 0% (0/108), respectively (relative risk, 10.5; 95% confidence interval, 1.3–82.1). PFGE patterns were identical or similar for the isolates in all 17 cases; 7 isolates were identical, and the others had one locus difference on MLVA. Conclusions We concluded that contact during the sports festival could have been responsible for spread of the shigellosis outbreak at the kindergarten, although the infection source was not determined. It is vital to inform guardians immediately after detection of shigellosis cases that symptomatic pupils should not participate in activities such as sports festivals.

Background Shigella is a leading cause of childhood diarrhea and target for vaccine development. Microbiologic and clinical case definitions are needed for pediatric field vaccine efficacy trials. Methods We compared characteristics of moderate to severe diarrhea (MSD) cases in the Global Enteric Multicenter Study (GEMS) between children with culture positive Shigella to those with culture-negative, quantitative polymerase chain reaction (qPCR)-attributable Shigella (defined by an ipaH gene cycle threshold, Molecular methods identified Shigella more commonly than microbiologic culture in younger and stunted children. A simplified clinical score containing dehydration, hospitalization, and diarrhea duration could be used to stratify vaccine trial endpoints by severity based on its ability to predict death.

In a cohort of infants, we found that lack of the Lewis histo-blood group antigen was associated with increased susceptibility to shigellosis. Broadly inhibiting fucosylation in epithelial cells in vitro decreased invasion by Shigella flexneri. These results support a role for fucosylated glycans in susceptibility to shigellosis.

To study the clinical characteristics and factors associated with mortality among children with Shigella encephalopathy. The data collection was done prospectively from January, 2018 to May, 2019 with retrospective data from June, 2016 to December, 2017. The study cohort consisted of 58 children 12 hours) were found to be independently associated with mortality. Recognition of factors associated with mortality in Shigella encephalopathy may assist in better monitoring of sicker children and improved outcomes.

Проведено аналіз клініко-параклінічних особливостей шигельозу у 72 дітей, хворих на шигельоз середньої тяжкості, в залежності від наявності або відсутності інфікування цих дітей цитомегаловірусом (ЦМВ). Встановлено, що шигельоз у дітей, інфікованих ЦМВ, перебігає переважно у формі ентероколіту, супроводжується більш високими цифрами температурної реакції тіла в дебюті хвороби, гіперемією задньої стінки ротоглотки, лімфоаденопатією, гепатомегалією, ознаками паренхіматозної реакції печінки. У цих дітей реєструють триваліші строки регресії клінічних симптомів – пролонгацію збереження лихоманки і порушення загального стану, диспепсичні явища, абдомінальний синдром, триваліше збереження ознак гепатомегалії, що призводить до збільшення строків перебування хворих у стаціонарі та є одним із факторів розвитку нозокоміальної інфекції.

A qualitative study among gay and bisexual men examining shigellosis-related knowledge, attitudes, and practices revealed low knowledge levels, limited concern about shigellosis, and mixed intention to engage in prevention behaviors., Background Shigellosis is a highly contagious enteric bacterial disease transmitted through the fecal-oral route. It is primarily transmitted through person-to-person contact and via contaminated food and water. Outbreaks of shigellosis among men who have sex with men (MSM) attributed to sexual person-to-person contact have been reported. These outbreaks are of concern because they are often caused by multidrug-resistant strains of Shigella. Little is known about shigellosis-related knowledge, attitudes, and practices among gay, bisexual, and other MSM. Methods Six focus groups were conducted among self-identified gay or bisexual men in Atlanta, GA, in Fall 2017. Participants were asked about shigellosis-related knowledge, attitudes, and practices. Focus groups were audio recorded, and the transcribed audio was analyzed using inductive and deductive thematic coding. Results Among the 24 focus group participants, most perceived that diarrheal illness was caused by contaminated food. Knowledge of shigellosis and Shigella was low, with most never having heard of the disease or bacteria. Participants did not perceive shigellosis to be a serious health concern, especially when compared with HIV; however, they did perceive gay and bisexual men to be at risk of Shigella infection. Participants reported mixed intentions to change sexual behaviors to prevent shigellosis or talk with sexual partners about diarrhea. Conclusions Health communication and education efforts could be used to increase knowledge about shigellosis and shift perceptions about the severity of shigellosis among gay, bisexual, and other MSM. Additional work is needed to identify effective ways to promote shigellosis-related prevention behaviors among gay, bisexual, and other MSM.

Background Sex differences in the incidence of infectious diseases can provide insight to the biological mechanism of infection, disease susceptibility, severity and vaccine development. The consistency of age-specific sex differences in the incidence rates (IRs) of shigellosis is unclear. Methods National data on cases of shigellosis by sex, age group and calendar year were obtained from nine countries, for a period of 6–25 years. The male to female incidence rate ratios (RR) were calculated by country, years and age group. For each age group, meta-analytic methods were used for computing pooled incidence RRs by country and years. Meta-regression was performed to estimate the contribution of age, country and time period to the differences in the male : female RRs. Results In the age groups Conclusions The higher IRs in male infants and young children does not appear to be related to behavioral factors and genetic and hormonal factors could be important. In the older age groups, the higher rates in adult females may be due to behavioral factors.

Acute intestinal infections, including intestinal amebiasis, remain a pressing public health problem. Amebiasis still represents an important and partially solved problem to health care. In the Astrakhan region, intestinal amebiasis is being continuously recorded. We analyzed the clinical picture of acute intestinal amebiasis in 150 adult patients dominated by female patients comprising 60.7%, aged 18 to 79 years old, and treated within 2010–2016 at the Regional Infectious Clinical Hospital. All patients were mostly of young and middle age (up to 50 years) — 108 patients. More than 50% of patients were admitted to the hospital within the first three days of the disease. However, in 35 cases (23.3%), late hospitalization was carried out (5 days after the onset). Proper diagnosis was made to 44 patients (29.3%), most commonly diagnosing preliminarily with acute gastroenteritis and acute dysentery. All cases of intestinal amebiasis were confirmed by detecting in the feces of patients with a vegetative form of entamoeba histolytica. The disease was featured with sporadic course, being mostly recorded during the summer-autumn period (78.0%). In 142 patients (94.7%), the moderate severity was observed. Cardiovascular disorders were mainly found in severe amebiasis as well as patients comorbid with cardiovascular diseases. A coprological method was used to confirm the diagnosis. Microscopic examination of feces was carried out immediately after defecation (warm type). A combination therapy was applied to patients with intestinal amebiasis. A great attention was paid to patient nutrition: high-protein sparing diet, grated food. Patients with ulcerative colitis received individualized diet (restricted carbohydrates, exclusion of milk and fiber). Etiotropic therapy was carried out with using 5-nitroimidazole preparations: metronidazole (Trichopol, Flagin, Tiberal), MacGioror, Tinidazole (Phasycin) combined with tetracycline. The treatment included group B vitamin cocktail, methyluracil (suppository), enzymes (creon, mezim, pancreatin), enterosorbents (smecta, polyphepan, enterosgel), antispasmodics (no-spa, drotaverin). Patients were administered with therapeutic microenemas containing furacilin solution, rosehip oil, and sea buckthorn oil. Infusion therapy consisting of polyionic solutions was applied by assessing blood electrolyte level. Fresh frozen plasma and albumin were transfused upon decline of serum protein and albumin level. Packed erythrocytes Erythrocyte mass and hemostatic drugs were injected in case of severe intestinal amebiasis if indicated: dicynone, cryoprecipitate, and calcium preparations. Finally, anemia cases were treated as well. In all cases, the disease outcome was favorable, without any mortality. Complications were noted in the form of intestinal bleeding observed in 6 patients (4.0%), wherein amebiasis proceeded together with ulcerative colitis. Acute intestinal amebiasis is currently featured with typical clinical picture that proceeds with less severe symptoms. Intestinal bleeding was observed in patients with intestinal amoebiasis in combination with ulcerative colitis. Chronization of intestinal amebiasis occurs in single cases (3.9%).

Background Azithromycin is frequently used to treat shigellosis; however, clinical outcomes are uncertain. Methods We performed an observational cohort study in Bangladesh of patients with invasive diarrhea treated empirically with azithromycin. Susceptibility testing was performed by broth microdilution and disk diffusion post hoc on all Shigella isolates and clinical response was correlated with in vitro susceptibility. Results There were 149 Shigella culture-positive patients in the primary analysis. Infection with Shigella with decreased susceptibility to azithromycin was significantly associated with persistence of diarrhea at day 5 (31% vs 12%; relative risk [RR], 2.66; 95% confidence interval [CI], 1.34–5.28), culture positivity at day 5 or 6 (35% vs 5%; RR, 5.26; 95% CI, 1.84–14.85), and a higher rate of overnight hospitalization (58% vs 39%; RR, 1.49; 95% CI, 1.06–2.09). Shigella flexneri was more common than Shigella sonnei (58% vs 36%); however, S. sonnei constituted most of the isolates with decreased susceptibility to azithromycin (67%) and most of the multidrug-resistant strains (54%); thus, poor clinical outcomes were associated with S. sonnei. The current epidemiological cutoff for S. flexneri of ≥16 µg/mL to define decreased susceptibility to azithromycin was clinically predictive of poor outcome. Patients with S. sonnei and a low MIC (4 µg/mL) still had elevated rates of persistent diarrhea and culture positivity. Conclusions This study documents worse clinical outcomes for S. flexneri with decreased susceptibility to azithromycin, as well as S. sonnei, and supports the utility of susceptibility testing and clinical breakpoints for azithromycin. S. sonnei is an emerging drug-resistant threat. Clinical Trials Registration NCT03778125.

Shigellosis outbreaks caused by Shigella with decreased susceptibility to azithromycin (DSA-Shigella) among men who have sex with men (MSM) have been reported worldwide. We describe sexual health indicators and antimicrobial drug resistance for shigellosis cases in Minnesota, USA. We analyzed a sample of isolates received during 2012-2015 and cross-referenced cases with the Minnesota Department of Health Sexually Transmitted Disease Database to ascertain patients' HIV status and recent chlamydia, gonorrhea, and syphilis infections. Of 691 Shigella isolates, 46 (7%) were DSA-Shigella; 91% of DSA-Shigella patients were men, of whom 60% were living with HIV. Among men, those with DSA-Shigella infection had greater odds of living with HIV, identifying as MSM, or having a recent diagnosis of a sexually transmitted disease. DSA-Shigella was associated with MSM, HIV infection, and recent sexually transmitted disease. To decrease spread of DSA-Shigella, interventions targeted at communities at high risk are needed.

BackgroundDeveloping countries exhibit a high disease burden from shigellosis. Owing to the different incidences in males and females, this study aims to analyze the features involved in the transmission of shigellosis among male (subscriptm) and female (subscriptf) individuals using a newly developed sex-based model.MethodsThe data of reported shigellosis cases were collected from the China Information System for Disease Control and Prevention in Hubei Province from 2005 to 2017. A sex-based Susceptible–Exposed–Infectious/Asymptomatic–Recovered (SEIAR) model was applied to explore the dataset, and a sex-age-based SEIAR model was applied in 2010 to explore the sex- and age-specific transmissions.ResultsFrom 2005 to 2017, 130 770 shigellosis cases (including 73 981 male and 56 789 female cases) were reported in Hubei Province. The SEIAR model exhibited a significant fitting effect with the shigellosis data (P 8forSARmm(secondary attack rate from male to male), 2.5729 × 108forSARmf, 2.7630 × 10-8forSARfm, and 2.1061 × 10-8forSARff. The top five mean values of the transmission relative rate in 2010 (where the subscript 1 was defined as male and age ≤ 5 years, 2 was male and age 6 to 59 years, 3 was male and age ≥ 60 years, 4 was female and age ≤ 5 years, 5 was female and age 6 to 59 years, and 6 was male and age ≥ 60 years) were 5.76 × 10-8forβ61, 5.32 × 10-8forβ31, 4.01 × 10-8forβ34, 7.52 × 10-9forβ62, and 6.04 × 10-9forβ64.ConclusionsThe transmissibility of shigellosis differed among male and female individuals. The transmissibility between the genders was higher than that within the genders, particularly female-to-male transmission. The most important route in children (age ≤ 5 years) was transmission from the elderly (age ≥ 60 years). Therefore, the greatest interventions should be applied in females and the elderly.

The analysis of the cellular immune response indicators in shigellosis in 90 children aged four to ten years infected with cytomegolovirus. It was found that in the acute period of the disease in children with mixed infection, the content of CD3 +, CD4 + and CD8 + cells of peripheral blood decreases, and by the period of early reconvalescence, the full recovery of cellular immunity indicators in these children does not occur. The revealed features of cellular immunity in shigellosis in children infected with CMV may be the cause of an unfavorable course of the disease and require further research.

Information on causative diarrheal pathogens and their associated antimicrobial susceptibility remains limited for Cambodia. This study describes antimicrobial resistance patterns for Shigella and nontyphoidal Salmonella isolates collected in Cambodia over a 5-year period. Multidrug resistance was shown in 98% of Shigella isolates, with 70%, 11%, and 29% of isolates being resistant to fluoroquinolones, azithromycin, and cephalosporin, respectively. As many as 11% of Shigella isolates were resistant to nearly all oral and parenteral drugs typically used for shigellosis, demonstrating extreme drug resistance phenotypes. Although a vast majority of nontyphoidal Salmonella isolates remained susceptible to cephalosporins (99%) and macrolides (98%), decreased susceptibility to ciprofloxacin was found in 67% of isolates, which is notably higher than previous reports. In conclusion, increasing antimicrobial resistance of Shigella and nontyphoidal Salmonella is a major concern for selecting empirical treatment of acute infectious diarrhea in Cambodia. Treatment practices should be updated and follow local antimicrobial resistance data for the identified pathogens.

It has recently been shown that children with early shigellosis are at increased risk of attention deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the association between antibiotic treatment of shigellosis with long-term ADHD rates. A retrospective cohort study was conducted that included all the Leumit Health Services (LHS) enrollees aged 5–18 years between 2000–2018 with a documented Shigella-positive gastroenteritis before the age of 3 years. Of the 5176 children who were positive for Shigella gastroenteritis before the age of 3 years, 972 (18.8%) were treated with antibiotics early (

Shigella spp. are a leading cause of diarrhea-associated global morbidity and mortality. Development and widespread implementation of an efficacious vaccine remain the best option to reduce Shigella-specific morbidity. Unfortunately, the lack of a well-defined correlate of protection for shigellosis continues to hinder vaccine development efforts. Shigella controlled human infection models (CHIM) are often used in the early stages of vaccine development to provide preliminary estimates of vaccine efficacy; however, CHIMs also provide the opportunity to conduct in-depth immune response characterizations pre- and postvaccination or pre- and postinfection. In the current study, principal-component analyses were used to examine immune response data from two recent Shigella CHIMs in order to characterize immune response profiles associated with parenteral immunization, oral challenge with Shigella flexneri 2a, or oral challenge with Shigella sonnei. Although parenteral immunization induced an immune profile characterized by robust systemic antibody responses, it also included mucosal responses. Interestingly, oral challenge with S. flexneri 2a induced a distinctively different profile compared to S. sonnei, characterized by a relatively balanced systemic and mucosal response. In contrast, S. sonnei induced robust increases in mucosal antibodies with no differences in systemic responses across shigellosis outcomes postchallenge. Furthermore, S. flexneri 2a challenge induced significantly higher levels of intestinal inflammation compared to S. sonnei, suggesting that both serotypes may also differ in how they trigger induction and activation of innate immunity. These findings could have important implications for Shigella vaccine development as protective immune mechanisms may differ across Shigella serotypes. IMPORTANCE Although immune correlates of protection have yet to be defined for shigellosis, prior studies have demonstrated that Shigella infection provides protection against reinfection in a serotype-specific manner. Therefore, it is likely that subjects with moderate to severe disease post-oral challenge would be protected from a homologous rechallenge, and investigating immune responses in these subjects may help identify immune markers associated with the development of protective immunity. This is the first study to describe distinct innate and adaptive immune profiles post-oral challenge with two different Shigella serotypes. Analyses conducted here provide essential insights into the potential of different immune mechanisms required to elicit protective immunity, depending on the Shigella serotype. Such differences could have significant impacts on vaccine design and development within the Shigella field and should be further investigated across multiple Shigella serotypes.

Introduction Shigellosis can present as a severe infection, including bloody diarrhea. About 22% of reported shigellosis cases in the Netherlands occur in men who have sex with men (MSM). Not all infections result in clinical symptoms and not all persons with clinical symptoms are diagnosed. We performed a study among MSM visiting the STI clinic in Amsterdam to assess the prevalence of Shigella. Methods From March to June, 2020, Anal swab samples taken from MSM routinely visiting the STI clinic to detect Chlamydia trachomatis and Neisseria gonorrhoeae were additionally tested pseudonymously for the presence of Shigella by PCR on the ipaH gene. Consecutive samples from MSM who reported no diarrhea, or diarrhea during last month, or diarrhea at visit of clinic were included. Predefined minimal numbers of inclusion of these groups were 150, 100 and 50, respectively. During the same months the frequency of Shigella as assessed by PCR in routinely tested samples sent by general physicians was assessed. Results We included samples from 214 MSM without diarrhea, 109 MSM who recently had diarrhea and 68 MSM who reported diarrhea at visit of the clinic. The total number of samples positive for Shigella was 13/389 (3.3%), of whom 6/212 (2.8%) had no diarrhea, 4/107 (3.7%) recently had diarrhea and 3/68 (4.4%) had diarrhea at clinic visit. Positive samples were more frequently found in persons using or recently having used PREP (10/152), compared to no PREP (2/163) or being HIV-positive (1/74) (p=0.02, chi square test). In comparison, only 11/774 (1.4%) routinely tested fecal samples sent by general physicians during the study period were positive for Shigella. Conclusion Shigella infections without symptoms or with minor symptoms are relatively common in MSM. More detailed studies should focus on the risk of transmission from these persons to others, leading to symptomatic infections.

A comparative analysis of the humoral immune response in shigellosis in 90 children aged four to ten years infected with cytomegolovirus (CMV) was performed. It was found that shigellosis in young children on the background of CMV infection is characterized by torpid changes in the parameters of the main classes of immunoglobulins in the dynamics of the disease. with the exception of serum IgG. The IgG content in patients with shigellosis and infected with CMV is significantly higher both in comparison with the control group. and in children without concomitant infection. The revealed features of the response of the humoral immune system can be an auxiliary diagnostic criterion for the infection of CMV in children with shigellosis. as well as the cause of the development of an unfavorable course of the disease. which requires further investigation.

The Shigella controlled human infection model (CHIM) is valuable for assessing candidate Shigella vaccine efficacy and potentially accelerating regulatory approval. The Shigella CHIM is currently being conducted at 3 sites in the United States using Shigella flexneri 2a strain 2457T and Shigella sonnei strain 53G. Shigellosis can present variably as watery diarrhea alone or with dysentery, and can be accompanied by manifestations including fever, abdominal cramps, tenesmus, and malaise. For comparability, it is important to harmonize the primary clinical endpoint. An expert working group was convened on 2 February 2018 to review clinical data from Shigella CHIM studies performed to date and to develop a consensus primary endpoint. The consensus endpoint enabled “shigellosis” to present as severe diarrhea or moderate diarrhea or dysentery. The latter 2 criteria are met when concurrent with fever of 38.0°C and/or vomiting, and/or a constitutional/enteric symptom graded at least as “moderate” severity. The use of a blinded independent committee to adjudicate the primary endpoint by subject was also regarded as important. As safety of volunteers in challenge studies is of paramount importance and treatment timing can affect primary outcomes, a standard for early antibiotic administration was established as follows: (1) when the primary endpoint is met; (2) if a fever of ≥39.0°C develops; or (3) if the study physician deems it appropriate. Otherwise, antibiotics are given at 120 hours postinfectious challenge. The working group agreed on objective and subjective symptoms to be solicited, and standardized methods for assessing subject-reported severity of symptoms.

Objective: to study the clinical and laboratory manifestations of acute intestinal infections of bacterial etiology in hospitalized children, depending on the etiology, age, topic of the lesion, and complications.A cohort clinical study of 570 children hospitalized from January to October 2019 in the infectious wards of Children's Clinical Hospital No.9 in Moscow was conducted. Studies included routine laboratory methods, bacteriological analysis of feces, Latex test, ELISA, PCR to detect pathogens, serological reactions to detect specific antibodies in blood serum. Two groups of patients were specially formed to compare the features of the course of bacterial diarrhea without hemorrhagic colitis (n = 111) and with hemorrhagic colitis (n = 125).Among 33.2% of cases of deciphered etiology of bacterial diarrhea, Salmonella was isolated in 14.6%, Campylobacter — in 4.7%, Shigella — in 3%, in other cases — conditionally pathogenic flora. Salmonellosis and Сampylobacteriosis with the same frequency are recorded in children in the age groups of 1—3 and 3—7 years, in half of the patients proceed as enterocolitis (58 and 52%, respectively). Shigellosis is diagnosed in children older than 1 year of life with the same frequency in age groups 1—3, 3—7 and older than 7 years, a third of patients (35%) develop severe forms.In most cases (83.2%), a complicated course of bacterial diarrhea was detected, more often dehydration 1 and 2 degrees (36.5%), acute respiratory viral infections (19.6%), mesadenitis (11.2%), community-acquired pneumonia (4.6%).Enterocolitis is the topic of lesion in half of the children, and every 5th patient develops hemorrhagic colitis (21.9%). In 44% of cases of established etiology of hemorrhagic colitis, Salmonella was confirmed. Hemocolitis also develops more often with shigellosis, campylobacteriosis and clostridiosis. In the group of bacterial diarrhea with hemorrhagic colitis, significant differences were revealed compared with the group without hemocolitis: by the frequency of development in children under 3 years of age; by the duration of treatment in a hospital; by the frequency of mesadenitis; by the content of stab neutrophils in the hemogram, reflecting a more pronounced inflammation in hemorrhagic colitis.Thus, bacterial diarrhea in children remains relevant due to the severity of inflammation, the incidence of complicated course and hemorrhagic colitis, which requires hospitalization.

Sexually transmitted infections (STIs) are a major problem worldwide. In addition, the spectrum of STIs is now expanding, including parasitic, bacterial, and viral infections. The study retrospectively describes the presence of enteric pathogens among 73 patients with gastrointestinal symptoms of enteritis and proctocolitis attending to an STI unit in Barcelona, Spain, between 2015 and 2016. Only patients investigated for intestinal parasitic infections were included in the study. Different diagnostic procedures were established for the detection of parasites, bacterial enteropathogens, and other STI agents. Entamoeba histolytica was the most prevalent pathogen in our cohort (20.5%), especially among individuals with proctocolitis. Contrarily, Giardia intestinalis was detected in 11.0% of patients, only associated with enteritis cases. Polymicrobial infections were common in our study (45.2%). Of note, 55.6% of shigellosis cases were coinfected with E. histolytica. The investigation highlights the importance of including parasites as differential gastrointestinal diagnosis, disregarding travel history, particularly among risk populations.

Shigella is a leading cause of gastroenteritis worldwide; however, data on clinical outcomes amongst adults are lacking. All adult cases (>16 years) of Shigella gastroenteritis diagnosed between January 2014 to December 2017 at an East London NHS Trust in the United Kingdom were included. Demographic, clinical, microbiological and whole genome sequencing (WGS) data were retrospectively collected. Shigella spp isolates from 169 cases were identified: S. flexneri 90 (53.3%), S. sonnei 75 (44.9%) and S. boydii 4 (2.0%). The median age was 34 years (IQR 29–45), and 127 (75.1%) were male. S. flexneri cases were more likely to attend accident and emergency (46.7% vs. 25.3%, p = 0.005), be admitted to hospital (26.7% vs. 10.7%, p = 0.01), and receive antibiotics (51.1% vs. 28.0%, p = 0.003) compared to S. sonnei cases. Thirty-two (18.9%) patients were admitted to hospital for a median of five days (IQR 3–8). Where recorded 42/84 (50.0%) reported recent travel. Seventeen (10.1%) patients experienced complications. There were no deaths within one year of diagnosis. Seventy-nine isolates were characterised by WGS. Fifty-seven (72.2%) belonged to known national clusters; 44 (55.7%) involving adult males and 11 (13.9%) travel-associated clusters. We demonstrate the development of severe complications of shigellosis among adults and highlight the changing epidemiology and antibiotic resistance patterns.

Using data of the branch statistical reporting of the State Sanitary and Epidemiological Service in Sumy region and Sumy Regional State Laboratory of Veterinary Medicine, the incidence rate, modern risk factors for the development and spreading of acute infectious diarrheas were determined in the North-Eastern region of Ukraine. Under the current conditions incidence rate indices of acute intestinal infections and food toxicoinfections are within the range of 159.8-193.6 per 100 thousands. pop. Seasonal and epidemical rises are associated with a species of the agent. In the etiological structure of acute diarrheal infections there are dominated viruses, of food toxicoinfections--Klebsiellae pneumoniae, Staphylococcus aureus and Enterobacter cloacae (p < 0.05). Predictors of the complication of epidemiological situation of Shigella infections are the gain in the detection of bacterially contaminated samples of milk and dairy products (r = 0.75), for food toxicoinfections caused by Klebsiellae pneumoniae and Enterobacter cloacae--pastry with cream and cooking meat products (r = 0.64; r = 0.75). Epizootic situation in the region affects on the salmonellosis incidence rate of the population (r = 0.89). There were revealed correlations between the selection of E. coli bacteria from swabs taken from the enterprises of catering, in child care centers and the levels of incidence rates of salmonellosis, acute intestinal infections of unknown etiology (r = 0.59; r = 0.60). Timely detection and sanitation of Shigella carriers are a powerful instrument to reduce the incidence rate of shigellosis (r = 0.83).

Food-borne illness are diseases happened because eating polluted water or nutriment containing microbes or their toxins. This paper reviews previous studies of foodborne illness, particularly foodborne illness happened because bacteria which represent 66% of problems. Vibrosis, Shigellosis, Bacillosis, Listerosis Salmonellosis, Botulism, and staphylococcal food poisoning are the main dietary disease happened because of bacteria. Bacteria in nutrition will increase beneath optimal cases and secrete poison in nutrition. After swallowing, poisons were absorbed by Intestinal epithelial lining that make natural harm to tissues. In certain cases, poisons are transmitted to tissues or devices like the central nervous system, kidney nor liver where they can cause damage. Foods carried diseases are divided into two collections which are food infection and poisoning. Food infection is happened because eating food, including fertile pathogens that secrete toxins in the intestine only, while poisoning is acquired by eating poison formed by pathogens (secrete toxins directly in the food). The most clinical sign of food poisoning are abdominal cramps, diarrhea, vomiting, nausea, and headache. Diagnosis of foodborne illnesses carried by a patient’s record and the symptoms. Protection of foodborne diseases can be depended on food safety control during the production, processing, and distribution, secession of uncooked from cooked food, cooking carefully, and save food at a safe temperature.

The incidence of acute intestinal infections in the Russian Federation remains high and does not tend to decrease. The General susceptibility of the population, the variety of pathogens of infectious diseases accompanied by diarrhea syndrome, necessitates the improvement of clinical diagnosis and differential diagnosis in the treatment of patients with diarrhea at the primary stage of medical care. The article presents the etiological and epidemiological aspects of the most common in the Russian Federation acute intestinal infectious diseases accompanied by diarrhea syndrome: food toxicoinfections, viral gastroenteritis, salmonellosis, shigellosis, campylobacteriosis, pseudomembranous colitis. The sources of infection and pathways of pathogens are characterized. The pathogenesis of the main types of diarrhea caused by various pathogens of intestinal infections is described. It is shown that the action of enterotoxins of pathogens that activate adenylate cyclase contributes to the development of secretory type of diarrhea; the place of localization of the pathological process is the small intestine. Pathogens exhibiting high invasive activity contribute to the development of inflammatory type of diarrhea; the pathological process is localized in the colon. With direct damage to enterocytes of the small intestine by pathogens of viral gastroenteritis, an osmotic type of diarrhea is formed, associated with a violation of the digesting and absorption function of the small intestine. Presented distinctive clinical criteria of three types of diarrhea: color, consistency of the stool, the presence of pathological impurities in it. The differences of abdominal syndrome in the analyzed nosology: the nature and localization of abdominal pain. The presented differential diagnostic signs of diarrhea and abdominal syndrome allow for early diagnosis of infectious disease before laboratory confirmation and contribute to the improvement of the algorithm of medical care in acute intestinal infections accompanied by diarrhea syndrome.

We reported earlier about nano-formulation of tetracycline through its entrapment within calcium-phosphate nano-particle (CPNP) and about killing of pathogenic bacterium Shigella flexnari 2a, resistant to tetracycline (and 9 other antibiotics), by the nanonized antibiotic (Tet-CPNP). Here, we report on therapeutic role of Tet-CPNP against deadly diarrheal disease 'shigellosis' in mice, caused by Shigella infection. Our findings revealed that occurrence of mushy-stool excretion, colon-length shortening, weight-loss and bacterial colonization in gastrointestinal tract of mice due to shigellosis was significantly reduced by Tet-CPNP treatment. Histo- and immuno-logical studies showed that changes in morphology and level of inflammatory cytokines TNF-α, IL-1β and IFN-γ in intestinal tissue of Shigella-infected mice were reverted to almost normal features by Tet-CPNP treatment. Bulk tetracycline had no anti-shigellosis action. Thus, nanonization of tetracycline rejuvenated the old, cheap, broad-spectrum antibiotic from obsolescence (due to resistance generation), making it highly beneficial for diarrhea-prone developing countries with limited health-care budgets.

Shigella is a leading cause of diarrhea among children globally and of diarrheal deaths among children under 5 years of age in low- and middle-income countries. To date, no licensed Shigella vaccin...

Objective: Acute gastroenteritis (AGE) is a risk factor for post-infectious irritable bowel syndrome (PI-IBS). This systematic review evaluates the prevalence and risk-factors of PI-IBS after AGE by specific pathogens. Materials and methods: Medline (1966–2019) and Embase (1974–2019) were searched for studies evaluating PI-IBS minimum 3 months after AGE with Campylobacter spp., Salmonella spp., Shigella spp., Escherischia coli, Clostridium difficile, norovirus, rotavirus, Cryptosporidium spp. or Giardia intestinalis using validated criteria for IBS. Pooled prevalence (PP), odds ratios (OR) and risk factors were determined for single pathogens, groups of bacteria, viruses and parasites, and overall for AGE caused by any pathogen. Random-effect models were used for meta-analyses. Results: A total of 34 articles were included. PP of PI-IBS after Campylobacter spp. was 12% (confidence interval 95% [CI]: 10–15%), Salmonellosis 12% (CI: 9–15%), Shigellosis 11% (CI: 8–15%), C. difficile 14% (CI: 4–29%) and E. coli spp. 12% (CI: 5–20%). OR of PI-IBS after salmonellosis was 5.5 (CI: 2.3–12.8) and after shigellosis 13.8 (CI: 4.2–45.4). Bacterial AGE overall showed OR 5.8 (CI: 4.0–8.3) and AGE caused by any pathogen OR 4.9 (CI: 3.9–6.1). Few studies exist on viral and parasitic gastroenteritis. Conclusions: Current literature show similar risks for bacterial pathogens. Studies are limited for viral and parasitic pathogens. The evaluated risk-factors for PI-IBS varied among the included studies and the existing evidence is insufficient to identify pathogen-specific risk factors.

Objectives: Ultraorthodox Jewish populations living in towns with good sanitary infrastructure but with conditions of crowding have been the epicenter of Shigella sonnei shigellosis outbreaks. In this study, the incidence and risk factors of S. sonnei shigellosis in children living in an ultraorthodox community were determined. Methods: Data for the years 2000–2013 for all reported culture-proven S. sonnei shigellosis cases in children aged 0–59 months in the city of Elad were compared with data for the rest of the sub-district. Environmental factors obtained through parental interviews were evaluated for 78 incident cases of S. sonnei shigellosis and 141 community controls, matched by age, sex, and neighborhood. Conditional logistic regression models were performed. Results: Cyclic epidemics of S. sonnei shigellosis occurred every 2 years. The mean annual incidence was 10.0 per 1000 children in Elad (95% confidence interval 7.9–12.6) vs. 3.8 per 1000 children (95% confidence interval 3.3–4.4) in the sub-district (p

Background We describe the epidemiology and antimicrobial susceptibility patterns of culture-confirmed Shigella infections in facility-based surveillance sites in Guatemala. Current studies using quantitative molecular diagnostics suggest Shigella may contribute most to the global diarrheal disease burden. Since identification of Shigella requires culturing techniques using stool specimens and few laboratories in Guatemala routinely culture for this pathogen, little is known about the true burden of Shigella in Guatemala or, importantly, the antimicrobial resistance patterns. Methods Clinical, epidemiological, and laboratory data were collected on 5399 patients with acute diarrhea (≥3 loose stools in 24 h) from June 2007–August 2012. Multidrug resistance (MDR) was defined as resistance to ampicillin and trimethoprim/sulfamethoxazole. Results Five percent (261) of stool specimens yielded Shigella spp. The annual incidence of laboratory-confirmed infections ranged from 5.0 to 24.1 per 100,000 persons in Santa Rosa and 0.3 to 6.2 per 100,000 in Quetzaltenango; 58% of cases occurred in children

Background Diarrhea caused by Shigella species remains a major public health threat especially in the pediatric population. A regular surveillance system needs to be in place, in order to explore the burden, antimicrobial resistance patterns and associated risk factors for Shigella infections. Therefore, the aim of this study was to assess the prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella infections among diarrheic pediatric population attending at selected healthcare institutions in Gondar town. Methods A cross-sectional study was conducted in Gondar town healthcare institutions from January to March 2018. A simple random sampling technique was used to enroll 272 study participants. Structured questionnaires were used to gather socio-demographic, environmental and associated risk factors data. Stool samples were collected from diarrheic pediatric patients and inoculated onto MacConkey media, salmonella-shigella agar, and xylose-lysine deoxy-cholate agar. Identification of the bacterial species was carried out by using biochemical tests. The disc-diffusion method was used to determine the antimicrobial susceptibility of the isolates by standardizing the bacterial suspension with a 0.5 McFarland solution. A statistical analysis was done using SPSS version 20 statistical package and P-value

Infectious diarrheas are a current problem of children’s age. Despite prevalence in structure of acute intestinal infections at children of a viral gastroenteritis dysentery keeps the relevance owing to development of severe forms of a disease and serious complications. The choice of drug for etiotropic treatment of bacterial diarrheas at children’s age taking into account the existing international and Russian recommendations is difficult and ambiguous. The efficiency of many modern antibacterial drugs which are traditionally used for treatment of a shigellosis and others infectious diarrheas decreases because of high prevalence of polyresistant strains. It is known that so far, at infectious diarrheas unreasonably long antibacterial therapy with change of 3–4 medicines is carried out, repeated courses of germicides at a reconvalescents bacterioexcretion of activators of infectious diarrheas are widely appointed, unfairly short antimicrobial therapy takes place less often. Despite existence modern diagnostic the test of systems antibiotic-associated diarrheas are often late diagnosed that lead to development of severe forms of a disease or complications. The negative C. difficile toxins test does not allow to exclude the antibiotic-associated nature of diarrhea completely. The clinical case of dysentery of Fleksneri at the child caused by a strain with a multiple antimicrobial resistance and which led to development of antibioticassociated colitis and dynamic intestinal impassability is given as an example in article. Therefore, when choosing antimicrobial drug means for treatment of infectious diarrheas it is necessary to consider regional features of the circulating activator strains.

Background In the event of a shigellosis outbreak in a childcare setting, exclusion policies are typically applied to afflicted children to limit shigellosis transmission. However, there is scarce evidence of their impact. Methods We evaluated five exclusion policies: Children return to childcare after: i) two consecutive laboratory tests (either PCR or culture) do not detect Shigella, ii) a single negative laboratory test (PCR or culture) does not detect Shigella, iii) seven days after beginning antimicrobial treatment, iv) after being symptom-free for 24 h, or v) 14 days after symptom onset. We also included four treatments to assess the policy options: i) immediate, effective treatment; ii) effective treatment after laboratory diagnosis; iii) no treatment; iv) ineffective treatment. Relying on published data, we calculated the likelihood that a child reentering childcare would be infectious, and the number of childcare-days lost per policy. Results Requiring two consecutive negative PCR tests yielded a probability of onward transmission of