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Objectives: Shigellosis is one of the infectious diseases causing severe intestinal illness in human beings. Development of an effective vaccine against Shigella is a key to deal with this bacterium. The present study aimed at evaluation of the antibody response as well as the protection of the recombinant chimeric protein containing IpaD, IpaB, StxB, and VirG against Shigella dysentery and flexneri., Methods: Chimeric protein was expressed and purified by Ni-NTA resin. The identity of the protein was determined by Western blot analysis. Mouse groups were immunized with the recombinant protein and the humoral immune response was measured by Enzyme-Linked Immunosorbent Assay (ELISA). Additionally, neutralization of the bacterial toxin by antibody was assessed by MTT assay. Animal challenge against S.dysentery and S. flexneri was evaluated, as well., Results: Protein expression and purification were confirmed by SDS-PAGE and western blotting. Analysis of the immune responses demonstrated that the antibody responses were higher in the sera of the subcutaneously immunized mice compared to those immunized intraperitoneally. In vitro neutralization analysis indicated that the 1:10000 dilution of the sera had a high ability to neutralize 0.25 ng/µl (CD50) of the toxin on the Vero cell line. Furthermore, the results of the animal challenge showed that the immunized mice were completely protected against 50 LD50 of the bacterial toxin. Immunization also protected 80% of the mice from 10 LD 50 by S. flexneri and S.dysentery. In addition, passive immunization conferred 60% protection in the mice against S. flexneri and S.dysentery. Organ burden studies also revealed a significant reduction in infection among the immunized mice., Conclusion: This study revealed that the chimeric protein produced inE. colicould be a promising chimeric immunogen candidate against Shigella., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Salmonella and Shigella bacteria are food- and waterborne pathogens that are responsible for enteric infections in humans and are still the major cause of morbidity and mortality in the emerging countries. The existence of multiple Salmonella and Shigella serotypes as well as the emergence of strains resistant to antibiotics requires the development of broadly protective therapies. Recently, the needle tip proteins of the type III secretion system of these bacteria were successfully utilized (SipD for Salmonella and IpaD for Shigella) as vaccine immunogens to provide good prophylactic cross-protection in murine models of infections. From these experiments, we have isolated a cross-protective monoclonal antibody directed against a conserved region of both proteins. Its conformational epitope determined by Deep Mutational Scanning is conserved among needle tip proteins of all pathogenic Shigella species and Salmonella serovars, and are well recognized by this antibody. Our study provides the first in vivo experimental evidence of the importance of this common region in the mechanism of virulence of Salmonella and Shigella and opens the way to the development of cross-protective therapeutic agents., Competing Interests: The authors have declared that no competing interests exist.

Shigella spp. are water-borne pathogens responsible for mild to severe cases bacilli dysentery all around the world known as Shigellosis. The progressively increasing of antibiotic resistance among Shigella calls for developing and establishing novel alternative therapeutic methods. The present study aimed to evaluate a novel phage cocktail of lytic phages against extended spectrum beta lactamase isolates of Shigella species in an aquatic environment. The phage cocktail containing six novel Shigella specific phages showed a broad host spectrum. The cocktail was very stable in aquatic environment. The cocktail resulted in about 99% decrease in the bacterial counts in the contaminated water by several species and strains of Shigella such as Shigella sonnei, Shigella flexneri and Shigella dysenteriae. Achieving such a high efficiency in this in-vitro study demonstrates a high potential for in-vivo and in-situ application of this phage cocktail as a bio-controlling agent against Shigella spp. contamination and infections., (© 2020 The Society for Applied Microbiology.)

GMMA are exosomes released from engineered Gram-negative bacteria resembling the composition of outer membranes. We applied the GMMA technology for the development of an O-Antigen (OAg) based vaccine against Shigella sonnei, the most epidemiologically relevant cause of shigellosis. S. sonnei OAg has been identified as a key antigen for protective immunity, and GMMA are able to induce anti-OAg-specific IgG response in animal models and healthy adults. The contribution of protein-specific antibodies induced upon vaccination with GMMA has never been fully elucidated. Anti-protein antibodies are induced in mice upon immunization with either OAg-negative and OAg-positive GMMA. Here we demonstrated that OAg chains shield the bacteria from anti-protein antibody binding and therefore anti-OAg antibodies were the main drivers of bactericidal activity against OAg-positive bacteria. Interestingly, antibodies that are not targeting the OAg are functional against OAg-negative bacteria. The immunodominant protein antigens were identified by proteomic analysis. Our study confirms a critical role of the OAg on the immune response induced by S. sonnei GMMA. However, little is known about OAg length and density regulation during infection and, therefore, protein exposure. Hence, the presence of protein antigens on S. sonnei GMMA represents an added value for GMMA vaccines compared to other OAg-based formulations.

Shigellosis is a diarrheal disease that causes high mortality every year, especially in children, elderly and immunocompromised patients. Recently, resistance strains to antibiotic therapy are in the rise and the World Health Organization prioritizes the development of a safe vaccine against the most common causal agent of shigellosis, Shigella flexneri. This pathogen uses autotransporter proteins such as SigA, Pic and Sap to increase virulence and some of them have been described as highly immunogenic proteins. In this study, we used immune-informatics analysis to identify the most antigenic epitope as a vaccine candidate on three passenger domains of auto-transporter proteins encoded on the pathogenic island SHI-1, to induce immunity against S. flexneri. Epitope identification was done using various servers such as Bepipred, Bcepred, nHLAPRED, NetMHCII, Rankpep and IEDB and the final selection was done based on its antigenicity using the VaxiJen server. Moreover, to enhance immunity, the GroEL adjuvant was added to the final construct as a Toll-like receptor 2 (TLR2) agonist. On the other hand, to predict the tertiary structure, the I-TASSER server was used, and the best model was structurally validated using the ProSA-web software and the Ramachandran plot. Subsequently, the model was refined and used for docking and molecular dynamics analyses with TLR2, which demonstrated an appropriate and stable interaction. In summary, a potential subunit vaccine candidate, that contains B and T cell epitopes with proper physicochemical properties was designed. This multiepitope vaccine is expected to elicit robust humoral and cellular immune responses and vest protective immunity against S. flexneri., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Shigellosis is one of the most important food-borne and water-borne diseases worldwide. Although antibiotics are considered as efficient agents for shigellosis treatment, improper use of these has led to the emergence of antibiotic-resistant Shigella spp. Therefore, finding a new strategy as alternative treatment seems necessary., Methodology: Different samples from a wastewater treatment plant were used to isolate Shigella spp. specific phages. Physiological properties were determined, and genomic analysis was also carried out., Results: A virulent Siphoviridae bacteriophage, vB_SsoS-ISF002, was isolated from urban wastewater in Iran and showed infectivity to different isolates of both Shigella sonnei and Shigella flexneri. vB_SsoS-ISF002 was stable at different pH values and temperatures. It had a short latent period (15 min), a large burst size (76±9 p.f.u. cell -1 ) and appropriate lytic activity especially at high MOI. Its genome (dsDNA) was 50 564 bp with 45.53 % GC content and 76 predicted open reading frames. According to comparative genomic analysis and phylogenic tree construction, vB_SsoS-ISF002 was considered as a member of the T1virus genus., Conclusion: These results indicated that vB_SsoS-ISF002 is a novel virulent T1virus phage and may have potential as an alternative treatment for shigellosis.

Shigellosis is a clinical syndrome caused by invasion of the epithelium lining the terminal ileum, colon, and rectum by Shigella species. Although infections occur globally, and in people of all ages, endemic infections among children aged 1-4 years living in low-income and middle-income settings constitute most of the disease burden. The versatile manifestations of these highly contagious organisms range from acute watery diarrhoea to fulminant dysentery characterised by frequent scant bloody stools with fever, prostration, and abdominal cramps. A broad array of uncommon, but often severe, intestinal and extraintestinal complications can occur. Despite marked reductions in mortality during the past three decades, there are roughly 164 000 annual deaths attributable to shigellosis. Intercontinental dissemination of multiresistant shigella strains, facilitated by travellers and men who have sex with men, has prompted new recommendations for antibiotic therapy. Awareness of disease burden and the emerging threats posed by shigella have accelerated interest in development of shigella vaccines, many of which are being tested in clinical trials., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Major achievements in the understanding of thrombotic microangiopathies (TMA) have not only resulted in a reclassification of TMA but most of all they have culminated in the design of new treatments and have enabled clinicians to better delineate their prognosis. Recent multicenter studies have improved our understanding of the prognosis of atypical hemolytic and uremic syndromes (aHUS). More specifically, they have highlighted the role of genetic testing on predicting the recurrence of aHUS, the risk of chronic kidney disease and the recurrence following kidney transplantation. A major advance consisted of the identification of the alternative complement pathway in the pathogenesis of aHUS, thus paving the way for the use of the C5a inhibitor eculizumab in this indication. Eculizumab has thereafter dramatically improved the management of patients affected with aHUS. During spring 2011, a great epidemic of entero-hemorrhagic Escherichia coli (EHEC) associated HUS occurred in Germany, providing clinicians the opportunity to examine the relevance of antibiotic prophylaxis, plasma exchange and eculizumab in EHEC-associated HUS. In this work, we herein present advances achieved in the setting of therapeutic management and prognosis in HUS and other related TMA syndromes., (Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Conjugation chemistry is among the most important parameters governing the efficacy of glycoconjugate vaccines. High robustness is required to ensure high yields and batch to batch reproducibility. Herein, we have established a robust bioconjugation protocol based on the thiol-maleimide addition. Major variables were determined and acceptable margins were investigated for a synthetic pentadecasaccharide-tetanus toxoid conjugate, which is a promising vaccine candidate against Shigella flexneri serotype 2a infection. The optimized process is applicable to any thiol-equipped hapten and provides an efficient control of the hapten:carrier ratio. Moreover, comparison of four S. flexneri 2a glycoconjugates only differing by their pentadecasaccharide:tetanus toxoid ratio confirmed preliminary findings indicating that hapten loading is critical for immunogenicity with an optimal ratio here in the range of 17 ± 5. In addition, the powerful influence of alum on the immunogenicity of a Shigella synthetic carbohydrate-based conjugate vaccine candidate is demonstrated for the first time, with a strong anti-S. flexneri 2a antibody response sustained for more than one year.

Acute infectious gastroenteritis continues to be a leading cause of morbidity and mortality in children below 5 years of age, with the majority of deaths concentrated in 35 'low income' countries. In these countries the under five years of age mortality rates reach 100 per 1000 live births, of which a significant proportion are associated with acute diarrhea. Rotavirus, cryptosporidium, Shigella spp and enterotoxigenic Escherichia coli are the main pathogens causing disease in these settings, although other bacteria and parasites can cause moderate to severe disease in different regions and situations. Treatment of children in these setting should be focused on appropriate rehydration, early hospitalization of severely malnourished children, zinc supplementation, and in specific situations, antimicrobials should be considered. The rationale for antimicrobial use should be based on the potential benefits based on published literature and the opportunity for use. This review provides a pathogen-specific update on the potential benefits of antimicrobials and suggests an empirical management approach for children suffering an acute watery or bloody diarrhea in a resource-limited region.

Hyperimmune bovine colostrum (HBC), produced by vaccination of a cow during gestation, is rich in targeted immunoglobulins, and can be used to treat a variety of diseases. The published history of HBC use for treating gastrointestinal infections in humans has developed over the past several decades and demonstrates the promise of this type of therapeutic for GI infectious disease. HBC, or purified derivative products, have been used successfully for treatment or prevention of cryptosporidiosis, shigellosis, rotavirus, enterotoxigenic E. coli, and C. difficile infection (CDI). Given the positive results of previous studies using HBC for treatment of CDI, we have produced HBC with antibodies against the two most important virulence factors of C. difficile, TcdA and TcdB, using a novel recombinant vaccine. Our preliminary results demonstrate efficacy of the HBC product for treatment of CDI in the gnotobiotic piglet model, and warrant more thorough investigation. HBC may provide an effective treatment alternative to antibiotics, which can spare the normal gut microflora, and reduce rates of recurrence and antibiotic resistance.

Shigella infections are a major cause of inflammatory diarrhea and dysentery worldwide. First-generation virG-based live attenuated Shigella strains have been successfully tested in phase I and II clinical trials and are a leading approach for Shigella vaccine development. Additional gene deletions in senA, senB and msbB2 have been engineered into second-generation virG-based Shigella flexneri 2a strains producing WRSf2G12 and WRSf2G15. Both strains harbor a unique combination of gene deletions designed to increase the safety of live Shigella vaccines. WRSf2G12 and WRSf2G15 are genetically stable and highly attenuated in both cell culture and animal models of infection. Ocular immunization of guinea pigs with either strain induces robust systemic and mucosal immune responses that protect against homologous challenge with wild-type Shigella. The data support further evaluation of the second-generation strains in a phase I clinical trial., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Shigellosis represents one of the main causes of bloody diarrhoea in South America. This study aimed to establish the incidence of shigellosis in an urban zone of Buenos Aires, Argentina, by examining the type of Shigella and living conditions associated with this infection., Methodology: Between January 2009 and December 2010 we analyzed shigellosis in children admitted to the public health service with bloody diarrhoea from La Plata, the capital of Buenos Aires, Argentina. A total of 372 children under 15 years old with Shigella present in their stool samples were admitted to the study. Variables studied were patient age, type of Shigella, family economic status, and access to sewage services and safe drinking water., Results: Shigella flexneri was found to be present in 66.8% of the cases. Incidence was 187 cases/year/100,000 children under 15 years old. Cases were mainly observed during the summer (38.5%) in the population of under 5 years old (69.1% of all cases). The risk of shigellosis increased 12 times in those children who lacked safe drinking water and this risk increased 1.5 times in the population without sewage services. Fewer cases of shigellosis were noted in downtown areas, while hot spots were identified in the suburbs. Treating one case of shigellosis has a local cost of US $976 while assuring safe drinking water and sewage services for one family costs US $634. , Conclusion: Incidence of shigellosis in urban areas is associated with quality of water and sewage services. Policies aimed at providing education and improving public utilities networks can help to reduce the incidence of shigellosis.

This study focused on identifying possible new options derived from natural sources for the treatment of bacterial infections. Several natural products were investigated for their potential in modulating Shigella-host-cell interactions. The proliferation of Shigella sonnei was effectively inhibited inside HEp-2 cells in the presence of 4-methoxycinnamic acid and propolin D. Propolin D also significantly reduced the apoptosis of infected macrophage-like U937 cells and moderately reduced the secretion of interleukin (IL)-1β and IL-18, which probably resulted from the inhibition of invasion plasmid antigen B secretion by this compound. Further characterization showed that propolin D did not prevent escape of Shigella from phagocytic vacuoles, as evidenced by actin-based motility and by the fact that addition of chloroquine did not further reduce the number of intracellular c.f.u. The role of propolin D in modulating autophagy could not be established under the experimental conditions used. As these compounds had no direct anti-Shigella activity in vitro, it was concluded that these compounds modulated Shigella-host-cell interactions by targeting yet-to-be defined mechanisms that provide benefits to host cells.

Background and Aims: Mature green banana (GB) fruit is rich in amylase-resistant starch that stimulates colonic production of short-chain fatty acids (referred to as fatty acid) and is useful in treating diarrheal diseases. We studied therapeutic effects of GB in childhood shigellosis by determining colonic fatty acid production in a double-blind, randomized, controlled, clinical trial., Methods: Seventy-three children aged 6 to 60 months with severe bloody dysentery caused by Shigella infection were either given a rice-based diet (54 kcal/dL), with cooked GB (250 g/L) (n = 34) or without GB (n = 39) for 5 days; all given ciprofloxacin (15 mg/kg, q12 hours). Stool volume, frequency, excretion of blood/mucus, and relevant clinical and laboratory indices were determined., Results: On day 5 (post-treatment), 59% children in GB group had no mucus compared with 36% in controls, fecal blood was completely cleared from 96% in GB group compared with 60% without GB (P < 0.05). GB treatment significantly reduced (P < 0.01) numbers of stools/day compared with controls (70% vs. 50%, P < 0.05). GB-specific reductions of mean fecal volumes (mL/kg) ranged from 25% to 40%; (P < 0.05) during the 5-day observations. Clinical success rates were 85% in GB group compared with 67% in controls (P < 0.05). GB significantly (P < 0.01) reduced fecal myeloperoxidase activity and increased fecal fatty acid concentrations (P < 0.01)., Conclusions: GB diet improves clinical severity in childhood shigellosis and could be a simple and useful adjunct for dietary management of this illness.

Objective: The purpose of this study was to develop a cost function model to estimate the public treatment cost of shigellosis patients in Thailand., Methods: This study is an incidence-based cost-of-illness analysis from a provider's perspective. The sample cases in this study were shigellosis patients residing in Kaengkhoi District, Saraburi Province, Thailand. All diarrhea patients who came to the health-care centers in Kaengkhoi District, Kaengkhoi District Hospital and Saraburi Regional Hospital during the period covering May 2002 to April 2003 were tested for Shigella spp. The sample for our study included all patients with culture that confirmed the presence of shigellosis. Public treatment cost was defined as the costs incurred by the health-care service facilities arising from individual cases. The cost was calculated based on the number of services that were utilized (clinic visits, hospitalization, pharmaceuticals, and laboratory investigations), as well as the unit cost of the services (material, labor and capital costs). The data were summarized using descriptive statistics. Furthermore, the stepwise multiple regressions were employed to create a cost function, and the uncertainty was tested by a one-way sensitivity analysis of varying discount rate, cost category, and drug prices., Results: Cost estimates were based from 137 episodes of 130 patients. Ninety-four percent of them received treatment as outpatients. One-fifth of the episodes were children aged less than 5 years old. The average public treatment cost was US$8.65 per episode based on 2006 prices (95% CI, 4.79, and 12.51) (approximately US$1 = 38.084 Thai baht). The majority of the treatment cost (59.3%) was consumed by the hospitalized patients, though they only accounted for 5.8% of all episodes. The sensitivity analysis on the component of costs and drug prices showed a variation in the public treatment cost ranging from US$8.29 to US$9.38 (-4.20% and 8.43% of the base-case, respectively). The public treatment cost model has an adjusted R(2) of 0.788. The positive predictor variables were types of services (inpatient and outpatient), types of health-care facilities (health center, district hospital, regional hospital), and insurance schemes (civil servants medical benefit scheme, social security scheme and universal health coverage scheme). Treatment cost was estimated for various scenarios based on the fitted cost model., Conclusion: The average public treatment cost of shigellosis in Thailand was estimated in this study. Service types, health-care facilities, and insurance schemes were the predictors used to predict nearly 80% of the cost. The estimated cost based on the fitted model can be employed for hospital management and health-care planning.

Shigellosis, commonly known as bacillary dysentery, is an enterobacterial disease caused by the Shigella genus, which now belongs to the Escherichia tribe, because of their genetic and phenotypic similarities. S. sonnei, flexneri, boydii and dysenteriae differ in their epidemiologic and pathogenic characteristics. S. sonnei is predominant in industrialized countries and causes the mildest disease. S. dysentery is especially dangerous because it occurs in outbreaks, sometimes in catastrophic situations, and has a high mortality rate. Shigellosis typically causes watery diarrhea followed by dysentery. It may be associated with a variety of mild to severe or even life-threatening complications. Shigellosis is a significant public health problem in developing countries where it remains a major cause of diarrhea-related morbidity and mortality, especially among children. Annual cases worldwide are estimated at 160 million. Shigellosis is a highly contagious disease of poor and crowded communities, with fecal-oral (hand-to-mouth) transmission, and an extremely low minimum infectious dose. Multidrug resistance is a serious problem. Ciprofloxacin is the first-line antibiotic, recommended for 3 days. Prevention and control should include personal hygiene, hand washing, sanitation, and water supply. No vaccine is available, but several candidates are currently being evaluated.

The O-specific polysaccharide (O-SP) domain of Shigella LPS is both an essential virulence factor and a protective antigen for this genus. A critical level of serum IgG anti-O-SP was shown to confer immunity to shigellosis, likely by complement-mediated bacteriolysis of the inoculum. Conjugate Shigella O-SP vaccines were shown to be safe and immunogenic in children, and, in a preliminary study, Shigella sonnei vaccine was protective in young adults. Characteristic of shigellosis is bacterial invasion of intestinal cells. Incubation of shigellae with postimmunization but not preimmunization sera of children vaccinated with S. sonnei or Shigella flexneri 2a O-SP conjugate vaccines inhibited in a type-specific and dose-dependent manner in vitro invasion of intestinal epithelial cells (Caco-2) and the infection-associated increases in IL-1beta and IL-8 mRNA and extracellular cytokine levels. Pretreatment of these sera or of Caco-2 cells with O-SP abrogated these effects also in a type-specific and dose-dependent manner. Confocal microscopy demonstrated antibody-specific inhibition of bacterial adhesion to HeLa cells. These protective effects were duplicated by IgG purified from these sera. These results suggest a dual role for IgG anti-O-SP. In addition to lysis of the inoculum in immune individuals, the newly synthesized IgG anti-O-SP in patients may terminate an established infection by inhibiting shigellae released from epithelial cells from invading new ones. A critical level of IgG anti-O-SP could, therefore, have a protective as well as a curative role in shigellosis.

Shigellosis , the acute enteric infection caused by bacteria of the genus Shigella , has a worldwide distribution with an estimated annual incidence of 164.7 million cases, of which 163.2 million occur in developing countries, and 1.1 million deaths. Sixty-nine percent of all episodes and 61 percent of all Shigella -related deaths involve children younger than 5 years old. In the United States, 10,000 to 15,000 cases of shigellosis are reported each year. Although usually confined to the colonic mucosa, shigellosis sometimes can cause extraintestinal complications. Recent publications have shed light on the clinical characteristics of Shigella -induced bacteremia, surgical complications, urogenital symptoms, and neurologic manifestations, and on the unique manifestations in the neonatal period. The mainstay of treatment of shigellosis in children is correction of the fluid and electrolyte loss, which often is achieved by the administration of oral rehydration solutions. Appropriate antibiotic therapy shortens the duration of both clinical symptoms and fecal excretion of the pathogen. However, the increasing antimicrobial resistance of shigellae worldwide constitutes a major problem. Regarding the pathophysiology of shigellosis and its complications, recent data not only elucidated the molecular mechanisms involved but also linked manifestations of disease to the interplay of bacterial virulence factors and host responses. The improved understanding of the pathophysiology is hoped to lead to innovative therapeutic approaches against shigellosis and new generations of vaccine candidates.

Dysentery, a severe form of diarrhoeal disease, is a major cause of morbidity and mortality. Paradoxically, virtually no studies have been conducted to examine beliefs and behaviours associated with dysentery. The explanatory model of dysentery was explored in a community in Dhaka, Bangladesh, to understand the acceptability of a vaccine against dysentery. A local term for bloody dysentery is widely known, and residents describe a progression of symptoms, which closely mirrors the biomedical model of the disease. Due to the symbolic significance of blood loss and the fact that there is much uncertainty regarding treatment, bloody dysentery is perceived to be extremely serious. Causal interpretations most commonly relate to humoral theories, and remedies involve the consumption of 'cooling' foods that will reduce the heat associated with dysentery. Despite many misconceptions about vaccines and the fact that this approach contradicts aetiological explanations, the perceived severity of the illness makes vaccines attractive compared to other preventative measures. The results illuminate relevant information for the implementation of a new vaccine.

Bovine colostrums are the "early" milk produced by cows during the first several days post-parturition. This "early" milk has a nutrient profile and immunological composition that differs substantially from "mature" milk. Included in the nutrient profile are higher amounts of immunoglobulins, growth factors, cytokines, and nucleosides than are found in milk. Bovine colostrums are also rich in oligosaccharides, antimicrobials, and immune-regulating factors. Available evidence suggests a beneficial effect of supplementation of bovine colostrums in improving body composition, aspects of athletic performance, diarrhea in persons with immune-deficiency syndromes, NSAID-induced gastrointestinal disturbances, and aspects of the acute phase response that occurs secondary to surgery. Specific hyperimmune bovine colostrums, produced to have high neutralizing titer activity against Cryptosporidia, H. pylori, measles, rotavirus, and Shigella sp., appear to have clinical utility in conditions associated with these infectious organisms.

Septic shock is a very unusual presentation of Shigella infection. We describe a 3-y-old child who developed severe septic shock and severe encephalopathy during an episode of dysentery caused by Shigella flexneri.

Background: Dysentery accounts for 20% of the 4.6 million diarrhea-associated deaths among children in developing countries, with the risk from death in dysenteric persistent diarrhea 10-fold higher than that in acute dysentery. Although Shigella accounts for the majority of dysenteric episodes, very little is known about the epidemiology of postshigellosis persistent diarrhea., Methods: Rural Bangladeshi children younger than 5 years of age (n = 1,756) were followed for 1 month after exposure to sentinel cases of Shigella dysentery. The likelihood of an acute diarrheal episode becoming persistent was assessed., Results: Diarrhea caused by Shigella was significantly associated with an increased risk of persistent diarrhea (age-adjusted relative risk, 1.83; 95% confidence interval, 1.19 to 2.81). Despite the use of nalidixic acid in dysenteric episodes, persistent diarrhea occurred in 23% of children with shigellosis. Infection by multiply antibiotic-resistant Shigella isolates (age-adjusted relative risk, 3.76; 95% confidence interval, 1.51 to 9.36) and occurrence of shigellosis during infancy were observed to be risk factors for initiation of Shigella diarrhea persistence. However, 88% of the persistent shigellosis episodes occurred in older children, 50% were associated with nondysenteric shigellosis and 79% were caused by Shigella species other than Shigella dysenteriae 1., Conclusions: These data demonstrate the importance of Shigella as a cause of persistent diarrhea and indicate that strategies to prevent postshigellosis persistent diarrhea must be broad-based, with a focus on older children as well as infants, management of nondysenteric as well as dysenteric disease and prevention of diarrhea caused by multiple Shigella species.

In Latin America, Shigella and shiga toxin-producing Escherichia coli are the two leading agents in the cause of bloody diarrhea. The already high and increasing antimicrobial resistance of Shigella also is a significant problem. Shiga toxin-producing E. coli is an emerging disease with life-threatening complications: hemolytic uremic syndrome. Although E. coli O157:H7 remains the most commonly recognized serotype, recently emerging, non-O157 bacteria may be the cause of a similar spectrum of disease in humans.

Gastrointestinal disease caused by Shiga toxin-producing bacteria (such as Escherichia coli O157:H7 and Shigella dysenteriae) is often complicated by life-threatening toxin-induced systemic sequelae, including hemolytic-uremic syndrome. Such infections can now be diagnosed very early in the course of the disease, but at present no effective therapeutic intervention is possible. Here, we constructed a recombinant bacterium that displayed a Shiga toxin receptor mimic on its surface, and it adsorbed and neutralized Shiga toxins with very high efficiency. Moreover, oral administration of the recombinant bacterium completely protected mice from challenge with an otherwise 100%-fatal dose of Shiga toxigenic E. coli. Thus, the bacterium shows great promise as a 'probiotic' treatment for Shiga toxigenic E. coli infections and dysentery.

Salmonella and Shigella are the second and third most common causes of bacterial food-borne disease in the United States and are a major global health problem. The prevention and treatment of disease caused by these organisms are complicated by the increase in multidrug-resistant strains and the lack of an effective vaccine. This article discusses the epidemiology, clinical features, and diagnostic techniques for both enteric pathogens.

Unlabelled: A 6-year-old girl is described who died following rapid neurological deterioration, ending in lethal cerebral oedema. Despite the absence of severe intestinal and metabolic derangement, Shigella was cultured from the stool. Toxic encephalopathy is responsible for death following this rare complication of childhood shigellosis in developed countries. The pathophysiology is unknown., Conclusion: Lethal toxic encephalopathy can be caused by Shigella despite the absence of severe intestinal and metabolic derangement. If shigelllosis is suspected, headache may be a first significant sign for the development of toxic encephalopathy. Early recognition and rapid measures to prevent brain oedema may improve outcome.

The paper presents results of multiple-modality treatment of patients with acute intestinal infections with making use of the drug preparation Kaopectate incorporating activated attapulgite which is a natural mixture of hydrates of magnesium silicate and silicate of alumina. The above drug has been shown to be endowed with a antidiarrheal and detoxifying activities.

The dynamic study of the characteristics of serum specific Shigella endotoxinemia was carried out in 60 patients with S.flexneri infection by EIA techniques. In addition, the level of Re-glycolipid in the blood of patients was determined in EIA with the use of Re-antibodies with the simultaneous study of the rectal microbiocenosis. The degree of dysbiotic disturbances in the intestine was found to be directly related to the levels of LPS of S.flexneri 2a O-antigens and Re-glycolipid of Gram-negative bacteria, circulating in the blood. In the presence of decompensation disturbances of intestinal microflora, delayed Shigella elimination was observed in 15% of the patients and the prolongation of clinical manifestions, in 79.2% of the patients. This investigation demonstrated the expediency of complex therapy with the use of the probiotic bifidumbacterin-forte, containing bifidobacteria adsorbed on activated carbon and capable of decreasing the level of endotoxinemia and correcting damaged microbiocenosis.

The paper presents analysis of clinical efficacy of etiotropic drugs in severe Flexner's dysentery chosen by sensitivity of the causing agent, schemes of antibacterial drugs of choice in the treatment of this disease, principles of detoxication therapy. Use of bacterial biological drugs in combined treatment of dysentery is validated.

Background: In some rare cases, Shigella flexneri infection may be associated with fulminating encephatopathy., Case Report: A 6-year-old girl was admitted with fever, diarrhea and consciousness abnormalities. Brain CT scan was normal. Shigella flexneri type 2 was isolated from the stools. Despite antibiotic therapy, the encephalopathy was lethal. Two siblings were also infected, the first with only diarrhea, the second with headache and mild consciousness abnormalities: both children had a favorable course., Conclusions: Shigella flexneri encephalopathy is associated with high mortality rate in developed countries. Presence of headache could be a poor prognostic factor.

A total of 234 patients with acute intestinal infections (AII) and chronic colitis presenting with diarrhoea were examined. In an acute phase of AII induced by conditionally pathogenic flora, salmonellae and shigellae, as well as in exacerbation of chronic colitis, blood aggregability appears to be on the increase, with the ability of erythrocytes to deformation getting worse. In rectal mucosa hemodynamic disorders are common, manifested by decrease in pulse blood filling, rate of bloodflow predominantly in small and medium-size arteries as well as blood supply as a whole. Applying polysorb to rectal mucosa of such patients with the aid of an atomizer in speedier manner than it is usually done in conventional modes of treatment makes for regression of clinical symptoms of the illness, decreases the level of endotoxicosis, speeds up normalization of blood aggregability, red cell deformability, promoting quick restoration of rectal mucose bloodflow, the anal canal sphincter strength, with its rigidity returning to normal.

A new inorganic sorbent is proposed endowed with high adsorption-chemical activity towards microorganisms. Animal studies showed that the preparation "Evirhip" is superior to coal-based sorbents (KAY and CKN) and polymethilsiloxan (PMS) towards pathogenic microorganisms, PMS having relatively higher adhesive activity towards Salmonellas than coal-based sorbents.

Since its first isolation in South Africa in 1994, Shigella dysenteriae type 1 has now spread to cause an epidemic outbreak in Natal Kwazulu, resulting in a steep rise in admissions for dysentery and the haemolytic uraemic syndrome in children. We report on the epidemic as it has evolved so far. A large outbreak is to be expected in South Africa in view of large scale poverty, lack of housing, and adequate water and sanitation, unless urgent public health measures are taken.

To evaluate if an energy-dense porridge liquefied by amylase-rich flour (ARF) from germinated wheat increased the calorie intake in children with acute shigellosis, we studied 66 children, aged 6-35 months, in a randomized, controlled clinical trial. Children were randomized to receive either an energy-dense porridge liquefied with ARF (group 1), a thick unaltered porridge (group 2) or a porridge diluted with water (group 3) to a similar viscosity as that in group 1. Mean +/- SD calorie intakes (kJ/kg/day) from the porridges were 280 +/- 113, 167 +/- 100 and 151 +/- 80 in groups 1, 2 and 3, respectively (p = 0.006, ANOVA). Total energy intakes (mean +/- SD) from the study diet and other food sources were 469 +/- 151, 377 +/- 121 and 351 +/- 100 kJ/kg/day, respectively (p = 0.006, ANOVA). Intake of breast milk was similar in all groups. Using multiple regression analysis the effect of ARF-treated energy-dense porridge in increasing the calorie intake persisted after adjusting for a number of confounders, such as age of the child, isolation of Shigella dysenteriae type 1 and fever. The results of this study suggest that ARF-treated porridge increases energy intake in infants and young children during acute shigellosis. This feeding approach may be useful in preventing malnutrition following dysentery due to shigellosis.

We describe septicemia due to Vibrio cholerae 0139 Bengal, the newly described causative agent of cholera, in a child who also had simultaneous intestinal infection with Shigella boydii. Because V. cholerae 0139 is capsulated, its propensity to cause extraintestinal infection is stressed.