trimethoprim--sulfamethoxazole-drug-combination and Dysentery--Bacillary

Annually, Shigella spp. cause ≈188 million cases of diarrheal disease globally, including 500,000 cases in the United States; rates of antimicrobial resistance are increasing. To determine antimicrobial resistance and risk factors in San Diego, California, USA, we retrospectively reviewed cases of diarrheal disease caused by Shigella flexneri and S. sonnei diagnosed during 2017-2020. Of 128 evaluable cases, S. flexneri was slightly more common than S. sonnei; most cases were in persons who were gay or bisexual cisgender men, were living with HIV, were unhoused, or used methamphetamines. Overall, rates of resistance to azithromycin, fluoroquinolones, ampicillin, and trimethoprim/sulfamethoxazole (TMP/SMX) were comparable to the most recent national data reported from the Centers for Disease Control and Prevention; 55% of isolates were resistant to azithromycin, 23% to fluoroquinolones, 70% to ampicillin, and 83% to TMP/SMX. The rates that we found for TMP/SMX were slightly higher than those in national data.

Topics: Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; California; Diarrhea; Drug Resistance, Bacterial; Dysentery, Bacillary; Fluoroquinolones; Humans; Male; Microbial Sensitivity Tests; Retrospective Studies; Shigella; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Shigella dysentery is a relatively common illness and occasionally causes death, worldwide. Mild symptoms are self-limiting but in more severe cases, antibiotics are recommended for cure and preventing relapse. The antibiotics recommended are diverse, have regional differences in sensitivity, and have side effects.. To evaluate the efficacy and safety of antibiotics for treating Shigella dysentery.. In June 2009 we identified all relevant trials from the following databases: Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4), MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT). We also checked conference proceedings for relevant abstracts, and contacted researchers, organizations, and pharmaceutical companies.. Randomized controlled trials of antibiotics for Shigella dysentery.. Four authors, working in pairs, independently assessed trial eligibility, methodological quality, and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model for significant heterogeneity. We explored possible sources of heterogeneity, when present, in subgroup analyses of participant age and percentage of participants with confirmed Shigella infection.. Sixteen trials (1748 participants), spanning four decades and with differing sensitivity to Shigella isolates, met the inclusion criteria. Seven were judged to be at risk of bias due to inadequate allocation concealment or blinding, and 12 due to incomplete reporting of outcome data. Limited data from one three-armed trial of people with moderately severe illness suggest that antibiotics reduce the episodes of diarrhoea at follow-up (furazolidone versus no drug RR 0.21, 95% CI 0.09 to 0.48, 73 participants; cotrimoxazole versus no drug RR 0.30, 95% CI 0.15 to 0.59, 76 participants).There was insufficient evidence to consider any class of antibiotic superior in efficacy in treating Shigella dysentery, but heterogeneity for some comparisons limits confidence in the results. All the antibiotics studied were safe. There was inadequate evidence regarding the role of antibiotics in preventing relapses.. Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.

Topics: Anti-Bacterial Agents; Diarrhea; Dysentery, Bacillary; Furazolidone; Humans; Randomized Controlled Trials as Topic; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Bacterial Infections; Campylobacter Infections; Child; Dysentery, Bacillary; Enteritis; Escherichia coli Infections; Humans; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: 4-Quinolones; Ampicillin; Anti-Infective Agents; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child, Preschool; Drug Combinations; Dysentery, Bacillary; Humans; Nutrition Disorders; Proctoscopy; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ampicillin; Animals; Anti-Infective Agents, Urinary; Antigens, Bacterial; Bacterial Toxins; Drug Combinations; Dysentery, Bacillary; Fluid Therapy; Host-Parasite Interactions; Humans; Intestines; Lactulose; Nalidixic Acid; O Antigens; Oxolinic Acid; Polysaccharides, Bacterial; Shiga Toxins; Shigella; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In a double-blind clinical study, 109 adult Egyptian patients infected with Shigella spp. and 45 infected with Salmonella spp. were randomly assigned to three treatment groups: 1) norfloxacin in a single 800-mg dose, 2) norfloxacin, 400 mg twice a day for three days, and 3) trimethoprim (160 mg)-sulfamethoxazole (800 mg) (TMP-SMX), twice a day for three days. Among Shigella-infected patients, diarrheal symptoms had resolved in 86-97% and bacteriologic failure (repeat positive stool culture) occurred in only two patients five days after the start of the three treatment regimens. Among Salmonella-infected patients, diarrheal symptoms had resolved in 76-82% of patients and bacteriologic failure was common (18-36%) five days after the start of therapy. These data indicate that short-course therapy with either norfloxacin or TMP-SMX can be effectively used to treat shigellosis in adults in developing countries. However, for uncomplicated Salmonella spp. infection, short-course therapy with norfloxacin and TMP-SMX may not lead to a rapid resolution of symptoms or consistently eliminate this enteropathogen.

Topics: Adult; Aged; Developing Countries; Diarrhea; Double-Blind Method; Drug Administration Schedule; Dysentery, Bacillary; Egypt; Humans; Male; Middle Aged; Norfloxacin; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

In a prospective randomized double-blind trial, pivmecillinam was compared with cotrimoxazole (TMP-SMX), both given orally for a period of 5 days, for the treatment of 59 children with shigellosis. 29 patients were treated with pivmecillinam and 30 with cotrimoxazole. 14% of shigella organisms isolated were resistant to pivmecillinam and 21% to TMP-SMX. The diarrhea persisted for a mean (+/- SD) period of 74 +/- 24.8 h in the pivmecillinam-treated patients versus 73.8 +/- 34 h in the TMP-SMX-treated patients. Duration of fever, positive stool culture, visible blood, occult blood, and pus cells in the stools were similar for both treatment groups. Five patients (17%) in the pivmecillinam group and 4 patients (13%) in the cotrimoxazole group fulfilled the clinical criteria that defined treatment failure. One patient (3.4%) in the pivmecillinam group and 2 (6.6%) in the TMP-SMX group evidenced recurrence of the diarrheal symptoms at the follow-up visit. No major drug-related side effects were observed in either group. We concluded that pivmecillinam is equivalent to cotrimoxazole in the treatment of shigellosis in children.

Topics: Acute Disease; Adolescent; Amdinocillin Pivoxil; Child; Child, Preschool; Double-Blind Method; Dysentery, Bacillary; Female; Humans; Infant; Male; Prospective Studies; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

We compared the clinical and bacteriologic response of 5-day treatment with cefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p < 0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p < 0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.

Topics: Adolescent; Cefixime; Cefotaxime; Child; Child, Preschool; Diarrhea, Infantile; Double-Blind Method; Dysentery, Bacillary; Female; Humans; Infant; Male; Prospective Studies; Shigella; Shigella boydii; Shigella flexneri; Shigella sonnei; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

In a prospective randomized study at two clinical sites, ceftibuten was compared with trimethoprim-sulfamethoxazole (TMP-SMX), both given orally for a period of 5 days, for the treatment of dysentery. Twenty-two children were found to have bacillary dysentery caused by Shigella and/or enteroinvasive Escherichia coli. All organisms isolated were susceptible to ceftibuten; 6 of 20 Shigella strains and 4 of 5 enteroinvasive E. coli were resistant to TMP-SMX. The diarrhea persisted for a mean (+/- SD) period of 2.4 +/- 1.4 days in the ceftibuten-treated patients vs. 3.4 +/- 1.7 days in the TMP-SMX-treated patients. The duration of fever was similar for both treatment groups. Patients treated with ceftibuten or TMP-SMX had equivalent clinical responses unless the pathogen was found to be TMP-SMX-resistant. Those who were randomized to receive TMP-SMX but who were eventually found to have TMP-SMX-resistant organisms had significantly more stools at days 3, 4 and 5 (P less than 0.02 to less than 0.00006) with more watery consistency for these days (P less than 0.02 to less than 0.005) compared to patients treated with ceftibuten. No clinical relapses were reported and no drug-related side effects were observed. We conclude that ceftibuten is at least as effective as TMP-SMX in the treatment of diarrhea caused by Shigella and enteroinvasive E. coli in children.

Topics: Adolescent; Ceftibuten; Cephalosporins; Child; Child, Preschool; Dysentery, Bacillary; Escherichia coli Infections; Humans; Infant; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

From June 1985 to September 1987, 202 adults were enrolled in a randomized, double-blinded study comparing ciprofloxacin (500 mg) with sulfamethoxazole and trimethoprim (160 mg/800 mg) or placebo for adults with acute diarrhea. All patients were treated on the day of presentation and received medication on a twice-daily schedule (every 12 hours) for 5 days. Bacterial isolates from these patients included 35 Campylobacter, 18 Shigella, and 15 Salmonella. Treatment at the time of presentation with ciprofloxacin compared with placebo shortened the duration of diarrhea (2.4 vs 3.4 days), and increased the percentage of patients cured or improved by treatment days 1, 3, 4, and 5. Similar significant differences for sulfamethoxazole and trimethoprim compared with placebo were not seen.

Topics: Adult; Bacterial Infections; Campylobacter fetus; Campylobacter Infections; Ciprofloxacin; Diarrhea; Double-Blind Method; Dysentery, Bacillary; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Salmonella Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Shigellae have been shown to be highly susceptible to new quinolone agents, with average MICs for 90% of isolates of less than 0.1 microgram/ml. Because these agents also reach high concentrations in the stool after a single dose, the effectiveness of a single 800-mg dose of norfloxacin and of 5-day treatment with trimethoprim-sulfamethoxazole (TMP-SMX) were compared in a randomized trial. Patients with clinical dysentery received one of these treatment regimens, and clinical data and follow-up culture results were analyzed for patients whose stool culture on presentation grew shigellae. When 55 patients with shigellosis (26 treated with TMP-SMX, 29 treated with norfloxacin) whose bacterial isolates were susceptible to the antibiotic given were compared by treatment group, no significant differences were seen in days of illness (mean, 2.5 +/- 0.65 days with TMP-SMX and 2.0 +/- 0.47 days with norfloxacin; P = 0.200) or number of unformed stools after starting treatment (mean, 9.7 +/- 2.37 stools with TMP-SMX and 7.6 +/- 3.19 stools with norfloxacin; P = 0.312). Resistance in vitro to TMP-SMX was seen in 15% of Shigella isolates, whereas none was resistant to norfloxacin. Bacteriologic failure was found in 1 patient among 24 receiving TMP-SMX and in none of 25 patients receiving norfloxacin. One single dose of norfloxacin was as effective as 5 days of treatment with TMP-SMX in these adults with shigellosis.

Topics: Adult; Clinical Trials as Topic; Diarrhea; Drug Combinations; Dysentery, Bacillary; Feces; Humans; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

An outpatient study of 125 children with acute invasive diarrhea was conducted at the Hospital Infantil de Mexico Federico Gomez. Through a single-blind randomization, we compared the efficacy of furazolidone, 7.5 mg/kg/day (49 patients), with trimethoprim-sulfamethoxazole (TMP-SMX), 8 mg/40 mg/kg/day (52 patients), each given for 5 days. A control group of 24 patients received no antimicrobials. Stool samples were collected from all patients at the time of admission, and active drugs were administered before the stool culture results were available. At baseline, 48 of 125 patients (38.5%) had negative stool cultures. In the other patients, the most frequently isolated pathogens were Shigella sp and enteropathogenic Escherichia coli. Of the total population who completed the study 43 of 49 (87.8%) of the patients in the furazolidone group and 43 of 52 (82.7%) of the patients in the TMP-SMX group achieved clinical cure by day 3, compared with 10 of 22 (45.5%) of the patients in the control group. Day 3 cure rates were similar between groups, independent of baseline stool culture results. Of those patients who had positive stool cultures on day 1, 20 of 34 (58.8%) in the furazolidone group and 19 of 29 (65.5%) in the TMP-SMX group had negative culture results on day 6, compared with 4 of 12 (33.3%) in the control group. Overall, clinical and bacteriologic success was achieved in 31 of 49 (63%) patients treated with furazolidone and in 36 of 52 (69%) patients treated with TMP-SMX, compared with 5 of 22 (23%) patients in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Child, Preschool; Diarrhea; Diarrhea, Infantile; Dysentery, Bacillary; Escherichia coli Infections; Female; Furazolidone; Humans; Infant; Male; Randomized Controlled Trials as Topic; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim (300 mg twice daily for five days) and co-trimoxazole (two tablets twice daily for five days) were compared as treatment for adult patients with severe shigellosis in Rwanda. Excellent bacteriological and clinical results were obtained with both regimens, with the exception of patients infected with a trimethoprim-resistant strain of Shigella dysenteriae type 1. Since only 20 patients were investigated, the conclusions of our study do not reach statistical significance. Before recommending trimethoprim as standard therapy for shigellosis, the validity of our results should be tested in a larger trial and the long-term ecological consequences of monotherapy carefully monitored.

Topics: Clinical Trials as Topic; Drug Combinations; Dysentery, Bacillary; Female; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

52 convalescent carriers of Salmonellae (n = 25) and Shigellae (n = 27) were treated with a 4-week course of either co-trimoxazole or the combination pivmecillinam/pivampicillin. 84% of the salmonella isolates and 89% of the shigella were resistant to one or more antibiotics. Sulphonamide resistance was observed in 52 and 58% of the strains, respectively. 12 and 44% of the isolates, respectively, were resistant to ampicillin. All were sensitive to mecillinam and all except 2 were sensitive to co-trimoxazole. In salmonella carriers, co-trimoxazole was successful in 54% of the subjects and pivmecillinam/pivampicillin in 58%. Co-trimoxazole cured 83% of the shigella carriers and pivmecillinam/pivampicillin 87%. Shigella carriers responded to therapy promptly. Concurrent biliary disease or diverticulosis adversely affected the prognosis in salmonella carriers.

Topics: Adult; Amdinocillin Pivoxil; Ampicillin; Anti-Bacterial Agents; Carrier State; Child, Preschool; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Dysentery, Bacillary; Female; Humans; Male; Middle Aged; Penicillanic Acid; Penicillin Resistance; Pivampicillin; Salmonella; Salmonella Infections; Shigella; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Diarrhea; Drug Combinations; Dysentery, Bacillary; Escherichia coli Infections; Female; Humans; Male; Premedication; Salmonella Infections; Sulfamethoxazole; Time Factors; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Following a nationwide outbreak of Shigella dysentery type 1 and the recognition of Shigella isolates resistant to ampicillin, the drug of choice, we conducted a clinical trial to compare the efficacy of ampicillin v. trimethoprim-sulphamethoxazole for the treatment of Shigella dysentery. Patients with symptoms of dysentery and no other complicating illness were randomized into one of two treatment groups. Patients in the two groups were comparable at the time of hospital admission with regard to age, sex, presenting complaints and Shigella strains. They responded well with both regimens and there was no significant difference in the mean time until stool became culture negative (1.4 days), temperatures returned to normal (2.7 days) and faecal leucocytes disappeared (3.0 days); abdominal pain, tenesmus and stool blood and mucus improved significantly more rapidly with trimethoprim-sulphamethoxazole than with ampicillin. There was no evidence of toxicity with either drug. While both drugs are effective for the treatment of Shigella dysentery, trimethoprim-sulphamethoxazole was considered to be superior.

Topics: Adolescent; Ampicillin; Bangladesh; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Dysentery, Bacillary; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Penicillin Resistance; Random Allocation; Shigella; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to discuss the correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri (S. flexneri) and the antibiotic resistance genes sul1, sul2, and sul3 and SXT element.From May 2013 to October 2018, 102 isolates of S. flexneri were collected from the clinical samples in Jinan. The Kirby-Bauer (K-B) test was employed to determine the antibiotic susceptibility of the S. flexneri isolates. The antibiotic resistance rate was analyzed with the WHONET5.4 software. The isolates were subject to the PCR amplification of the sul genes (sul1, sul2, and sul3) and the SXT element. On the basis of the sequencing results, the correlation between the sulfamethoxazole-trimethoprim resistance of the S. flexneri isolates and the sul genes was analyzed.The antibiotic resistance rates of the 102 S. flexneri isolates to ampicillin, streptomycin, chloramphenicol, tetracycline, and sulfamethoxazole-trimethoprim were 90.2%, 90.2%, 88.2%, 88.2%, and 62.7%, respectively. The antibiotic resistance rates of these isolates to cefotaxime, ceftazidime, and ciprofloxacin varied between 20% and 35%. However, these isolates were 100% susceptible to cefoxitin. Positive fragments were amplified from 59.8% (61/102) of the 102 S. flexneri isolates, the sizes of the sul1 and sul2 genes being 338 bp and 286 bp, respectively. The sequence alignment revealed the presence of the sul1 and sul2 genes encoding for dihydrofolate synthase. The carrying rate of the sul1 gene was 13.7% (14/102), and that of the sul2 gene was 48.0% (49/102). No target gene fragments were amplified from the 3 isolates resistant to sulfamethoxazole-trimethoprim. The sul3 gene and SXT element were not amplified from any of the isolates. The testing and statistical analysis showed that the resistance of the S. flexneri isolates to sulfamethoxazole-trimethoprim correlated to the sul1 and sul2 genes.The acquired antibiotic resistance genes sul1 and sul2 were closely associated with the resistance of the 102 S. flexneri isolates to sulfamethoxazole-trimethoprim.

Topics: Bacterial Proteins; Carrier Proteins; DNA Transposable Elements; DNA, Bacterial; Dysentery, Bacillary; Feces; Humans; Microbial Sensitivity Tests; Polymerase Chain Reaction; Shigella flexneri; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to assess antibiotic resistance and the molecular epidemiology of shigella isolates from a case-control study of diarrhoea, conducted from 2007 to 2012 in children aged less than 5 years in Manhiça district, southern Mozambique. All isolates were tested for antimicrobial susceptibility using the disc diffusion method. Polymerase chain reaction was used to detect different molecular mechanisms of antibiotic resistance. Serotyping was performed using specific antisera. The clonal relationship of Shigella flexneri and Shigella sonnei was assessed by pulsed-field gel electrophoresis (PFGE). Of the 67 shigella isolates analysed, 59 were diarrhoeal cases and eight were controls. S. flexneri (70.1%; 47/67) was the most common species, followed by S. sonnei (23.9%; 16/67). The most prevalent S. flexneri serotypes were 2a (38.3%; 18/47), 6 (19.2%; 9/47) and 1b (14.9%; 7/47). High rates of antimicrobial resistance were observed for trimethoprim-sulfametoxazole (92.5%; 62/67), tetracycline (68.7%; 46/67), chloramphenicol (53.7%; 36/67) and ampicillin (50.7%; 34/67). Multi-drug resistance (MDR) was present in 55.2% (37/67) of the isolates and was associated with a case fatality rate of 8.1% (3/37). PFGE revealed 22 clones (16 S. flexneri and 6 S. sonnei), among which P1 (31.9%; 15/47), P9 (17%; 8/47) and P2 (10.6%; 5/47) were the most prevalent clones of S. flexneri. In conclusion, S. flexneri was the most prevalent species, with MDR isolates mainly belonging to three specific clones (P1, P9 and P2). The case fatality rate observed among MDR isolates is a matter of concern, indicating the need for appropriate treatment.

Topics: Ampicillin; Anti-Bacterial Agents; Case-Control Studies; Child, Preschool; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Molecular Epidemiology; Mozambique; Shigella flexneri; Shigella sonnei; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Salmonella and Shigella remain the major contributors to acute enteric infections and diarrhoea. Hence, the objective of this study was to isolate and determine the antimicrobial susceptibility pattern of Shigella and Salmonella species from children with acute diarrhoea in Mekelle Hospital and Semen Health Center.. A cross sectional study was conducted among 260 children with acute diarrhoea from November 2011 to March 2012 in Mekelle, Ethiopia. Stool specimen was collected from all study participants who presented with acute diarrhoea. Microscopy, culture and confirmatory identification were done by the pattern of biochemical reactions using a standard bacterial identification system (API 20E, BioMerieux, Marcy-l'Etoile, France) and polyvalent (Poly O and H) antiseras for Salmonella species and Vi for S.typhi. Isolated colonies were assessed for antimicrobial susceptibility profile using disk diffusion method. Data was entered and analyzed using SPSS version 16.0 software.. Out of the 260 study participants, 145(55.8%) were males while 115(44.2%) were females. The majority of the patients (44.2%) were of children under five years old. A total of 120 enteropathogens were isolated. The frequency of isolation was 19(7.3%), 18(6.9%) and 83(31.9%) for Salmonella species, Shigella species and intestinal parasites respectively. Most of the Shigella isolates were resistant to ampicillin (88.9%), Tetracycline (77.8), cotrimoxazole (55.6%) and chloramphenicol (55.6%). Among the Salmonella isolates, the highest resistance was observed to ampicillin (89.5%), Tetracycline (89.5%), chloramphenicol (78.9%) and cotrimoxazole (57.9%). Multi-drug resistance was noted in 19(100%) and 16(88.9%) of Salmonella and Shigella species respectively.. Shigella and Salmonella are still challenging pathogens in children < 5 years of age. High antibiotic resistance was observed among both isolates to ampicillin, tetracycline, chloramphenicol and cotrimoxazole.

Topics: Acute Disease; Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Cross-Sectional Studies; Diarrhea; Dysentery, Bacillary; Ethiopia; Feces; Female; Hospitals; Humans; Infant; Male; Microbial Sensitivity Tests; Pediatrics; Salmonella; Salmonella Infections; Shigella; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The emergence of multidrug resistance (MDR) is a serious problem in treating shigellosis. There are limited existing data examining the change in the antimicrobial resistance profile of Shigella in Egypt. We previously reported that 58% of the Shigella isolates in Egypt were resistant to at least one member of the three different antimicrobial groups. This study was performed to determine the antimicrobial resistance profile of Shigella, determine their possible mechanisms of resistance, and compare their resistance profile to those reported 20 years ago.. Stool samples were collected from 500 subjects and processed for the isolation and identification of Shigella. The susceptibility of the isolates to 11 different antimicrobials was determined using the disc diffusion method.. Of 500 stool cultures, 24 (4.8%) samples were positive for Shigella. There was a high percentage of resistance to ampicillin (88%), tetracycline (83%), and sulfamethoxazole-trimethoprim (75%). Also, there was a moderate percentage of resistance to chloramphenicol (46%), streptomycin (42%), ceftazidime (33%), and cefotaxime (25%). A lower percentage of resistance was recorded for amikacin, nalidixic acid (17% each), and ofloxacin (7%), while no resistance was found to ciprofloxacin (0%). Twenty-one of the isolates (88%) were resistant to at least three different antimicrobial groups (indicating MDR). The average number of antimicrobial agents to which the Shigella isolates were resistant was 4.3±1.4, while it was 3.4±1.5 in the same locality in 1994.. These data demonstrate that there is a marked increase in MDR and change in the resistance patterns of Shigella over the past 20 years.

Topics: Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; beta-Lactams; Child; Child, Preschool; Chloramphenicol; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Egypt; Feces; Female; Humans; Incidence; Infant; Male; Middle Aged; Quinolines; Shigella; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

A retrospective study conducted on patients with diarrhea in Shanghai, China from 2004-2011, indicated that of 77,600 samples collected, 1,635 (2.1%) tested positive for Shigella. Species isolated included S. sonnei (1,066, 65.1%), S. flexneri (569, 34.7%), and S. boydii (3, 0.2%). Most of the Shigella isolates were found to be resistant to streptomycin (98.7%), trimethoprim (98.0%), ampicillin (92.1%), and nalidixic acid (91.7%). Additionally, many isolates were resistant to tetracycline (86.9%), trimethoprim + sulfamethoxazole (80.1%), sulfisoxazole (76.8%) and gentamicin (55.5%). Approximately 80% of the isolates were resistant to at least eight antimicrobial agents, 14% to at least ten antimicrobials tested and 10 isolates to fourteen antimicrobials, including sulfonamides, fluoroquinolones, tetracyclines, aminoglycosides and β-lactamases. Importantly, co-resistance to fluoroquinolones and the third- and fourth-generation cephalosporins was also identified. The high levels of resistance to antimicrobial agents commonly used in clinical medicine presents a great challenge to treating patients with shigellosis.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Child; Child, Preschool; China; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Female; Fluoroquinolones; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Serotyping; Shigella; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

In this study, mechanisms of plasmid-mediated sulfamethoxazole resistances in the clinical strains of multi-drug resistant (MDR) Shigella flexneri 2a were elucidated for the first time in Bangladesh. From 2006 to 2011, a total of 200 S. flexneri 2a strains were randomly selected from the stock of the Enteric and Food Microbiology Laboratory of icddr,b. Antimicrobial susceptibility of the strains showed 73%, 98%, 93%, 58%, 98%, 64% and 4% resistance to trimethoprim-sulfamethoxazole, nalidixic acid, ampicillin, erythromycin, tetracycline, ciprofloxacin and ceftriaxone respectively. Plasmid profiling revealed heterogeneous patterns and interestingly, all the trimethoprim-sulfamethoxazole resistant (SXT(R)) strains yielded a distinct 4.3 MDa plasmid compared to that of the trimethoprim-sulfamethoxazole susceptible (SXT(S)) strains. Curing of this 4.3 MDa plasmid resulted in the susceptibility to sulfamethoxazole alone suggesting the involvement of this plasmid in the resistance of sulfamethoxazole. Moreover, PCR analysis showed the presence of sul2 gene in SXT(R) strains which is absent in SXT(S) strains as well as in the 4.3 MDa plasmid-cured derivatives, confirming the involvement of sul2 in the resistance of sulfamethoxazole. Furthermore, pulsed-field gel electrophoresis (PFGE) analysis revealed that both the SXT(R) and SXT(S) strains were clonal. This study will significantly contributes to the knowledge on acquired drug resistance of the mostly prevalent S. flexneri 2a and further warrants continuous monitoring of the prevalence and correlation of this resistance determinants amongst the clinical isolates of Shigella and other enteric pathogens around the world to provide effective clinical management of the disease.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; Bangladesh; Carrier Proteins; Diarrhea; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Gene Expression; Humans; Plasmids; Shigella flexneri; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination

Southern Israel is inhabited by Bedouins, living in conditions similar to developing countries and Jews, living in conditions similar to developed countries. We determined the epidemiology of Shigella spp. in these populations. We retrospectively reviewed Shigella spp. stool isolations between 2005-2009. Overall, 3295 isolates were analyzed. S. sonnei was isolated in 2057/3295 (62.4%) and S. flexneri in 1058 (32.1%). S. sonnei was isolated in 1567/1707 (91.8%) from Jewish patients and S. flexneri in 931/1542 (60.4%) from Bedouin patients. Ampicillin resistance increased linearly from 217/373 (58.2%) in 2005 to 186/256 (72.7%) in 2009, (P < 0.001). Trimethoprim-sulfamethoxazole resistance decreased linearly from 328/373 (87.9%) in 2005 to 133/256 (51.9%) in 2009 (P < 0.001). Higher resistance of Shigella spp. to ampicilin and trimethoprim-sulfamethoxazole were found in Jewish patients: 1527/1706 (89.5%) versus 977/1542 (63.4%) (P < 0.0001), 1635/1706 (95.8%) versus 1026/1542 (66.5%) (P < 0.0001). The epidemiology of Shigella spp. infections can differ in populations residing in the same geographical area.

Topics: Ampicillin; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Feces; Humans; Israel; Microbial Sensitivity Tests; Retrospective Studies; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

Diarrhoeal disease is still considered a major cause of morbidity and mortality among children. Among diarrhoeagenic agents, Shigella should be highlighted due to its prevalence and the severity of the associated disease. Here, we assessed Shigella prevalence, drug susceptibility and virulence factors. Faeces from 157 children with diarrhoea who sought treatment at the Children's Hospital João Paulo II, a reference children´s hospital in Belo Horizonte, state of Minas Gerais, Brazil, were cultured and drug susceptibility of the Shigella isolates was determined by the disk diffusion technique. Shigella virulence markers were identified by polymerase chain reaction. The bacterium was recovered from 10.8% of the children (88.2% Shigella sonnei). The ipaH, iuc, sen and ial genes were detected in strains isolated from all shigellosis patients; set1A was only detected in Shigella flexneri. Additionally, patients were infected by Shigella strains of different ial, sat, sen and set1A genotypes. Compared to previous studies, we observed a marked shift in the distribution of species from S. flexneri to S. sonnei and high rates of trimethoprim/sulfamethoxazole resistance.

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; Brazil; Child, Preschool; Diarrhea; Disk Diffusion Antimicrobial Tests; Dysentery, Bacillary; Feces; Female; Genotype; Humans; Infant; Male; Polymerase Chain Reaction; Prevalence; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence Factors

Shigella is a frequent cause of bacterial dysentery in the developing world. Treatment with antibiotics is recommended for shigellosis, but the options are limited due to globally emerging resistance. This study was conducted to determine the frequency and pattern of antimicrobial susceptibility of Shigella in China.. We studied the antimicrobial resistance profiles of 308 Shigella spp. strains (260 S. flexneri, 40 S. sonnei, 5 S. boydii, and 3 S. dysenteriae) isolated from fecal samples of patients (age, from 3 months to 92 yr) presenting with diarrhea in different districts of Anhui, China. The antimicrobial resistance of strains was determined by the agar dilution method according to the CSLI guidelines.. The most common serogroup in the Shigella isolates was S. flexneri (n=260, 84.4%), followed by S. sonnei (n=40, 13.0%). The highest resistance rate was found for nalidixic acid (96.4%), followed by ampicillin (93.2%), tetracycline (90.9%), and trimethoprim/sulfamethoxazole (80.8%). Among the isolates tested, 280 (91.0%) were multidrug resistant (resistant to ≥2 agents). The most common resistance pattern was the combination of ampicillin, tetracycline, and trimethoprim/sulfamethoxazole (70.8%). Resistance to ampicillin and tetracycline were more common among S. flexneri than among S. sonnei isolates.. S. flexneri is predominant in Anhui, China, and its higher antimicrobial resistance rate compared with that of S. sonnei is a cause for concern. Continuous monitoring of resistance patterns is necessary to control the spread of resistance in Shigella. The recommendations for antimicrobial treatment must be updated regularly based on surveillance results.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Infective Agents; Child; Child, Preschool; China; Drug Resistance, Bacterial; Dysentery, Bacillary; Feces; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Shigella; Shigella flexneri; Shigella sonnei; Tetracycline; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Shigellosis, caused by Shigella species, is a major public health problem in Bangladesh. To determine the prevalence and distribution of different Shigella species, we analyzed 10,827 Shigella isolates from patients between 2001 and 2011. S. flexneri was the predominant species isolated throughout the period. However, the prevalence of S. flexneri decreased from 65.7% in 2001 to 47% in 2011, whereas the prevalence of S. sonnei increased from 7.2% in 2001 to 25% in 2011. S. boydii and S. dysenteriae accounted for 17.3% and 7.7% of the isolates respectively throughout the period. Of 200 randomly selected S. sonnei isolates for extensive characterization, biotype g strains were predominant (95%) followed by biotype a (5%). Resistance to commonly used antibiotics including trimethoprim-sulfamethoxazole, nalidixic acid, ciprofloxacin, mecillinam and ampicillin was 89.5%, 86.5%, 17%, 10.5%, and 9.5%, respectively. All isolates were susceptible to ceftriaxone, cefotaxime, ceftazidime and imipenem. Ninety-eight percent of the strains had integrons belonging to class 1, 2 or both. The class 1 integron contained only dfrA5 gene, whereas among class 2 integron, 16% contained dhfrAI-sat1-aadA1-orfX gene cassettes and 84% harbored dhfrA1-sat2 gene cassettes. Plasmids of ∼5, ∼1.8 and ∼1.4 MDa in size were found in 92% of the strains, whereas only 33% of the strains carried the 120 MDa plasmid. PFGE analysis showed that strains having different integron patterns belonged to different clusters. These results show a changing trend in the prevalence of Shigella species with the emergence of multidrug resistant S. sonnei. Although S. flexneri continues to be the predominant species albeit with reduced prevalence, S. sonnei has emerged as the second most prevalent species replacing the earlier dominance by S. boydii and S. dysenteriae in Bangladesh.

Topics: Amdinocillin; Ampicillin; Anti-Bacterial Agents; Bangladesh; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Humans; Integrons; Nalidixic Acid; Phylogeny; Prevalence; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination

Shigella flexneri 4a caused sustained outbreaks in a large long-stay psychiatric centre, Taiwan, 2001-2006. Trimethoprim-sulphamethoxazole (SXT) prophylaxis was administered in 2004. We recovered 108 S. flexneri 4a isolates from 83 symptomatic (including one caregiver) and 12 asymptomatic subjects (11 contacts, one caregiver). The isolates were classified into eight antibiogram types and 15 genotypes (six clusters) by using antimicrobial susceptibility testing and pulsed-field gel electrophoresis of NotI-digested DNA, respectively. These characteristics altered significantly after SXT prophylaxis (P < 0·05), with concomitant emergence of SXT-resistant isolates in two antibiogram types. P01 (n = 71), the predominant epidemic genotype, caused infection in two caregivers and five patients under their care; two P01 isolates were recovered from the same patient 6 months apart. These results indicate the importance of sustained person-to-person transmission of S. flexneri 4a by long-term convalescent, asymptomatic or caregiver carriers, and support the emergence of SXT-resistant strains following selective pressure by SXT prophylaxis.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Long-Term Care; Microbial Sensitivity Tests; Molecular Epidemiology; Shigella flexneri; Taiwan; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002.. A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics.. The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p<0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p<0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively).. There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cross Infection; Dehydration; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Female; Gastroenteritis; Humans; Infant; Male; Microbial Sensitivity Tests; Nalidixic Acid; Prevalence; Shigella; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Topics: Anti-Bacterial Agents; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Humans; Papua New Guinea; Shigella; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Shigellosis is a common cause of morbidity, especially in the very young and old, in developing countries. The disease is treated with antibiotics. Surveillance of antimicrobial resistance trends is essential owing to the global emergence of antimicrobial resistance.. The study involved 1,573 isolates of Shigella species (1996-2007) that were analyzed for trends in antimicrobial resistance.. The majority of the specimens (1046; 66.5%) were from the pediatric population, and of these 887 (84.8%) were under 5 years of age (p = 0.001). S. flexineri was the most frequent species (54.5%) isolated. Isolation of S. sonnei increased from 15.4 % (1996) to 39% (2007) (p = 0.001). Although none of the isolates was found sensitive to all the antibiotics tested, 58% (n =9 07) were resistant to ampicillin and 85% (n = 1,338) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Out of a total of 198 (12.6%) nalidixic acid resistant isolates, 6 (3.0%) were also resistant to ofloxacin. Overall 1.7 % of isolates were resistant to ofloxacin, 2.4% to ceftriaxone and 2.3% were resistant to combination of ampicillin, nalidixic acid and TMP-SMX.. Ofloxacin is still an effective drug for treatment of acute shigellosis in Pakistan. Emergence of resistance to ceftriaxone in Shigella may have grave implications in treatment of severe shigellosis in very young patients.

Topics: Adolescent; Adult; Age Factors; Ampicillin; Anti-Infective Agents; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Dysentery, Bacillary; Humans; Infant; Microbial Sensitivity Tests; Nalidixic Acid; Ofloxacin; Pakistan; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

We applied a previously reported method to clarify whether a multidrug-resistant Shigella colonizes in a south Asian country. At Kansai Airport Quarantine Station, stool samples were collected from overseas travelers who reported a history of diarrhea. Shigella strains were isolated, ranging from 53 to 106 (average, 82.4) isolates/year (2001-2005), and almost 80% of the isolates were Shigella sonnei. The most frequent country of origin was India. Strains from the country of the most frequent origin were studied by antimicrobial susceptibility testing. Resistance to tetracycline, sulfamethoxazole-trimethoprim and nalidixic acid was observed at the highest frequency: in 23 of the 25 strains isolated in 2001, 5 of the 13 strains isolated in 2002, and 16 of the 19 strains isolated in 2005. Strains showing the most prevalent multidrug-resistance pattern were analyzed by pulsed-field gel electrophoresis (PFGE). The PFGE profiles showed that 27 of the 44 strains isolated in 2001, 2002, and 2005 were identical in PFGE pattern, as determined using two restriction enzymes. We concluded that a multidrug-resistant Shigella sonnei colonizes in a south Asian country.

Topics: Anti-Bacterial Agents; Diarrhea; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Humans; India; Japan; Nalidixic Acid; Quarantine; Seroepidemiologic Studies; Shigella sonnei; Tetracycline; Time Factors; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

This study was designed to determine the role of a new temperate DNA phage BcP15 in relation to drug resistance. The multidrug resistant Shigella flexneri NK1925 was isolated from a patient of Infectious Diseases Hospital, Kolkata, India. This strain contained five plasmids ranging in size from 3 to 212 kb. After curing of five plasmids, this strain became sensitive to antibiotics. A plasmidless multidrug-resistant strain Burkholderia cepacia DR11 was isolated during the survey of microorganisms from coastal waters of deltaic Sunderbans. This strain always released a temperate phage BcP15 into culture supernatant. Turbid plaque formation was observed on the lawn of a plasmidless version (Pl(-)35) of Shigella flexneri NK1925. A few distinct clones (Pl(-)35R) appeared within the region of each plaque after 18 h incubation. S. flexneri NK1925, Pl(-)35, and Pl(-)35R clones showed the same PFGE band pattern of XbaI-digested chromosomal DNA. However, Pl(-)35R clones were resistant to co-trimoxazole, trimethoprim, and eryth- romycin, to which B. cepacia DR11 was also resistant. Southern hybridization results indicated that these three antibiotic resistances in Pl(-)35R clones were due to a BcP15 phage lysogen in the Pl(-)35 version of S. flexneri NK1925.

Topics: Anti-Bacterial Agents; Bacteriophages; Blotting, Southern; Burkholderia cepacia; Deoxyribonucleases, Type II Site-Specific; DNA Fingerprinting; DNA, Bacterial; DNA, Viral; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Erythromycin; Gene Transfer, Horizontal; Humans; India; Plasmids; Polymorphism, Restriction Fragment Length; Prophages; Shigella flexneri; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Plaque Assay

Diarrheal diseases are an important cause of morbidity and mortality in children in developing countries. Of the bacterial causes of dysentery, Shigella are the major enteropathogens with outbreak potential and common development of antimicrobial resistance. This study determined the prevalence and antimicrobial susceptibility patterns of different spp. of Shigella in Asmara, Eritrea.. Diarrheic stool specimens of a total of 2,420 children were screened for Shigella organisms over a period of 3 years using standard methods. The Shigella isolates were tested for antimicrobial susceptibility pattern by the disk diffusion method.. Of the 84 Shigella isolates, 54 were Shigella flexneri and 20 were Shigella dysenteriae type 1. High rates of resistance were observed against ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 6% of the S. flexneri isolates were resistant to nalidixic acid.. The study emphasizes the need for continuous monitoring of the occurrence of Shigella organisms and their antimicrobial susceptibility pattern for the successful treatment and control of Shigella dysentery, and also for the development of public health policy for populations at risk for shigellosis.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Dysentery, Bacillary; Eritrea; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Shigella; Species Specificity; Trimethoprim, Sulfamethoxazole Drug Combination

The MICs for 162 diarrheagenic Escherichia coli strains and 28 Shigella strains were determined on the basis of NCCLS guidelines. More than 75% of the strains were resistant to ampicillin, chloramphenicol (53.6% of Shigella strains), and trimethoprim-sulfamethoxazole. Multiresistance was detected in 89.5% of E. coli strains and 78.6% of Shigella strains.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Child; Chloramphenicol Resistance; Diarrhea; Drug Resistance; Drug Resistance, Bacterial; Dysentery, Bacillary; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Shigella; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Vietnam

Inherited interleukin-1-receptor-associated kinase-4 (IRAK-4) deficiency is a recently described immunodeficiency associated with pyogenic bacterial infections and a poor inflammatory response. Shigella sonnei is generally associated with outbreaks of rectocolitis in developed countries, but systemic illnesses have occasionally been reported. An underlying primary immunodeficiency has not been found in such cases before now.. We report the clinical and immunological features of a patient with IRAK-4 deficiency who has a history of systemic shigellosis in addition to other infections.. The patient has a history of Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa infections during childhood and an episode of S. sonnei septicemia and meningitis at 10 years of age. This patient's history contrasted with that of other individuals infected concurrently by the same organism. Of note, these episodes were not accompanied by acute phase responses in our patient. Subsequently, the patient has had more episodes of staphylococcal disease, but no systemic illnesses. The patient is now 30 years old and has been doing well since prophylactic antibiotic treatment was stopped 4 years ago.. To our knowledge, this is the first report of a case of systemic shigellosis in a person with a primary immunodeficiency, expanding the spectrum of infections associated with IRAK-4 deficiency. Thus, immunity mediated by IRAK-4 seems to be crucial for both the containment of and the inflammatory response to S. sonnei infection in the intestinal mucosa. IRAK-4 deficiency and related disorders should be considered in patients with systemic shigellosis.

Topics: Anti-Bacterial Agents; Child; Dysentery, Bacillary; Female; Gene Expression Regulation; Humans; Immunologic Deficiency Syndromes; Interleukin-1 Receptor-Associated Kinases; Interleukin-10; Interleukin-6; Intracellular Signaling Peptides and Proteins; Meningitis, Bacterial; Protein Serine-Threonine Kinases; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination

Antimicrobial-resistant Shigella sonnei is a growing problem in the United States and poses treatment challenges particularly among children. Azithromycin is recommended as an alternative oral agent for shigellosis.. All isolates of Shigella submitted to Johns Hopkins clinical laboratory during the outbreak year (2002) were compared with a historical comparison group (1996-2000). Isolates were considered multiresistant if they were resistant to ampicillin and trimethoprim-sulfamethoxazole (TS). Selected outbreak and reference isolates were tested for azithromycin susceptibility by E-test, disk diffusion and broth dilution methods.. Between 1996-2000, among the 111 isolates submitted, 63% were from pediatric patients; 63% of isolates were resistant to ampicillin and 12% to TS. In 2002, among the 205 isolates submitted, 82% were from pediatric patients; 91% isolates were resistant to ampicillin and 67% to TS. The proportion of multiresistant isolates increased from 6% in 1996 to 65% in 2002 (P < 0.05). Azithromycin susceptibility by E-test and disk diffusion demonstrated 2 zones of inhibition for S. sonnei. Interpretation using the inner zone resulted in higher MICs (minimal inhibitory concentration) compared with the outer zones by E-test (P < 0.0001) and disk diffusion (P < 0.0001).. With increasing interest in using azithromycin for shigellosis, clinical laboratories should be aware of the interpretation difficulty caused by the dual-zone phenomenon seen with E-test and disk diffusion methods for S. sonnei.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Humans; Infant; Microbial Sensitivity Tests; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to evaluate the demographic data and clinical presentation of childhood shigellosis, and to study the microbiological data and antimicrobial susceptibilities of Shigella spp. Nine thousand nine hundred fourteen stool culture specimens from children aged 0-15 years who were treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1996 and 2000 were retrospectively reviewed. Data were collected from microbiological records and medical charts of childhood shigellosis in terms of demographic data, symptoms, signs, and complications of the patients, and the species and antimicrobial susceptibilities of the organisms. The data were analyzed in terms of means, ranges, and percentages. Of 1,523 children whose stool cultures were positive for pathogenic bacteria, 80 (5.3%) were infected with Shigella spp; 34 females and 46 males. The age distribution ranged from 1 day to 13 years with a mean age of 3.6 years. Common clinical presentations included diarrhea (96.6%), fever (77.6%) and vomiting (44.8%); seizures were the most common complication found (27.6%). Watery and mucous were the most common characteristics of stools. The major Shigella spp found was S. sonnei (62.8%), which was susceptible to co-trimoxazole, ampicillin, cefazolin and ciprofloxacin in 2.3, 84.1, 100 and 100%, respectively. A short course of quinolones or oral cephalosporins should be recommended for the treatment of childhood shigellosis in areas with low susceptibility rates to co-trimoxazole and ampicillin.

Topics: Adolescent; Age Distribution; Ampicillin; Anti-Infective Agents; Cefazolin; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Dysentery, Bacillary; Feces; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Shigella; Thailand; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We investigated the etiology of acute diarrhea among Peruvian military recruits undergoing three months of basic combat training near the Amazonian city of Iquitos. From January through September 2002, 307 of 967 recruits were seen at the Health Post for diarrhea (attack rate [AR] = 31.8%, incidence = 1.28 95% confidence interval [CI] = 1.14-1.43] episodes/person-year). Shigella spp. were the most common bacterial pathogen recovered from recruits experiencing diarrhea episodes. These bacteria were isolated from 89 (40%) of 225 diarrheal stools examined (AR = 7.6%, incidence = 0.30 [95% CI = 0.24-0.38] episodes/person-year). Most (83 of 90; 92%) of the Shigella isolates were S. flexneri, of which 57 (69%) were serotype 2a. Seventy-six percent of Shigella isolates were resistant to sulfamethoxazole/trimethoprim and all were sensitive to ciprofloxacin. Peruvian soldiers may be an excellent population in which to test the efficacy of S. flexneri vaccines in advanced development.

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Ciprofloxacin; Diarrhea; Drug Resistance, Bacterial; Dysentery, Bacillary; Humans; Incidence; Male; Microbial Sensitivity Tests; Military Personnel; Peru; Shigella; Shigella flexneri; Trimethoprim, Sulfamethoxazole Drug Combination

Mycoplasma contamination of the licensed anthrax vaccine administered to military personnel has been suggested as a possible cause of Persian Gulf illness. Vaccine samples tested by nonmilitary laboratories were negative for viable mycoplasma and mycoplasma DNA and did not support its survival. Mycoplasma contamination of anthrax vaccine should not be considered a possible cause of illness.

Topics: Adult; Anti-Bacterial Agents; Child; Diarrhea; Dysentery, Bacillary; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Prevalence; Salmonella Infections; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Zambia

This retrospective study of patients treated between 1992 and 1996 was undertaken as a preliminary step to identifying the main bacterial causes of diarrheal disease in Libreville, Gabon. A total 371 files showing positive stool cultures were analyzed. From an epidemiological standpoint, data showed that the high risk population was young people of both sexes. The incidence of diarrhea was correlated with climatic conditions with an endemic-epidemic pattern characterized by peak activity during the rainy season. In the vast majority of cases, the underlying etiology was gastroenteritis due to invasive organisms. The most commonly identified agents were salmonellae (46.6%) and Shigellae (44.2%). Treatment should focus on rehydration. Fluoro-quinolones were the most commonly indicated drugs for antimicrobial treatment but cotrimoxazole was often useful. In general, the prognosis of bacterial diarrhea is favorable provided that it is treated early and concurrent conditions are taken into account.

Topics: Acute Disease; Adult; Anti-Infective Agents; Bacterial Infections; Diarrhea; Dysentery, Bacillary; Feces; Female; Fluoroquinolones; Gabon; Humans; Male; Retrospective Studies; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to evaluate epidemiological, clinical and laboratory data of shigellosis in children from northern Greece, hospitalized in our department during the period 1971-96. In total, 422 cases of shigellosis, aged 1 month to 14 y (238M, 184F) were hospitalized during the study period. The annual distribution was approximately stable until 1990, the mean number of cases per year being about 20. During the last 4 y the incidence significantly decreased. Shigella was serotyped in 138/422 cases. Seventy six of the strains were S. flexneri (55%) and 56 S. sonnei (40%). In the majority of cases the clinical picture was mild. Severe dehydration was seen in only 6 patients. Ninety four patients (22%) had extra-intestinal manifestations. Most common of these were convulsions (16%) and, less frequently, disturbances of consciousness (n = 26), rash (n = 9), shock and disseminated intravascular coagulopathy (n = 2), nerve paralysis (n = 2), severe anaemia (n = 2) and haemolytic-uraemic syndrome (n = 1). Nine patients had acute encephalopathy of 12 h to 12 d duration. It is important to note that all these cases recovered completely with no residual neurological deficit, except for 1 girl who developed temporal epilepsy 8 y later. Spinal fluid was normal in all 42 examined patients. Antibiotics were given to 212 of 422 patients, mainly during the first half of the study period. Shigella resistance to antibiotic was significant for cotrimoxazole (24%) and ampicillin (16%). All patients were cured. Shigellosis is a mild disease in our area, with a decreasing prevalence.

Topics: Adolescent; Ampicillin; Anemia; Anti-Bacterial Agents; Child; Child, Preschool; Consciousness Disorders; Dehydration; Disseminated Intravascular Coagulation; Drug Resistance, Microbial; Dysentery, Bacillary; Exanthema; Female; Greece; Hemolytic-Uremic Syndrome; Humans; Incidence; Infant; Male; Paresis; Penicillins; Seizures; Shigella; Shock; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of the present investigation was to study the frequency of Shigella spp. in patients with bloody diarrhea in Pakistan and the susceptibility of isolated Shigella to three antibiotics: ampicillin, cotrimoxazole and nalidixic acid. In addition, the frequency of Campylobacter and Salmonella was also determined. Stool samples (n = 152) were collected from 152 diarrheic children less than six years of age passing blood and mucus in their stools who were admitted to Paediatric Department of Mayo Hospital in Lahore, Pakistan from June to September 1990. The samples were cultivated on standard media for Shigella, Campylobacter, and Salmonella. Susceptibility of Shigella isolates was tested by disk diffusion method. The frequency of isolation was 19.1% for Shigella spp., 7.9% for Campylobacter, and 4.6% for Salmonella. Shigella flexneri (7.9%) was the most frequently isolated species, followed by S. dysenteriae (6.6%), S. boydii, (3.3%) and S. sonnei (1.3%). All Shigella isolates were susceptible to nalidixic acid (100%), while only a few were susceptible to cotrimoxazole (7.0%) and ampicillin (3.5%). In Pakistan, self-medication and purchases of drugs without a prescription are commonly practiced. Thus, there is a greater possibility of development of resistant strains due to over use of antibiotics.

Topics: Age Factors; Ampicillin; Anti-Bacterial Agents; Campylobacter; Child, Preschool; Diarrhea; Dysentery, Bacillary; Feces; Female; Gastrointestinal Hemorrhage; Humans; Incidence; Infant; Infant, Newborn; Male; Nalidixic Acid; Pakistan; Penicillins; Salmonella; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

Traveller's Diarrhea (TD, turista) is the most common health disturbance in travellers, affecting 20-50% of two-week travellers depending on their origin, destination and eating habits. The etiological agents most frequently isolated from the stools are enterotoxinogenic Escherichia coli (ETEC), Salmonella spp., Shigella spp., but the rate of isolation of Campylobacter spp. and non cholera vibrios is also high in Asia. Preventive measures in eating habits should in principle be able to curb the incidence of TD but compliance of travellers is usually poor. Antibiotic chemoprophylaxis has proved effective, but economic, safety and microbiological (drug resistance) considerations discourage its widespread use. Any treatment strategy should consider that TD is usually a self-limiting, benign illness in most travellers, even though infants, elderly people or persons with severe baseline diseases (heart diseases, diabetes, immunocompromised hosts, etc...) may sometimes suffer severe consequences. Adequate rehydration is the cornerstone of treatment and intestinal motility inhibitors may be used in adults (not in children) with severe diarrhea during the first 24 hours if the suspicion of invasive pathogen has been ruled out. Routine antibiotic treatment of TD is controversial, due to the benign nature of the syndrome and to the impossibility to ascertain its causative agent. It should be limited to severe and disabling cases. Among the many antibiotics tested, quinolones are now considered first-choice treatment worldwide, even though disturbing reports of the increasing prevalence of quinolone-resistant Campylobacter spp. from Asia have been recently published. Cotrimoxazole is efficient in Central America. The role of non absorbed antibiotics and probiotics is still to be fully elucidated.

Topics: 4-Quinolones; Adult; Aged; Ambulatory Care; Anti-Infective Agents; Antibiotic Prophylaxis; Child; Diarrhea; Disease; Dysentery, Bacillary; Escherichia coli Infections; Feeding Behavior; Fluid Therapy; Humans; Immunocompromised Host; Infant; Patient Compliance; Salmonella Infections; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

A primate colony comprising three distinct but interrelated units had long-term history of undiagnosed diarrhea and associated deaths for many years. In 1989, the clinical problem was recognized as a confounding factor for the experimental work, and steps were taken to eradicate the disease. This was done by a combined approach involving improved sample collection techniques and microbiological methods, treatment of all animals in the colony, and improvement in management. These management changes included alterations in basic facility and cage design, disinfection procedures, and continuous routine microbiological sampling of all groups of animals on a random basis, as well as sampling of those suspected to be at risk for stress-associated Shigella shedding. Using this approach, we have eliminated clinical cases of shigellosis and have not have any further isolations of Shigella from this colony.

Topics: Animals; Carrier State; Diarrhea; Disinfection; Dysentery, Bacillary; Feces; Macaca fascicularis; Male; Shigella dysenteriae; Shigella flexneri; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination

A prospective study was performed on 20 bacteriologically proven pediatric cases of severe shigellosis admitted to the Department of Pediatrics, Chulalongkorn Hospital during March 1989 to March 1990. Fourteen patients were male and six were female. Shigella B was found in 85% and Shigella D in 15% of cases. The major indications for admission were convulsions and dehydration. Fifteen per cent of cases had underlying malignancies and 42.1% had malnutrition. Most patients had a peak of fever between 39.5 and 40.5 degrees C, serum sodium between 128-144 mEq/l. Mild acidosis was detected in 45% and moderate acidosis in 30% of cases. There were no statistical differences in peak of fever and serum sodium between patients who had convulsion and who did not. Shigellemia was found in one case who also had underlying neuroblastoma. One patient died due to necrotizing enterocolitis, septic shock and renal failure. Most of the organisms found resisted to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX). However, TMP-SMX was prescribed in most immunocompetent patients and they recovered well. All of three patients with underlying malignancy responded well to ceftriaxone.

Topics: Adolescent; Anti-Bacterial Agents; Bicarbonates; Child; Child, Preschool; Dysentery, Bacillary; Female; Hospitalization; Humans; Infant; Male; Microbial Sensitivity Tests; Nutritional Status; Prospective Studies; Severity of Illness Index; Shigella boydii; Shigella dysenteriae; Sodium; Thailand; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulphamethoxazole (SXT) resistance increased among Shigella flexneri isolates in 1995 relative to previous years, in the Trakya region, the European part of Turkey. Since this region is the entrance to Turkey from northern countries, a heavy traffic of travellers passing through should have been importing or exporting the resistant isolates. We studied the genetic basis and epidemiology of this resistance and monitored the clonal changes which have taken place in the meanwhile. During the study period, a total of 70 Shigella spp. were isolated. Of these 58 were S. flexneri, 10 were S. sonnei and two were S. boydii. S. dysenteriae was not isolated. Of S. flexneri isolates 32 were SXT, ampicillin, chloramphenicol and tetracycline resistant (pattern I), while two isolates were found to be resistant only to SXT (Pattern II). Transconjugation experiments revealed that an approximately 80 Kbp self-transmissible plasmid carried the SXT resistance genes in both groups. However, EcoRI and HindIII restriction patterns of the plasmids from resistance pattern I and resistance pattern II were different. Ribotypes of three randomly selected isolates from pattern I were identical and were distinguishable from the ribotype of the isolate from pattern II. We concluded that at least two different clones with different plasmids and resistance patterns were spreading in our territory.

Topics: Anti-Bacterial Agents; DNA, Ribosomal; Drug Resistance, Microbial; Drug Resistance, Multiple; Dysentery, Bacillary; Humans; Plasmids; Shigella boydii; Shigella flexneri; Shigella sonnei; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Topics: Cefotaxime; Cephalosporins; Child, Preschool; Drug Resistance, Microbial; Dysentery, Bacillary; Feces; Humans; Male; Microbial Sensitivity Tests; Shigella flexneri; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate antimicrobial treatment and resistance in clinical childhood shigellosis.. Retrospective.. St. Elisabeth Hospital, Willemstad, Curaçao, Dutch Antilles.. From September 1991 through August 1995 shigellosis was diagnosed in 93 children out of 456 hospitalised with gastroenteritis (S. flexneri in 60, S. sonnei in 32, S. dysenteriae in 1). From hospital and laboratory records, the clinical presentation, antibiotic treatment and duration of hospitalization were indexed as well as the antibacterial resistance pattern of shigellae.. Of the hospitalised children 52 (56%) were treated with antibiotics. Ampicillin was given most frequently (71%), followed by the combination trimethoprim-sulfamethoxazole (25%). Isolated shigellae were resistant to ampicillin in 52% and to trimethoprim-sulfamethoxazole in 34%; 42% of the antibiotic treatments were in accordance with susceptibility of the isolated Shigella.. A high percentage of shigellae isolated on Curaçao was resistant to the most frequently used antibiotics ampicillin and trimethoprim-sulfamethoxazole.

Topics: Ampicillin; Ampicillin Resistance; Anti-Bacterial Agents; Child; Child, Preschool; Dysentery, Bacillary; Female; Gastroenteritis; Humans; Infant; Male; Netherlands Antilles; Penicillins; Retrospective Studies; Shigella flexneri; Shigella sonnei; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Six hundred and ninety-four cases of shigellosis in Nakhon Nayok Hospital from January 1985 to December 1993 were studied to determine epidemiologic and microbiological features. Forty-five percent of cases were children under the age of 14 years. The majority of cases were in children under the age of four. The organism was found throughout the year, with peak incidence in June and July. The most common type isolated was Shigella flexneri, about 74.43%. Only 0.32% of organisms were Shigella dysenteriae. Shigella isolates showed a high rate of resistance to ampicillin and co-trimoxazole, in 1993 only 16.67% and 22.22% were sensitive respectively to these 2 drugs, but 100% were still sensitive to nalidixic acid. Fewer cases of shigellosis were isolated in recent years possible due to widespread use of quinolones in the treatment of acute infective diarrhea in adults.

Topics: Adolescent; Adult; beta-Lactam Resistance; Child; Child, Preschool; Drug Resistance, Microbial; Drug Resistance, Multiple; Dysentery, Bacillary; Humans; Infant; Nalidixic Acid; Prevalence; Retrospective Studies; Risk Factors; Rural Health; Shigella flexneri; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination

Empiric treatment with ciprofloxacin and norfloxacin has been recommended recently for patients with acute diarrhoeal disease. In a retrospective 6-month study period the results of stool cultures from 209 patients with acute diarrhoea admitted to the emergency room were analysed. Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonnei comprised 72% and Shigella flexneri 19% of all the bacterial isolates. While no antimicrobial resistance to ciprofloxacin was found for both Shigella species, only 36 and 26% of the Shigella isolates were sensitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), respectively. These findings point out to the emergence of drug resistance to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fact that indiscriminate use of this drug could result in the emergence of resistance similar to that noted with ampicillin and TMP-SMZ.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Bacteriological Techniques; Child; Child, Preschool; Ciprofloxacin; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Emergency Service, Hospital; Escherichia coli Infections; Feces; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Transfer of shigella R-plasmids in vivo has seldom been demonstrated. Strains of Shigella dysenteriae type 1 and Shigella flexneri type 5b were isolated from a Bulgarian traveller who visited Vietnam and developed dysentery, which was treated with trimethoprim/sulfamethoxazole (TMP/SMZ) for a short time. Both species of shigellae are unusual in Bulgaria where strains of S. sonnei predominate. Both shigella strains were multiresistant to the same antimicrobial agents. Each strain contained a 48-kilobase plasmid that conferred the entire resistance phenotype to a susceptible Escherichia coli. Restriction endonuclease patterns of plasmid DNA from the respective strains were identical. Transmissible plasmids of the same resistance phenotypes and restriction patterns were isolated from the patient's colonic E. coli. Transconjugants hybridized to a dihydrofolate reductase type I-DNA probe. These studies support the hypothesis that R-plasmid transfer may occur between non-pathogenic, faecal strains and pathogenic shigellae, a process that may have been facilitated by inadequate treatment with TMP/SMZ at the onset of the illness.

Topics: Aged; Conjugation, Genetic; DNA Probes; Dysentery, Bacillary; Escherichia coli; Humans; Male; Phenotype; R Factors; Restriction Mapping; Serotyping; Shigella dysenteriae; Shigella flexneri; Tetrahydrofolate Dehydrogenase; Travel; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

After control measures were initiated to stop an outbreak of shigellosis in an institution for the developmentally disabled, there was a sharp decline in the number of cases of Shigella sonnei infection. Among ill residents, those treated with antibiotics had shorter mean duration of diarrhea (2.4 vs. 4.5 days, P < .01) and were less likely to have stool cultures positive for shigellae 2-4 weeks after onset of diarrhea (0/25 vs. 5/19; relative risk [RR] = undefined; P = .02). The attack rate was higher in villages where segregation of ill residents was not practiced (46/73 vs. 53/155; RR = 1.8; 95% confidence limits [CL], 1.4, 2.4). In individual housing units where ill residents were not segregated (preintervention), a correlation was found between mean duration of diarrhea and unit attack rates (r = .88; 95% CL, 0.29, 0.99). A study of all 305 residents 10 weeks after the intervention began revealed no positive stool cultures.

Topics: Adolescent; Child; Child, Preschool; Disabled Persons; Disease Outbreaks; Dysentery, Bacillary; Evaluation Studies as Topic; Humans; Infant; Institutional Practice; Institutionalization; Long-Term Care; Louisiana; Patient Isolation; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination

Rectal histopathology was evaluated in 34 cases (2 months-12 yrs old) of endemic "invasive diarrhea" [> 20 WBCs per high-power field on stool microscopy with (RBC positive) or without (RBC negative) associated RBCs] where S. dysenteriae (n = 9), S. flexneri (n = 11), and nontyphoidal Salmonella were isolated as the sole identifiable enteropathogens. Persistent diarrhea (> 14 days duration) was more common with Salmonella infection whereas RBC-positive "invasive diarrhea" was more frequent with Shigella, particularly S. dysenteriae (all cases) infection. The histopathological profile was comparable to the earlier descriptions of infective colitis to a large extent and the nature of the infecting organism could not be determined on the basis of rectal histology alone. The other noteworthy features were as follows: (i) mild crypt distortion (26%) and branching (21%) in both Shigella and Salmonella infection; in Salmonella infection, dilation of the glands was significantly greater with persistent diarrhea; (ii) presence of chronic inflammatory cells either alone or in combination with neutrophils in 62%; a predominant neutrophilic response was significantly higher with S. dysenteriae infection and an acute presentation; (iii) pseudomembrane formation (six subjects; 18%) especially in S. dysenteriae (four cases); and (iv) a significant association of neutrophilic response, edema, and neutrophils within the vessels in the lamina propria and mucin depletion in the glands with RBC-positive "invasive diarrhea."

Topics: Ampicillin; Cephalexin; Child; Child, Preschool; Diarrhea; Dysentery, Bacillary; Female; Gentamicins; Humans; Infant; Male; Nalidixic Acid; Rectum; Salmonella Infections; Shigella dysenteriae; Shigella flexneri; Trimethoprim, Sulfamethoxazole Drug Combination

To study the incidence, clinical features, treatment and outcome of patients with Salmonella, Shigella or Campylobacter infection.. Retrospective analysis.. Two dedicated HIV units within a London teaching hospital.. All patients with Salmonella, Shigella or Campylobacter infection were reviewed retrospectively by correlating the records of the gastrointestinal and microbiology departments with the computerized records of all HIV-positive patients attending the two clinics.. Between July 1985 and June 1991, 56 episodes of Salmonella, 37 of Campylobacter and eight of Shigella infection were documented in HIV-seropositive patients. Shigella was most likely to occur early in HIV disease, whilst patients with Campylobacter or Salmonella were more likely to have had a previous AIDS diagnosis. Septicaemica was most common in patients with Salmonella and was especially likely to occur in individuals with an AIDS diagnosis. Relapse of infection was common in patients with Salmonella, especially in those with low CD4 lymphocyte counts, those with an initial septicaemic illness and those not treated with ciprofloxacin.. Patients with Salmonella who have low CD4 lymphocytes counts and/or a septicaemic illness should be considered for life-long secondary prophylaxis with ciprofloxacin because of the high rate of relapse observed. Administration of zidovudine or cotrimoxazole as prophylaxis against Pneumocystis carinii pneumonia may prevent the development of salmonellosis: significantly fewer patients with this infection were taking these drugs than patients with Campylobacter.

Topics: Adult; Aged; AIDS-Related Opportunistic Infections; Campylobacter Infections; CD4-Positive T-Lymphocytes; Ciprofloxacin; Dysentery, Bacillary; Feces; HIV Seropositivity; Humans; Leukocyte Count; Male; Middle Aged; Pneumonia, Pneumocystis; Recurrence; Retrospective Studies; Salmonella Infections; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

During surveillance of antimicrobial resistance in Shigella strains isolated in the Netherlands from 1984 to 1989 and forwarded to the National Institute of Public Health and Environmental Protection for typing, sensitivity to twelve antimicrobial agents was assessed. High rates of resistance to the older drugs of choice in treating shigellosis were found, i.e. ampicillin and trimethoprim-sulfamethoxazole. Ampicillin resistance varied from 33 to 53% among Shigella flexneri strains and from 10 to 17% among Shigella sonnei strains. Trimethoprim and trimethoprim-sulfamethoxazole resistance increased from 8% to about 25% among Shigella flexneri and from 16 to 46% among Shigella sonnei isolates. All strains were susceptible to the newer quinolones, but five strains resistant to nalidixic acid showed decreased susceptibility to norfloxacin. Approximately 10% of the isolates were resistant to the combination of ampicillin, trimethoprim and sulfamethoxazole.

Topics: Ampicillin; Anti-Bacterial Agents; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Netherlands; Population Surveillance; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

The susceptibility to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ) was determined for 15,824 isolates of Shigella obtained from patients attending a treatment center in Dhaka, Bangladesh, from 1983 through 1990 and for 520 isolates obtained during community surveys from 1988 through 1990. Susceptibility to nalidixic acid was determined for isolates obtained after 1985. In 1983 13% of isolates were resistant to ampicillin, 23.5% to TMP-SMZ, and 0.8% to both drugs. By 1990 51.2% of isolates obtained at the Diarrhea Treatment Centre were resistant to ampicillin, 47.7% to TMP-SMZ, and 40.5% to both drugs (for comparison with figures for 1983, P less than .001). Resistance to nalidixic acid increased from 0.8% in 1986 to 20.2% in 1990 (P less than .001). In 1990 71.5% of Shigella dysenteriae type 1 isolates were resistant to ampicillin, 68.5% to TMP-SMZ, 67.7% to both drugs, and 57.9% to nalidixic acid. The resistance pattern of isolates obtained during community surveillance was similar to that of Treatment Centre isolates. In Bangladesh ampicillin and TMP-SMZ are no longer useful for treatment of infection with any species of Shigella, and nalidixic acid is no longer useful for treatment of infections due to S. dysenteriae type 1.

Topics: Ampicillin Resistance; Bangladesh; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Feces; Humans; Nalidixic Acid; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical effects of Nifuroxasid (N), Trimetoprim sulphametoxasol (TS) and Bactisubtil (B) on bacillar dysentery and alimentary toxicoinfections in the patients treated at the Clinic from January 1984 to the end of December 1989 have been analysed. According to the clinical signs, patients have been divided in ten categories of light, mild and heavy forms. In total, 329 cases of bacillar dysentery and 89 cases of alimentary toxicoinfections have been analysed. The following was established: A. Bacilar dysentery: the fastest normalization of the stool was achieved with N in every clinical form (averages 2.2, 3.5 and 4.05 days). With TS the effects were slower (3.0, 3.9 and 4.4 days), but the slowest normalization was recorded with B (3.4, 4.6 and 5.4 days). However, with TS, some Shigella strains showed resistance (in 23 out of 94 antibiograms), which diminished the effects. B. Alimentary toxicoinfections were treated only with N and B, since these forms of diarrhea caused by toxigenic factors were milder. Better results were achieved with N in this case as well.

Topics: Acute Disease; Adjuvants, Immunologic; Anti-Infective Agents; Bacillus subtilis; Biological Factors; Diarrhea; Dysentery, Bacillary; Foodborne Diseases; Humans; Hydroxybenzoates; Nitrofurans; Trimethoprim, Sulfamethoxazole Drug Combination

Under combat conditions infectious disease can become a major threat to military forces. During Operation Desert Shield, there were numerous outbreaks of diarrhea among the U.S. forces. To evaluate the causes of and risk factors for diarrheal disease, we collected clinical and epidemiologic data from U.S. troops stationed in northeastern Saudi Arabia.. Between September and December 1990, stool cultures for enteric pathogens were obtained from 432 military personnel who presented with diarrhea, cramps, vomiting, or hematochezia. In addition, a questionnaire was administered to 2022 soldiers in U.S. military units located in various regions of Saudi Arabia.. A bacterial enteric pathogen was identified in 49.5 percent of the troops with gastroenteritis. Enterotoxigenic Escherichia coli and Shigella sonnei were the most common bacterial pathogens. Of 125 E. coli infections, 39 percent were resistant to trimethoprim-sulfamethoxazole, 63 percent to tetracycline, and 48 percent to ampicillin. Of 113 shigella infections, 85 percent were resistant to trimethoprim-sulfamethoxazole, 68 percent to tetracycline, and 21 percent to ampicillin. All bacterial isolates were sensitive to norfloxacin and ciprofloxacin. After an average of two months in Saudi Arabia, 57 percent of the surveyed troops had at least one episode of diarrhea, and 20 percent reported that they were temporarily unable to carry out their duties because of diarrheal symptoms. Vomiting was infrequently reported as a primary symptom, but of 11 military personnel in whom vomiting was a major symptom, 9 (82 percent) had serologic evidence of infection with the Norwalk virus.. Gastroenteritis caused by enterotoxigenic E. coli and shigella resistant to a number of drugs was a major problem that frequently interfered with the duties of U.S. troops during Operation Desert Shield.

Topics: Adolescent; Adult; Ampicillin; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Escherichia coli; Escherichia coli Infections; Feces; Gastroenteritis; Humans; Male; Middle Aged; Military Personnel; Norwalk virus; Saudi Arabia; Shigella sonnei; Surveys and Questionnaires; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Vomiting; Warfare

We report a case of severe urinary tract infection caused by Shigella sonnei in a 3-year-old girl with vesico-ureteric reflux and no history of dysentery. Treatment with co-trimoxazole in a dose of 48 mg/kg for 10 days was given and the infection was eradicated. Possible sources of infection are discussed.

Topics: Child, Preschool; Dysentery, Bacillary; Female; Humans; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Two strains of trimethoprim-resistant Shigella sonnei bearing R plasmids pBH600 and pBH700 each elaborated a dihydrofolate reductase (DHFR) and were moderately resistant to trimethoprim (minimum inhibitory concentrations, 128 and 256 micrograms/ml, respectively). Neither plasmid hybridized to probes for DHFR types I, II, or III. The trimethoprim resistance genes from the R plasmids resided on a 1600-base pair (bp) PstI fragment of pBH600 and an 1800-bp PstI fragment of pBH700. Isoelectric focusing showed distinct isoelectric points for the enzymes coded for on pBH600 (5.3) and pBH700 (5.6-5.7). Trimethoprim-resistant S. sonnei from 10 locations in nine states were examined. Isolates from 8 locations hybridized only to a pBH700-derived probe and one isolate hybridized to a pBH600-derived probe. These two trimethoprim resistance genes appear novel. The gene on plasmid pBH700 codes for an enzyme that seems widespread among S. sonnei isolates in the USA.

Topics: Ampicillin Resistance; Blotting, Southern; Chloramphenicol Resistance; Disease Outbreaks; DNA Probes; DNA, Bacterial; Dysentery, Bacillary; Humans; Microbial Sensitivity Tests; North Carolina; Nucleic Acid Hybridization; R Factors; Shigella sonnei; Tennessee; Tetrahydrofolate Dehydrogenase; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) emerged among Shigella isolates from the Navajo Reservation in the southwestern United States in 1985, years after this antimicrobial agent came into common use. In the study area, TMP-SMX resistance increased dramatically from 3 per cent in 1983 to 21 per cent in 1985. Resistance was polyclonal and occurred in both S. sonnei and S. flexneri. No single plasmid was common to all resistant strains. However, all 28 TMP-SMX resistant isolates examined were resistant to ampicillin and streptomycin and had minimum inhibitory concentrations to sulfamethoxazole of greater than or equal to 4,096 micrograms/ml and to trimethoprim of greater than or equal to 1,024 micrograms/ml. The authors found that 28 of 101 Navajo children with gastrointestinal symptoms who were not taking antimicrobials had TMP-SMX-resistant aerobic fecal flora. To determine risk factors for acquiring resistant strains, they compared 40 case-patients with TMP-SMX-resistant Shigella to 66 controls with TMP-SMX-sensitive Shigella. Case-patients were more likely than controls to have used antimicrobials recently (p = 0.004) and to be hospitalized for shigellosis (p = 0.05). These findings suggest that polyclonal highly TMP-SMX-resistant Shigella emerged by transfer of trimethoprim resistance genes from aerobic bowel flora to endemic Shigella strains, that use of antimicrobials can lead to symptomatic shigellosis and thus the persistence of trimethoprim-resistant Shigella, and that appropriate therapy of shigellosis on the reservation is now a major challenge.

Topics: Adolescent; Adult; Child; Child, Preschool; Cohort Studies; Drug Combinations; Dysentery, Bacillary; Feces; Female; Humans; Indians, North American; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Retrospective Studies; Shigella; Shigella boydii; Shigella flexneri; Shigella sonnei; Southwestern United States; Sulfamethoxazole; Trimethoprim; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ampicillin; Child; Child, Preschool; Drug Combinations; Dysentery, Bacillary; Female; Gastroenteritis; Humans; Infant; Male; Salmonella Infections; Shigella flexneri; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

To develop guidelines for community health workers in the treatment of patients with diarrhoea, diarrhoea prevalence was actively surveyed for a year in a remote rural community of 915,000 persons, and the enteric pathogens and clinical features associated with diarrhoeal illness were determined in a sample of 300 patients. Bloody diarrhoea accounted for 39% of all diarrhoea episodes and 62% of diarrhoea-associated deaths. 51 (50%) of 101 patients with a history of bloody diarrhoea had Shigella infection, compared with 31 (16%) of 199 patients with other types of diarrhoea. A history of bloody diarrhoea was as predictive of the presence of shigella infection (positive predictive value 50%, negative predictive value 86%) as more complex prediction schemes incorporating other clinical features or stool microscopic examination. In the area of Bangladesh where the study was done reduction of diarrhoea-related morbidity and mortality will depend on control and treatment of shigellosis, and community health workers have been instructed to provide antibiotics for patients with a history of bloody dysentery.

Topics: Anti-Infective Agents, Urinary; Bacteria; Bangladesh; Child, Preschool; Community Health Workers; Drug Combinations; Dysentery; Dysentery, Bacillary; Female; Fluid Therapy; Humans; Infant; Nalidixic Acid; Rural Population; Specimen Handling; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Drug resistance patterns of shigella strains were investigated in a prospective manner in Etimesgut district during a period of 1 year. Thirty strains shigella were isolated, belonged to three subgroups with preponderance of Sh. flexneri (70%), followed by Sh. sonnei (27%) and Sh. boydii (3%). The resistance was highest with streptomycin (80%), followed by trimethoprim-sulfamethoxazole (TMP-SMZ) (53%) and ampicillin (43%). Only three strains (10%) were sensitive to all eight antibiotics tested. Sixteen (53%) were resistant to three or more antibiotics. The data showed an increase in resistance to the commonly used antimicrobial agents--namely IMP-SMZ and ampicillin. IMP-SMZ is no longer the drug of choice in severe shigellosis, at least in this region of Turkey.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Ceftriaxone; Chloramphenicol Resistance; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Nalidixic Acid; Ofloxacin; Prospective Studies; Serotyping; Shigella; Shigella boydii; Shigella flexneri; Shigella sonnei; Streptomycin; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

In an epidemic of shigellosis in southern Bangladesh the causal organism, Shigella dysenteriae type 1, was resistant to nalidixic acid as well as to co-trimoxazole (trimethoprimsulphamethoxazole) and ampicillin. The genes coding for resistance to nalidixic acid, but not those coding for resistance to co-trimoxazole or ampicillin, are located on a conjugative 20 megadalton plasmid. This epidemic is of particular importance because of the resistance to nalidixic acid, an antibiotic to which shigellae are seldom resistant, and because plasmids were previously thought not to mediate resistance to nalidixic acid.

Topics: Ampicillin; Bangladesh; Disease Outbreaks; DNA, Bacterial; Drug Combinations; Dysentery, Bacillary; Evaluation Studies as Topic; Humans; Nalidixic Acid; Penicillin Resistance; Plasmids; Shigella dysenteriae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Child; Child, Preschool; Disease Outbreaks; Drug Combinations; Dysentery, Bacillary; Female; Humans; Hygiene; Jews; Male; Shigella sonnei; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; United States

The percentage of Shigella and enterotoxigenic Escherichia coli (ETEC) strains resistant to trimethoprim (TMP)-sulfamethoxazole isolated from children with diarrhea at the outpatient department of the Children's Hospital in Bangkok increased from 3 and 0%, respectively, in 1982 to 29% and 25% in 1986. One hundred thirty-nine Shigella and 22 ETEC strains resistant to greater than 1024 micrograms/ml of trimethoprim (TMPr) isolated from children with diarrhea in Bangkok in 1984 and 1985 were analyzed for the presence of type I, II and III plasmid-specific dihydrofolate reductase (DHFR) genes. Thirty-two percent (45 of 139) of TMPR Shigella had genes encoding type II and 9% (13 of 139) had genes encoding type I DHFR genes. Fifty percent (11 of 22) of TMPR ETEC had type II and 14% (3 of 22) had type I DHFR genes. Plasmids encoding DHFR were identified by the Southern technique in 24% (14 of 58) of Shigella and 1 of 14 ETEC that contained genes encoding DHFR. Plasmids coding for type II DHFR were transferred to E. coli K12 by conjugation from 13 of 14 Shigella and a plasmid coding for type I DHFR was transferred from the single ETEC containing a plasmid coding for type I DHFR. Genes coding for DHFR were presumably situated on the chromosome in 76% (44 of 58) of Shigella and 93% (13 of 14) of ETEC that contained genes encoding DHFR. Since 58% (81 of 139) of TMPR Shigella and 36% (8 of 22) of TMPR ETEC strains examined did not contain genes encoding type I, II or III DHFR, high level TMP resistance was presumably caused by other types of DHFR genes.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anti-Bacterial Agents; Child; Conjugation, Genetic; Diarrhea; DNA, Bacterial; Drug Combinations; Dysentery, Bacillary; Enterotoxins; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Nucleic Acid Hybridization; R Factors; Shigella; Sulfamethoxazole; Tetrahydrofolate Dehydrogenase; Thailand; Trimethoprim; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child, Preschool; Drug Combinations; Drug Resistance, Microbial; Dysentery, Bacillary; Female; Hemolytic-Uremic Syndrome; Humans; Shigella dysenteriae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Child; Drug Combinations; Dysentery, Bacillary; Humans; Male; Nalidixic Acid; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Stool specimens collected systematically from a group of Celebes black macaques (Macaca nigra) with a high incidence of diarrhea were examined microbiologically. Numerous isolates of Shigella flexneri, Campylobacter jejuni and pathogenic Escherichia coli were recovered. Previous parasitology reports had revealed that the majority of the animals had Balantidium coli. Subsequently, the group was treated with trimethoprim-sulfamethoxazole, erythromycin and tetracycline. After treatment, Shigella flexneri was not detected in the stool of any animal for 1 year, and the clinical condition of the group was improved. Reduced recovery rates were obtained with other enteric pathogens.

Topics: Animals; Drug Combinations; Drug Therapy, Combination; Dysentery, Bacillary; Erythromycin; Macaca; Monkey Diseases; Shigella flexneri; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ampicillin; Bangladesh; Drug Combinations; Dysentery, Bacillary; Humans; Nalidixic Acid; Penicillin Resistance; Shigella dysenteriae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Shigellosis is usually a non-invasive enteric disease, rarely accompanied by extra-intestinal manifestations. Shigella septicaemia is therefore reported in a child aged 10 months. In the laboratory the organism was resistant to ampicillin and only moderately susceptible to chloramphenicol. The patient responded well to cotrimoxazole to which the organism isolated was susceptible in vitro. We recommend that blood as well as faeces should be cultured in exceptionally ill patients with suspected or otherwise confirmed shigella infection.

Topics: Drug Combinations; Dysentery, Bacillary; Female; Humans; Infant; Saudi Arabia; Sepsis; Shigella flexneri; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Arthritis, Infectious; Child, Preschool; Drug Combinations; Dysentery, Bacillary; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Shigella flexneri; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Bangladesh; Child; Child, Preschool; Disease Outbreaks; Drug Combinations; Drug Resistance, Microbial; Dysentery, Bacillary; Female; Humans; Male; Shigella dysenteriae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Combinations; Dysentery, Bacillary; Furazolidone; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Although acute renal failure secondary to infections is relatively common in adult patients, uremia requiring dialysis has not previously been reported in an adult patient with shigella enterocolitis. Our patient, infected with S flexneri, had severe renal failure without any evidence of sepsis, rhabdomyolysis, or the hemolytic-uremic syndrome. Antibiotic therapy with trimethoprim-sulfamethoxazole appeared to play a role in his eventual recovery.

Topics: Acute Kidney Injury; Adult; Drug Combinations; Dysentery, Bacillary; Enterocolitis, Pseudomembranous; Humans; Male; Peritoneal Dialysis; Shigella flexneri; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Drug Combinations; Dysentery, Bacillary; Humans; Otitis Media; Pneumonia, Pneumocystis; Salmonella Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Administration, Oral; Adult; Bacteria; Child; Drug Combinations; Drug Interactions; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Infusions, Parenteral; Neutropenia; Nocardia Infections; Otitis Media; Pneumonia, Pneumocystis; Salmonella Infections; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections