BACKGROUND: Systemic disease due to shigellae is associated with human immunodeficiency virus (HIV), malnutrition, and other immunosuppressed states. We examined the clinical and microbiologic characteristics of systemic shigellosis in South Africa, where rates of HIV infection are high. METHODS: From 2003 to 2009, 429 cases of invasive shigellosis were identified through national laboratory-based surveillance. At selected sites, additional information was captured on HIV serostatus and outcome. Isolates were serotyped and antimicrobial susceptibility testing performed. RESULTS: Most cases of systemic shigellosis were diagnosed on blood culture (408 of 429 cases; 95%). HIV prevalence was 67% (80 of 120 cases), highest in patients aged 5-54 years, and higher among females (55 of 70 cases; 79%) compared with males (25 of 48 cases; 52%; P = .002). HIV-infected people were 4.1 times more likely to die than HIV-uninfected cases (case-fatality ratio, 29 of 78 HIV-infected people [37%] vs 5 of 40 HIV-uninfected people [13%]; P = .008; 95% confidence interval [CI], 1.5-11.8). The commonest serotype was Shigella flexneri 2a (89 of 292 serotypes [30.5%]). Pentavalent resistance occurred in 120 of 292 isolates (41.1%). There was no difference in multidrug resistance between HIV-infected patients (33 of 71 [46%]) and uninfected patients (12 of 33 [36%]; 95% CI, .65--3.55). CONCLUSIONS: Systemic shigellosis is associated with HIV-infected patients, primarily in older girls and women, potentially due to the burden of caring for sick children in the home; interventions need to be targeted here. Death rates are higher in HIV-infected versus uninfected individuals.
BACKGROUND: Systemic disease due to shigellae is associated with human immunodeficiency virus (HIV), malnutrition, and other immunosuppressed states. We examined the clinical and microbiologic characteristics of systemic shigellosis in South Africa, where rates of HIV infection are high. METHODS: From 2003 to 2009, 429 cases of invasive shigellosis were identified through national laboratory-based surveillance. At selected sites, additional information was captured on HIV serostatus and outcome. Isolates were serotyped and antimicrobial susceptibility testing performed. RESULTS: Most cases of systemic shigellosis were diagnosed on blood culture (408 of 429 cases; 95%). HIV prevalence was 67% (80 of 120 cases), highest in patients aged 5-54 years, and higher among females (55 of 70 cases; 79%) compared with males (25 of 48 cases; 52%; P = .002). HIV-infectedpeople were 4.1 times more likely to die than HIV-uninfected cases (case-fatality ratio, 29 of 78 HIV-infectedpeople [37%] vs 5 of 40 HIV-uninfectedpeople [13%]; P = .008; 95% confidence interval [CI], 1.5-11.8). The commonest serotype was Shigella flexneri 2a (89 of 292 serotypes [30.5%]). Pentavalent resistance occurred in 120 of 292 isolates (41.1%). There was no difference in multidrug resistance between HIV-infectedpatients (33 of 71 [46%]) and uninfected patients (12 of 33 [36%]; 95% CI, .65--3.55). CONCLUSIONS:Systemic shigellosis is associated with HIV-infectedpatients, primarily in older girls and women, potentially due to the burden of caring for sick children in the home; interventions need to be targeted here. Death rates are higher in HIV-infected versus uninfected individuals.
Authors: Carlos Toro; Ana Arroyo; Ana Sarria; Nuria Iglesias; Ana Enríquez; Margarita Baquero; Concepción Ladrón de Guevara Journal: Am J Trop Med Hyg Date: 2015-07-20 Impact factor: 2.345
Authors: P B Pavlinac; D M Denno; G C John-Stewart; F M Onchiri; J M Naulikha; E A Odundo; C E Hulseberg; B O Singa; L E Manhart; J L Walson Journal: J Pediatric Infect Dis Soc Date: 2015-07-12 Impact factor: 3.164
Authors: Andi L Shane; Rajal K Mody; John A Crump; Phillip I Tarr; Theodore S Steiner; Karen Kotloff; Joanne M Langley; Christine Wanke; Cirle Alcantara Warren; Allen C Cheng; Joseph Cantey; Larry K Pickering Journal: Clin Infect Dis Date: 2017-11-29 Impact factor: 9.079
Authors: Karen H Keddy; Arvinda Sooka; Alfred Musekiwa; Anthony M Smith; Husna Ismail; Nomsa P Tau; Penny Crowther-Gibson; Frederick J Angulo; Keith P Klugman Journal: Clin Infect Dis Date: 2015-11-01 Impact factor: 9.079
Authors: Mariaelena Caboni; Thierry Pédron; Omar Rossi; David Goulding; Derek Pickard; Francesco Citiulo; Calman A MacLennan; Gordon Dougan; Nicholas R Thomson; Allan Saul; Philippe J Sansonetti; Christiane Gerke Journal: PLoS Pathog Date: 2015-03-20 Impact factor: 6.823
Authors: Karen H Keddy; Arvinda Sooka; Anthony M Smith; Alfred Musekiwa; Nomsa P Tau; Keith P Klugman; Frederick J Angulo Journal: PLoS One Date: 2016-10-25 Impact factor: 3.240