Shigella boydii Bacteremia in an Ederly Patient with No Underlying Disease / 대한임상미생물학회지

Shigella bacteremia is rare, occurring mainly in children. Shigella species often cause diarrhea or gastrointestinal inflammation in humans and are rarely associated with bacteremia. This report describes an unusual case of Shigella boydii bacteremia in an 84-year-old patient visiting our hospital after experiencing nausea, vomiting, and febrile sensation for 2 days. Peripheral blood cultures revealed S. boydii and 16S rDNA sequence analysis produced the same result. However, the organism was not isolated from the patient's stool. She was started on ciprofloxacin, to which this organism is sensitive, and was subsequently discharged with instructions to complete a 14-day course of ciprofloxacin. Shigellosis is usually a self-limiting enteric disease. However, in contrast to its isolation from both blood and stool, isolation of the organism from blood only is associated with a high mortality rate. As is frequently pointed out, blood cultures should be obtained from elderly or immunocompromised patients with acute febrile gastroenteritis to detect infection caused by enteric pathogens, including Shigella.

Analysis of a Temporal Cluster of Shigella Boydii Isolates in Mpumalanga; South Africa; November to December 2007

Background: Shigellosis is a global human health problem. The disease is most prevalent in developing countries with poor access to safe potable water and sanitation. Shigella boydii is of particular epidemiological importance in developing nations such as African and Asian countries. In the present study; we report on the analysis of a temporal cluster of 29 S. boydii serotype 2 strains; isolated in the Mpumalanga Province of South Africa (SA) over the period of November to December 2007. Methodology: Bacteria were identified as S. boydii using standard microbiological identification techniques and serotyped using commercially available antisera. Susceptibility testing to antimicrobial agents was determined by the Etest. Genotypic relatedness of strains was investigated by pulsed-field gel electrophoresis (PFGE) analysis of digested genomic DNA. Results: The cluster of 29 isolates revealed comparable antimicrobial susceptibility profiles; while dendrogram analysis of PFGE patterns showed that the cluster of isolates grouped together and could clearly be differentiated from a random selection of unrelated S. boydii serotype 2 strains. Our data has strongly suggested that this cluster of isolates may share a common ancestry. However; this cannot be substantiated by epidemiological data because a detailed epidemiological investigation was not conducted. Conclusions: We have documented the first cluster of S. boydii infection in SA. Due to the lack of adequate epidemiological investigation; we cannot emphatically state that an outbreak had occurred. However; we do hypothesis that this was an outbreak for which a waterborne source cannot be excluded. This study has highlighted the urgent need for timely and appropriate systems of epidemiological investigation of all suspected outbreaks of disease in developing countries

Antibiotic susceptibility and plasmid profiles of shigella species in Sudan

This study was carried out to determine the antibiotic susceptibility, plasmid profile and conjugative abilities of Shigella species isolated from different towns in Sudan during 2005-2007. Stool specimens were collected in Carry Blair transport medium from patients presenting with diarrhea from different sites in Sudan between the years 2005-2007. All specimens were inoculated on Mac Conkey' s agar and Xylose Lysine Dioxycholate [XLD] [Mast group Ltd. Merseyside UK]. Bacteria was isolated and subjected to different antibiotics to detect sensitivity and transference of resistance. One hundred and fourteen Shigella isolates were included in the study. Eighty [70.1%] were Shigella flexeneri representing the dominant isolate, followed by 20 [17.5%] isolates of Shigella dysenteriae, 9 [7.9%] Shigella sonnei and 5 [4.5%] Shigella boydii. Most of the isolates showed resistance to streptomycin [70%], tetracycline [52%] and co-trimoxazole [43%]. They were highly sensitive to norfioxacin [97%], nalidixic acid [95%], gentamicin [89%] and chloramphenicol [77%]. Multi-drug resistance to two or more antibiotics was apparent in most of the isolates [64, 56.1%]. Fifty nine of the resistant Shigella isolates were studied for their ability to transfer resistance to the donor E. coli K[12] by conjugation. Of these, six were able to transfer resistance to streptomycin, tetracycline and co-trimoxazole. Extraction of the plasmid DNA from both donors and trans-conjugants showed a single type of plasmid with a molecular weight of 4.6 Kb. The transfer of multi-drug resistant plasmids and the emergence of antibiotic Shigella and other bacterial species should raise the awareness and the seriousness of the uncontrolled [unsupervised] use of antibiotics in the medical practice

Validation of salmonellosis and shigellosis diagnostic test kits at a provincial hospital in Thailand.

Rapid Diagnosis of salmonellosis and shigellosis was performed using six different diagnostic test kits which recently have been made available commercially. They were Salmo-Dot, Typhi-Dot, Shigel Dot A, B, C, and D test kits for detection of Salmonella spp., group D salmonellae, and groups A, B, C, and D Shigella spp., respectively. The principle of all test kits is a membrane (dot) ELISA using specific monoclonal antibodies to the respective pathogens as the detection reagents. The present study was designed to validate the accuracy of the test kits, at a laboratory in a provincial hospital in Thailand, in comparison with the conventional bacterial culture method alone or with the combined results of the culture and the Western blot analysis (WB) for detecting the respective bacterial lipopolysacchharides (LPS) in specimens. Five hundred rectal swab samples of patients with diarrhea who seeked treatment at the hospital, were evaluated. The diagnostic accuracy of the Salmo-Dot was 91.0% when compared with the conventional bacterial culture method alone but was 100.0% in comparison with the combined results of the culture and the WB. The Typhi-Dot and the Shigel-Dot A, B, C, and D showed 100%, 99.2%, 95.0%, 94.0% and 96.4%, respectively when compared with the culture alone and all were 100% in comparison with the combination of the results of the bacterial culture and the WB. The Shigel-Dot A revealed antigen of type 1 Shigella dysenteriae in several specimens in which the bacteria could not be recovered by the culture method. This difference is important as type 1 Shigella dysenteriae have high epidemic potential and often cause severe morbidity. Unawareness of their presence by the conventional culture may have great impact on disease surveillance for public health. The pathogen detection using the six diagnostic test kits is sensitive, specific, rapid, and relatively simple and less expensive. Several specimens can be tested at the same time without much increase in turn around time. Moreover, these kits produce no contaminated waste as compared with the bacterial culture method. The test kits should be used for rapid screening of specimens of patients with diarrhea especially in areas where culture facilities are inadequate.

Patrones de sensibilidad in vitro y comportamiento clínico de shigella / Susceptibility patterns and clinical presentation of shigella

Shigella mantiene un importante lugar como causa de diarrea en niños con aumento de su resistencia antimicrobiana en los últimos años, lo que dificulta la elección de terapia empírica en cuadros disentéricos. Se estudió la susceptibilidad antimicrobiana in vitro a 163 cepas aisladas entre 1997 y 1999. S. sonnei representó el 63 por ciento de las cepas aisladas. Se observó aumento en los patrones de resistencia de Shigella a los antimicrobianos tradicionales. La resistencia global de las cepas alcanzó a 95 por ciento para ampicilina, 84 por ciento para cloranfenicol, 43,6 por ciento para cotrimoxazol y 3,7 por ciento para furazolidona; no hubo resistencia a ciprofloxacina. De 57 niños hospitalizados por shigelosis, 82,5 por ciento tenían sobre 2 años de edad. Todos presentaron fiebre, 56 por ciento disentería y 8,8 por ciento convulsiones. Seis pacientes con evolución tórpida recibieron ciprofloxacina con éxito clínico. Ciprofloxacina representa una alternativa a evaluar como terapia empírica en niños con disentería de causa bacteriana. Es necesario mantener vigilancia local en la susceptibilidad antimicrobiana de Shigella a fin de guiar su terapia específica

Caracterización de un brote de Shigella boydii 14 por primera vez en Cuba / Characterization of an aoutbreak of Shigella boydii 14 for the first time in Cuba

Se propuso la caracterización de 14 cepas de Shigella boydii 14 aisladas de pacientes con enfermedad diarreica aguda mediante sus plásmidos de resistencia y de las proteínas de la membrana externa presentes en ellas. Se realizó la determinación de la susceptibilidad antimicrobiana por el método de concentración mínima inhibitoria, la extracción de plásmidos R fue según Manaitis, los extractos proteicos de las cepas se obtuvieron según el método de Blaser modificado y las proteínas de la membrana externa fueron separadas por SDS-PAGE por el método de Laemmli. Se comprobó que las cepas resultaron resistentes a la ampicilina (100 porciento), la tetraciclina (70 porciento) y al cotrimoxazol (50 porciento), y sensibles al ácido nalidíxico y a la ciprofloxacina. Se observó la presencia de plásmidos al nivel de los 43; 23; 20; 5,6 y 1,2 kb. Las proteínas de la membrana externa y el perfil proteico demostraron diferencias con otras especies de Shigella. Este serotipo de Shigella se aísla por primera vez en Cuba y y sus características la hacen altamente patógena y de muy difícil diagnóstico, por lo que la caracterización de este brote es importante desde el punto de vista epidemiológico

Frecuencia y biodiversidad de algunas bacterias enteropatógenas aisladas en niños con síndrome diarreico agudo / Frequency and biodiversity of some enteropathogenic bacteria recovered from children with acute diarrheic syndrome

El estudio etiológico de la diarrea aguda en el niño se ve limitado por las técnicas actualmente disponibles con fines clínicos. La aplicación de técnicas de biología molecular en el análisis de deposiciones permite incrementar la detección de enteropatógenos y una caracterización fenotípica más acabada de las cepas aisladas permite describir mejor su diversidad y caracterizar epidemiológicamente los episodios observados en cada temporada estival. En un estudio piloto efectuado en la ciudad de Concepción, se aplicaron en el estudio etiológico de la diarrea en niños entre 0 y 4 años de edad consultantes en un servicio de urgencia, las técnicas convencionales de cultivo e identificación por pruebas bioquímicas según Edwards y Ewing, la búsqueda de genes de virulencia de Escherichia coli enterohemorrágica más el análisis de serotipo, biotipo, antibiotipo y perfil plasmidial de las cepas enteropatógenas aisladas. En 32 (25,3 por ciento) de 127 niños con diarrea de edad entre 5 meses y 4 años de detectó la frecuencia de los siguientes enteropatógenos: Shigella sonnei 13,4 por ciento Shigella flexneri 6,3 por ciento, Yersinia enterocolitica 2,4 por ciento, Shigella boydii 0,8 por ciento, Salmonella typhimurium 1,6 por ciento y Salmonella hadar 0,8 por ciento. La frecuencia de aislamiento aumentó en relación al aumento de la edad desde 0 por ciento en el grupo etario de 4 a 5 meses, 6,3 por ciento en el de 6 a 11 meses, 33,1 por ciento en el de 12 a 23 meses, hasta 68,7 por ciento en el grupo de 24 a 47 meses. Shigella spp. fueron las de mayor frecuencia relativa de aislamiento con 81,1 por ciento. El rendimiento de las determinaciones feno y genotípicas para estudio de biodiversidad fue variable en las especies. Las 8 cepas de S. flexneri se diferenciaron en 6 grupos en base a 3 serotipos, 5 antibiotipos y 5 perfiles plasmidiales. Las 17 cepas de S. sonnei se discriminaron en 11 grupos determinados preferentemente por los patrones plasmidiales. La amplificación aleatoria mediante RAPD en S. flexneri y S. sonnei no aportó mayor grado de biodiversidad que la establecida por las otras determinaciones. El antibiotipo y perfil plasmidial fueron útiles en discriminar en 2 grupos las 3 cepas de Y. enterocolitica, marcadores que además permitieron sugerir que las S. typhimurium aisladas serían una misma cepa

Severe shigellosis in childhood.

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.

Aislamientos de Shigella y Salmonella durante el período 1990-1994 / Isolation of Shigella and Salmonella during the period 1990-1994

En el siguiente trabajo se comunican los aislamientos de Shigella y Salmonela en pacientes con diarreas agudas que fueron atendidos en el Hospital de Niños Ricardo Gutierrez de la ciudad de Santa Fe en el período 1990-1994. Shigella prevaleció en cada uno de los años estudiados con respecto a Salmonella, y el serogrupo predominante fue flexneri. La recuperación de Salmonella fue similar en cada año, debiéndose destacar un brote intrahospitalario a Salmonella typhimurium. Es importante conocer los agentes más frecuentes para que las medidas de control sean dirigidas y permitan orientar investigaciones futuras relacionadas con las enfermedades diarreicas

Shigella em alimentos / Shigella in the foods

Comenta-se nesta breve revisao a participacao e o significado de Shigella em processos de infeccao alimentar. Sao tambem abordados as caracteristicas do microrganismo, seus fatores de virulencia e determinancia genetica.Aspectos epidemiologicos da infeccao, bem como, condicoes de crescimento e metodos de deteccao em alimentos, sao tambem abordados

Shigellosis in children: a prospective hospital based study.

From 1985 to 1988, fecal samples of 950 hospitalized children suffering from diarrhea or dysentery were screened for Shigella species using standard methods. Shigella species were isolated as sole pathogen from 192 (20.2%) cases and S. flexneri type 2 was the predominant serotype. Shigella infection was prevalent throughout the year with high isolation rate during the summer and early monsoon months. Shigella strains isolated during the period were resistant to most of the commonly used drugs for the treatment of shigellosis. Nearly 16% of the Shigella strains were also resistant to nalidixic acid. Presence of blood and mucus in stools (dysentery) was the common clinical presentation of shigellosis cases. Malnutrition was associated with longer duration of illness. High cases fatality rate (16.7%) was observed among hospitalized children infected with Shigella.

Molecular analysis of virulence plasmids of invasive shigella species

A total of 48 isolates of Shigella species obtained from the Military Central Laboratories was examined for serotype, antibiotic resistance and invasiveness. The transferability and molecular structure of the virulence plasmids from each isolate were also examined. Twenty strains were evasive and 70% of these virulent strains were multidrug resistant. Ten virulent strains [tra+] transferred ampicillin resistance and virulence simultaneously, i.e. they carried conjugative plasmids; while the other strains [10 strains] were tra-. By plasmid analysis and DNA homology, almost all the virulent strains carried a large plasmid of 230 Kb, and 2-3 small cryptic plasmids [6.4, 3.3 and 2.7 Kb]. The results suggested that the cryptic plasmids can be transferred to other strains of the same species by conjugation or mobilization, predicting that the virulent multidrug resistant strains may no longer be restricted to a narrow range of serotypes in the near future. Further genetic analysis of virulence plasmids may be essential for the development of recombinant vaccines against Shigella species

Shigelosis en niños observada en necropsias / Shigellosis in children observed in necropsies

Se estudiaron 36 casos en los cuales los coprocultivos post mortem y/o clínicos señalaron desarrollo de algún tipo de Shigella. Hubo 31 cultivos con Sh. flexneri, tres con Sh. sonnei y dos con Sh. boydii. Se trataba de 22 pacientes del sexo masculino y de 14 del sexo femenino; 28 tuvieron edad de 29 días a 12 meses y 81% presentó desnutrición de segundo y tercer grado. Hubo enteritis en 15 casos, enterocolitis en 16 y colitis en cinco casos. Se observaron cuatro pacientes con hemorragia intestinal severa, tres con perforación y peritonitis y tres con neumatosis intestinal. En ningún caso hubo desarrollo de Shigella en hemocultivo ni en el cultivo de pulmón. Hubo ocho casos de septicemia y 13 de bronconeumonía, alteraciones debidas en la mayoría a Pseudomonas aeruginosa y Klebsiella pneumoniae. En 15 pacientes se encontró aparte de la shigelosis, otras enfermedades importantes

Frecuencia etiológica de la shigelosis por especie y serotipo en Venezuela / Etiological frequency for species and serotypes of Shigella in Venezuela

Se determina la frecuencia etiológica por especie y por serotipo de 1369 cepas de Shigella aisladas durante el período 1968-1982 de coprocultivos procedentes principalmente de niños con clínica de disentería bacilar. De ellas, 870 (63.55%) son Shigella flexneri y 414 (30.24%) son Shigella sonnei. El predominio de Shigella flexneri se hace en base a los serotipos B2, B1, B3 y B6. Un incremento en los aislamientos de Shigella sonnei ocurre en el transcurso del estudio. A Shigella dysenteriae corresponden 77 (5.62%) cepas, 15 (19.48%) de ellas son Shigella dysenteriae A1 ocurriendo el último aislamiento de este serotipo en 1975. Shigella dysenteriae A2 se ha hecho endémico en la región y es responsable en los últimos 8 años del 96.6% de los aislamientos de Shigella dysenteriae. Shigella boydii es infrecuentemente aislada en nuestro medio (0.58%)

Shigella boydii 9 rápida fermentadora da lactose / Shigella boydii 9, fast lactose-fermenting

E relatado pela primeira vez no Brasil o isolamento de uma cepa de Shigella boydii 9, rápida fermentadora da lactose (AU).