Antimicrobial resistance of Shigella isolates in the USA: the importance of international travelers

Article Abstract:

Shigella species are responsible for a significant amount of diarrheal disease, the treatment of which has been complicated by the presence and rapid development of resistance to antimicrobial agents. In this study, researchers assessed the prevalence of antimicrobial resistant strains of Shigella, and clarified the epidemiologic patterns of the diseases caused by these organisms. Twenty-five counties in 14 states sent a total of 270 isolates to the Centers for Disease Control. Cultures were collected from August 1985 to July 1986. For purposes of comparison, a panel of antimicrobial agents used in an earlier study was again evaluated. Risk factors and possible sources of infection were identified as travel-related (20 percent), contact with a sick family member, sexual contact, and possible exposure swimming, in an institutional setting or a farm labor camp. Strains represented were S. sonnei (152), S. flexneri (88), S. boydii (10), and S. dysenteriae (2). Of the isolates obtained, 82 percent were resistant to at least one antimicrobial agent, and 51 percent were multiply resistant. Wide variability in antimicrobial sensitivity was determined. Resistance to ampicillin or trimethoprim-sulfamethoxazole was most common. Treatment of shigellosis is largely dependent on regional success, and a history of recent international travel by the patient or a family member. The factor of international travel appears to be more significant in identifying the possibility of a resistant strain than the usual foci of outbreaks of shigellosis, principally, children in day care centers, institutionalized persons, native Americans on reservations, and homosexual men. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Travel, Risk factors, Drug therapy, Drug resistance in microorganisms, Microbial drug resistance, Shigella

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Chronic diarrhea associated with drinking untreated water

Article Abstract:

In 1984 and 1985, outbreaks of chronic diarrhea occurred in two communities in Minnesota and Texas. The Minnesota epidemic was thought to be linked to unpasteurized milk products, but no such association was made in the Texas epidemic, and no particular organism was isolated in either outbreak. The characteristics of another diarrheal outbreak in a rural community in Illinois were examined. Seventy-two patients with chronic diarrhea were compared with similarly matched local residents and companions without the disease; an additional 80 truck drivers were also included in the study. Chronic diarrhea was defined as three or more watery loose stools per day lasting four or more weeks. The average number of stools was 12 per day. The diarrhea affecting these residents was not bloody and was associated with urgency, incontinence and loss of weight. It took an average of 10 days from exposure for symptoms of diarrhea to appear. The diarrhea continued for up to six months in 87 percent of the patients. No pathogenic organisms were isolated from stool samples or local water supplies. Eating at a local restaurant four weeks prior to the onset of symptoms was strongly associated with chronic diarrhea. The source of the diarrhea was traced to an untreated water supply supplying the restaurant. Biopsies of nine selected patients revealed mild swelling in the intestines. Although the actual cause of the diarrhea remains unknown, an environmental agent is suspected. This is the first known report of an epidemic of chronic diarrhea caused by untreated water. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Environmental aspects, Water pollution, Waterborne infections, Environmentally induced diseases, Environmental illness

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Hyperendemic shigellosis in the United States: a review of surveillance data for 1967-1988

Article Abstract:

Shigella are bacteria that are found normally in the intestines of humans and monkeys. They are a common cause of diarrhea in children, responsible for shigellosis (severe diarrhea with pain, fever, and dehydration) and gastroenteritis (inflammation of the stomach and intestines causing fever, nausea and diarrhea). People living in poor, overcrowded urban communities with poor sanitation and hygiene have the greatest risk of developing shigellosis caused by Shigella sonnei. Over the last several decades, improvements in socioeconomic conditions, sanitation and hygiene have led to a decrease in the national incidence of shigellosis. However, between 1986 and 1988, there was a dramatic increase in the number of cases of shigellosis reported to the Centers for Disease Control. During this time period, the number of cases of shigellosis almost doubled, to 10 cases per 100,000 people. It was surprising to find that the greatest rate of increase in shigellosis occurred in wealthy countries with predominantly white populations. The greatest increase occurred in persons over the age of 20, indicating a trend toward infection occurring at older ages. It is concluded that the overall rate of transmission of shigellosis will remain low, but there will be brief periods where the incidence of shigellosis will increase. This may be due to cyclical changes in the level of immunity to Shigella sonnei in the community. (Consumer Summary produced by Reliance Medical Information, Inc.)

Shigella sonnei

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