Abstract
Shigella are ranked among the most prevalent aetiologies of diarrhoeal disease worldwide, disproportionately affecting young children in developing countries and high-risk communities in developed settings. Antimicrobial treatment, most commonly with fluoroquinolones, is currently recommended for Shigella infections to alleviate symptoms and control disease transmission. Resistance to fluoroquinolones has emerged in differing Shigella species (S. dysenteriae, flexneri and sonnei) since the turn of the 21st century, originating in endemic areas, and latterly spreading into non-endemic regions. Despite occurring independently, the emergence of fluoroquinolone resistance in these different Shigella species shares striking similarities regarding their epidemiology and resistance mechanisms. Here, we review and discuss the current epidemiology of fluoroquinolone-resistant Shigella species, particularly in the light of recent genomic insights.
Highlights
Shigella, a pathogenic genus within the extensive Gramnegative family Enterobacteriaceae, is a major cause of diarrhoeal disease worldwide [1, 2]
This review aims to summarize the epidemiology of various FQR Shigella species, highlighting insights provided through genome sequencing and Received 23 October 2017; Accepted 20 March 2018 Author affiliation: Enteric Infections, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. *Correspondence: Hao Chung The, haoct@oucru.org Keywords: Shigella; fluoroquinolone resistance; Asia; quinolone resistance determining region (QRDR); epidemiology; genomic
The emergence of FQR Shigella has been quickly followed by the expansion and, for S. sonnei, rapid international spread
Summary
A pathogenic genus within the extensive Gramnegative family Enterobacteriaceae, is a major cause of diarrhoeal disease worldwide [1, 2]. The disease disproportionately affects young children in low-income tropical settings, where malnutrition, inadequate sanitation and limited access to clean water appear to facilitate the transmission of the infecting organisms. Current serology classifies the genus into four species or serogroups (S. dysenteriae, boydii, flexneri and sonnei), which differ significantly in their epidemiology. S. boydii is only sporadically isolated from diarrhoeal cases in the Indian subcontinent [6,7,8]. The overwhelming majority of shigellosis cases are presently attributed to S. flexneri and S. sonnei, which predominantly circulate in developing and developed regions, respectively [9]. Due to its low prevalence and research focus, S. boydii will be excluded from this discussion
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