Shigella flexneri serotype 3a: the rise of a superbug

Abstract

Shigellosis is a highly contagious acute gastrointestinal infection conferred by faeco-oral transmission of the pathogen Shigella spp. 1 Musher DM Musher BL Contagious acute gastrointestinal infections. N Engl J Med. 2004; 351: 2417-2427 Crossref PubMed Scopus (129) Google Scholar In low-income countries and high-risk regions, poor sanitation is responsible for about 165 million cases of shigellosis annually, with at least 1 million of these resulting in death. 2 Kotloff KL Winickoff JP Ivanoff B et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ. 1999; 77: 651-666 PubMed Google Scholar In high-income countries and low-risk regions, shigellosis is typically associated with travel to high-risk regions (Africa, Asia, and Latin America). 3 Borg ML Modi A Tostmann A et al. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009–2011. Euro Surveill. 2012; 17: 1-5 Google Scholar Since 2000, shigellosis has also been reported as a sexually transmitted infection (STI) among men who have sex with men (MSM). 4 CDCShigella sonnei outbreak among men who have sex with men San Francisco, California, 2000–2001. MMWR Morb Mortal Wkly Rep. 2001; 50: 922-926 PubMed Google Scholar In most cases of shigellosis, treatment relies on replacement of fluids and salts lost due to severe diarrhoea, which usually lasts for less than a week. 5 US National Library of MedicineNational Institutes of Health http://www.nlm.nih.gov/medlineplus/ency/article/000295.htm Google Scholar However, severe infections in young children and old adults, or immunocompromised people, might require antibiotic treatment. 6 DuPont HL Approach to the patient with infectious colitis. Curr Opin Gastroenterol. 2012; 28: 39-46 Crossref PubMed Scopus (25) Google Scholar The emergence of Shigella spp strains with decreased antibiotic susceptibility is a growing public health concern. 7 Gu B Cao Y Pan S et al. Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe-America and Asia-Africa from 1998 to 2009. Int J Antimicrob Agents. 2012; 40: 9-17 Summary Full Text Full Text PDF PubMed Scopus (106) Google Scholar Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional studyWe identified transmission-facilitating behaviours and atypical course(s) of infection as precipitating factors in shigellosis-affected MSM. The intercontinental spread of antimicrobial-resistant shigella through established transmission routes emphasises the need for new approaches to tackle the public health challenge of sexually transmitted infections in MSM. Full-Text PDF