Systemic shigellosis in South Africa
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Date
Authors
Keddy, Karen H.
Sooka, Arvinda
Crowther-Gibson, Penny
Quan, Vanessa
Meiring, Susan
Cohen, Cheryl
Nana, Trusha
Sriruttan, Charlotte
Seetharam, Sharona
Hoosen, Anwar Ahmed
Journal Title
Journal ISSN
Volume Title
Publisher
University of Chicago Press
Abstract
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 5 .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 5 .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.
Description
Keywords
South Africa, Systemic shigellosis, Human immunodeficiency virus (HIV)
Sustainable Development Goals
Citation
Keddy, KH, Sooka, A, Crowther-Gibson, P, Quan, V, Meiring, S, Cohen, C, Nana, T, Sriruttan, C, Seetharam, S, Hoosen, A, Naicker, P, Elliott, E, Haffejee, S, Whitelaw, A & Klugman, KP 2012, "Systemic shigellosis in South Africa', Clinical Infectious Diseases, vol. 54, no. 10, pp. 448–1454.