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. 2015 Nov;93(5):918-24.
doi: 10.4269/ajtmh.14-0319. Epub 2015 Aug 31.

Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children

Brianna Lindsay  1 , Debasish Saha  1 , Doh Sanogo  1 , Sumon Kumar Das  1 , Richard Omore  1 , Tamer H Farag  1 , Dilruba Nasrin  1 , Shan Li  1 , Sandra Panchalingam  1 , Myron M Levine  1 , Karen Kotloff  1 , James P Nataro  1 , Laurence Magder  1 , Laura Hungerford  1 , A S G Faruque  1 , Joseph Oundo  1 , M Anowar Hossain  1 , Mitchell Adeyemi  1 , Oscar Colin Stine  2
Affiliations

Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children

Brianna Lindsay et al. Am J Trop Med Hyg. 2015 Nov.

Abstract

Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case-control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28-0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24-35 months of age (OR = 8.2, 95% CI = 4.3-15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3-23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.

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Figures

Figure 1.
Figure 1.
Association between ipaH copies ≥ 14,000, Shigella identification by culture and moderate-to-severe diarrhea (MSD) stratified by site (A) and age (B) adjusted for breast-feeding status.
Figure 2.
Figure 2.
Proportions of (A) breast-feeding, (B) height-for-age, and (C) weight-for-height z score groups across controls and moderate-to-severe diarrhea (MSD) cases in high (≥ 14K) and low (< 14K) levels of Shigella measured by quantitative polymerase chain reaction (qPCR). These graphs demonstrate the breast-feeding and nutritional status of children with ipaH < 14,000 in controls vs. ipaH ≥ 14,000 in controls in addition to ipaH < 14,000 in cases vs. ipaH ≥ 14,000 in cases.
See this image and copyright information in PMC

Comment in

  • Enteroinvasive Escherichia coli May Account for Uncultured Shigella.
    Okeke IN, Aboderin AO, Opintan JA. Okeke IN, et al. Am J Trop Med Hyg. 2016 Feb;94(2):480-481. doi: 10.4269/ajtmh.15-0777a. Am J Trop Med Hyg. 2016. PMID: 26843611 Free PMC article. No abstract available.
  • In Response.
    Nataro J, Stine OC. Nataro J, et al. Am J Trop Med Hyg. 2016 Feb;94(2):482. doi: 10.4269/ajtmh.15-0777b. Am J Trop Med Hyg. 2016. PMID: 26843612 Free PMC article. No abstract available.

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