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Studies of Diarrheal Disease in Central America^*

VI. An Epidemic of Diarrhea in a Guatemalan Highland Village, with a Component due to Shigella dysenteriae, Type 1

John E. Gordon, Werner Ascoli, Virginia Pierce, Miguel A. Guzmán^|| AND Leonardo J. Mata^¶

An epidemic of 30 cases of Shiga dysentery, caused by Sh. dysenteriae, type 1, occurred in a rural village of the Guatemalan highlands, with one death. The outbreak was a part of a far larger epidemic of acute diarrheal disease in which 82.6% of 997 cases examined bacteriologically had no demonstrable bacterial pathogen. All 4 groups of Shigella were present in a variety of serotypes, none of which dominated the epidemic. Enteropathogenic Escherichia coli was demonstrated in 3.5% of cases and Salmonella and Entamoeba histolytica in a scattered few. Cases among children aged 0 to 4 years, an estimated four-fifths of the total epidemic, were 1,212. Four deaths resulted for an annual mortality of 9.5 per 1,000. The outbreak, including its Shiga component, lasted 25 months, and spread was mainly by contact infection.

By clinical criteria, Shiga dysentery in this experience was no more severe than any other shigellosis, although shigellosis had more than twice as many clinically severe cases as did the bacteriologically undifferentiated diarrheas and about four times the number attributable to Esch. coli.

^* This work was supported by the Pan American Health Organization, the World Health Organization, and Grant AM-4827 from the National Institutes of Health (U.S.A.). INCAP Publication I-332.

Professor of Preventive Medicine and Epidemiology, Emeritus, Harvard University, and Consultant in Epidemiology to INCAP.

Chief, Advisory Services, Division of Applied Nutrition, INCAP.

Consultant in bacteriology, Division of Clinical Pathology, INCAP.

Chief, Division of Statistics, INCAP.

^¶ Chief, Microbiology Section, Division of Clinical Pathology, INCAP.