Volume 93, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Molecular identification of the invasion plasmid antigen-H () gene has been established as a useful detection mechanism for 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 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 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 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 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 and age, site, and breast-feeding status were significant risk factors for MSD.


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  • Received : 22 May 2014
  • Accepted : 01 Jun 2015
  • Published online : 04 Nov 2015

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