Volume 68, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


We conducted laboratory-based surveillance and a case-control study to characterize the epidemiology of bloody diarrhea in rural Western Kenya. From May 1997 through April 2001, we collected stool from 451 persons with bloody diarrhea presenting to four rural clinics. Cultures of 231 (51%) specimens yielded 247 bacterial pathogens: 198 (97 41 type 1, 39 type non-1, 13 , 8 ), 33 , 15 non-typhoidal , and 1 O1. More than 90% of the isolates (excluding ) were resistant to trimethoprim-sulfamethoxazole and tetracycline, and more than 80% were resistant to ampicillin. Most (74%) ill persons received medication to which their isolate was resistant. Drinking Lake Victoria water and sharing latrines between multiple households increased risk of bloody diarrhea. Washing hands after defecating was protective. Providing safe drinking water and more latrines, and promoting hand washing could reduce the burden of illness from bloody diarrhea while limiting injudicious antimicrobial use.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. WHO, 1999. World Health Report 1999. Geneva: World Health Organization.
  2. Ronsmans C, Bennish ML, Wierzba T, 1988. Diagnosis and management of dysentery by community health workers. Lancet 2 : 552–555. [Google Scholar]
  3. Henry FJ, 1991. The epidemiologic importance of dysentery in communities. Rev Infect Dis 13 : S238–S244. [Google Scholar]
  4. WHO, 1995. Guidelines for the Control of Epidemics Due to Shigella dysenteriae 1. Geneva: World Health Organization.
  5. 2000. Red Book, Report of the Committee on Infectious Diseases. Elk Grove, IL: American Academy of Pediatrics.
  6. Guerrant RL, van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, Hennessy T, Griffin PM, DuPont H, Sack RB, Tarr P, Neill M, Nachamkin I, Reller LB, Osterholm MT, Bennish ML, Pickering LK, 2001. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 32 : 331–351. [Google Scholar]
  7. Sack DA, Lyke C, McLaughlin C, Suwanvanichkij V,2001. Antimicrobial Resistance in Shigellosis, Cholera, and Campylobacteriosis. Geneva: World Health Organization.
  8. Ries AA, Wells JG, Olivola D, Ntakibirora M, Nyandwi S, Ntibakivayo M, Ivey CB, Greene KD, Tenover FC, Wahlquist SP, Griffin PM, Tauxe RV, 1994. Epidemic Shigella dysenteriae type 1 in Burundi: panresistance and implications for prevention. J Infect Dis 169 : 1035–1041. [Google Scholar]
  9. Butler T, Islam MR, Azad MA, Jones PK, 1987. Risk factors for development of hemolytic uremic syndrome during shigellosis. J Pediatr 110 : 894–897. [Google Scholar]
  10. Legros D, Paquet C, Dorlencourt F, Le Saoult E, 1999. Risk factors for death in hospitalized dysentery patients in Rwanda. Trop Med Int Health 4 : 428–432. [Google Scholar]
  11. Malakooti MA, Allai J, Shanks GD, Phillips-Howard PA, 1997. Epidemic dysentery in western Kenya. Trans R Soc Trop Med Hyg 91 : 541–543. [Google Scholar]
  12. Shapiro RL, Kumar L, Phillips-Howard P, Wells JG, Adcock P, Brooks J, Ackers ML, Ochieng JB, Mintz E, Wahlquist S, Waiyaki P, Slutsker L, 2001. Antimicrobial-resistant bacterial diarrhea in rural western Kenya. J Infect Dis 183 : 1701–1704. [Google Scholar]
  13. Shori R, 2000. Impact of socioeconomic indicators on the health of children in Kenya households, with emphasis on poverty, malnutrition, childhood mortality, morbidity, and HIV/AIDS. Malaguerra C, Fust W, eds. International Association for Official Statistics Conference on “Statistics, Development and Human Rights.” Montreux, Switzerland: International Association for Official Statistics.
  14. 2001. AIDS in Kenya: Background, Projections, Impact, Interventions, and Policy. Sixth edition. Nairobi, Kenya: Kenya Ministry of Health, National AIDS and STD Control.
  15. Olsvik O, Rimstad E, Hornes E, Strockbine N, Wasteson Y, Lund A, Wachsmuth K, 1991. A nested PCR followed by magnetic separation of amplified fragments for detection of Escherichia coli Shiga-like toxin genes. Mol Cell Probes 5 : 429–435. [Google Scholar]
  16. Karch H, Bohm H, Schmidt H, Gunzer F, Aleksic S, Heesemann J, 1993. Clonal structure and pathogenicity of Shiga-like toxin-producing, sorbitol-fermenting Escherichia coli O157:H-. J Clin Microbiol 31 : 1200–1205. [Google Scholar]
  17. 1998. Performance Standards for Antimicrobial Disk Diffusion Susceptibility Tests: 8th Informational Supplement. NCCLS Document M100S8. Villanova, PA: National Committee for Clinical Laboratory Standards.
  18. Nakano T, Binka FN, Afari EA, Agbodaze D, Aryeetey ME, Mingle JAA, Kamiya H, Sakurai M, 1990. Survey of entero-pathogenic agents in children with and without diarrhoea in Ghana. J Trop Med Hyg 93 : 408–412. [Google Scholar]
  19. Adeleye IA, Adetosoye AI, 1993. Antimicrobial resistance patterns and plasmid survey of Salmonella and Shigella isolated is Ibadan, Nigeria. East Afr Med J 70 : 259–262. [Google Scholar]
  20. Pitman C, Amali R, Kanyerere H, Siyasiya A, Phiri S, Phiri A, Chakanika I, Kampondeni S, Chintolo FE, Kachenje E, Squire SB, 1996. Bloody diarrhea of adults in Malawi: clinical features, infectious agents, and antimicrobial sensitivities. Trans R SocTrop Med Hyg 90 : 284–287. [Google Scholar]
  21. Nakano T, Kamiya H, Matsubayashi N, Watanabe M, Sakurai M, Honda T, 1998. Diagnosis of bacterial enteric infections in children in Zambia. Acta Paediatr Jpn 40 : 259–263. [Google Scholar]
  22. Townes JM, Quick R, Gonzales OY, Linares M, Damiani E, Bopp CA, Wahlquist SP, Hutwanger LC, Hanover E, Mintz ED, Tauxe RV, 1997. Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. J Infect Dis 175 : 1527–1530. [Google Scholar]
  23. Taylor D, Bodhidatta L, Echeverria P, 1991. Epidemiologic aspects of shigellosis and other causes of dysentery in Thailand. Rev Infect Dis 13 : S226–S230. [Google Scholar]
  24. Coker AO, Isokpehi RD, Thomas BN, Amisu KO, Obi CL, 2002. Human campylobacteriosis in developing countries. Emerg Infect Dis 8 : 237–243. [Google Scholar]
  25. Oberhelman RA, Taylor DN, 2000. Campylobacter infections in developing countries. Nachamkin I, Blaser MJ, eds. Campylobacter. Washington, DC: American Society for Microbiology, 139–153.
  26. Kruse H, Kariuki S, Soli N, Olsvik O, 1992. Multiresistant Shigella species from African AIDS patients: antibacterial resistance patterns and application of E-test for determination of minimal inhibitory concentration. Scand J Infect Dis 2 : 733–739. [Google Scholar]
  27. Materu SF, Lema OE, Mukunza HM, Adhiambo CG, Carter JY, 1997. Antibiotic resistance patterns of Vibrio cholerae and Shigella causing diarrhoea outbreaks in the eastern African region. East Afr Med J 74 : 193–197. [Google Scholar]
  28. Legros D, Ochola D, Lwanga N, Guma G, 1998. Antibiotic sensitivity of endemic Shigella in Mbarara, Uganda. East Afr Med J 75 : 160–161. [Google Scholar]
  29. Navia MM, Capitano L, Ruiz J, Vargas M, Urassa H, Schellemberg D, Gascon J, Vila J, 1999. Typing and characterization of mechanisms of resistance of Shigella spp. isolated from feces of children under 5 years of age from Ifakara, Tanzania. J Clin Microbiol 37 : 3113–3117. [Google Scholar]
  30. Iwalokun BA, Gbenle GO, Smith SI, Ogunledun A, Akinsinde KA, Omonigbehin EA, 2001. Epidemiology of shigellosis in Lagos, Nigeria: trends in antimicrobial resistance. J Health Popul Nutr 19 : 183–190. [Google Scholar]
  31. Panhotra BR, Desai B, Sharma PL, 1985. Nalidixic-acid-resistant Shigella dysenteriae 1. Lancet 1 : 763. [Google Scholar]
  32. Mutwewingabo A, Mets T, 1987. Increase in multiresistance of Shigella dysenteriae type 1 strain in Rwanda. East Afr Med J 64 : 812–815. [Google Scholar]
  33. Munshi MH, Sack DA, Haider K, Ahmed ZU, Rahaman MM, Morshed MG, 1987. Plasmid-mediated resistance to nalidixic acid in Shigella dysenteriae type 1. Lancet 2 : 419–421. [Google Scholar]
  34. Paquet C, Leborgne P, Sasse A, Varaine F, 1995. An outbreak of Shigella dysenteriae type 1 dysentery in a Rwandan refugee camp. Sante 5 : 181–184. [Google Scholar]
  35. Ahmed F, Clemens JD, Rao MR, Ansaruzzaman M, Haque E, 1997. Epidemiology of shigellosis among children exposed to cases of Shigella dysentery: a multivariate assessment. Am J Trop Med Hyg 56 : 258–264. [Google Scholar]
  36. WHO, 1999. Containing Antimicrobial Resistance: Review of the Literature and Report of a WHO Workshop on the Development of a Global Strategy for the Containment of Antimicrobial Resistance. Geneva: World Health Organization.
  37. Shapiro RL, Otieno MR, Adcock PM, Phillips-Howard PA, Hawley WA, Kumar L, Waiyaki P, Nahlen BL, Slutsker L, 1999. Transmission of epidemic Vibrio cholerae O1 in rural western Kenya associated with drinking water from Lake Victoria: an environmental reservoir for cholera? Am J Trop Med Hyg 60 : 271–276. [Google Scholar]
  38. Tuttle J, Ries AA, Chimba RM, Perera CU, Bean NA, Griffin PM, 1995. Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission. J Infect Dis 171 : 371–375. [Google Scholar]
  39. Gasem MH, Dolmans WM, Keuter MM, Djokomoeljanto RR, 2001. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health 6 : 484–490. [Google Scholar]
  40. Birmingham ME, Lee LA, Ntakibirora M, Bizimana F, Deming MS, 1997. A household survey of dysentery in Burundi: implications for the current pandemic in sub-Saharan Africa. Bull World Health Organ 75 : 45–53. [Google Scholar]
  41. Khan MU, 1982. Interruption of shigellosis by hand washing. Trans R Soc Trop Med Hyg 76 : 164–168. [Google Scholar]
  42. Weber JT, Mintz ED, Canizares R, Semiglia A, Gomez I, Sempertegui R, Davila A, Greene KD, Puhr ND, Cameron DN, 1994. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood. Epidemiol Infect 112 : 1–11. [Google Scholar]
  43. Koo D, Aragon A, Moscoso V, Gudiel M, Bietti L, Carrillo N, Chojoj J, Gordillo B, Cano F, Cameron DN, Wells JG, Bean NH, Tauxe RV, 1996. Epidemic cholera in Guatemala, 1993: transmission of a newly introduced epidemic strain by street vendors. Epidemiol Infect 116 : 121–126. [Google Scholar]
  44. Luby SP, Faizan MK, Fisher-Hoch SP, Syed A, Mintz ED, Bhutta ZA, McCormick JB, 1998. Risk factors for typhoid fever in an endemic setting, Karachi, Pakistan. Epidemiol Infect 120 : 129–138. [Google Scholar]
  45. Engels D, Madaras T, Nyandwi S, Murray J, 1995. Epidemic dysentery caused by Shigella dysenteriae type 1: a sentinel site surveilllance of antibiotic resistance patterns in Burundi. Bull World Health Organ 73 : 787–791. [Google Scholar]
  46. Chiron JP, Denis F, Samb A, Sow A, Diop Mar I, 1977. Incidence of shigellosis in Dakar hospitals during a four-year period, 1973–1976. Bull Soc Med Afr Noire Lange Francaise 22 : 174–180. [Google Scholar]

Data & Media loading...

  • Received : 26 Dec 2002
  • Accepted : 03 Mar 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error