EPIDEMIOLOGY OF SHIGELLA-ASSOCIATED DIARRHEA IN RURAL EGYPTIAN CHILDREN

REMON R. ABU-ELYAZEED U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by REMON R. ABU-ELYAZEED in
Current site
Google Scholar
PubMed
Close
,
THOMAS F. WIERZBA U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by THOMAS F. WIERZBA in
Current site
Google Scholar
PubMed
Close
,
ROBERT W. FRENCK U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by ROBERT W. FRENCK in
Current site
Google Scholar
PubMed
Close
,
SHANNON D. PUTNAM U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by SHANNON D. PUTNAM in
Current site
Google Scholar
PubMed
Close
,
MALLA R. RAO U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by MALLA R. RAO in
Current site
Google Scholar
PubMed
Close
,
STEPHEN J. SAVARINO U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by STEPHEN J. SAVARINO in
Current site
Google Scholar
PubMed
Close
,
KARIM A. KAMAL U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by KARIM A. KAMAL in
Current site
Google Scholar
PubMed
Close
,
LEONARD F. PERUSKI JR. U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by LEONARD F. PERUSKI JR. in
Current site
Google Scholar
PubMed
Close
,
IBRAHIM A. ABD-EL MESSIH U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by IBRAHIM A. ABD-EL MESSIH in
Current site
Google Scholar
PubMed
Close
,
SAHAR A. EL-ALKAMY U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by SAHAR A. EL-ALKAMY in
Current site
Google Scholar
PubMed
Close
,
ABDOLLAH B. NAFICY U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by ABDOLLAH B. NAFICY in
Current site
Google Scholar
PubMed
Close
, and
JOHN D. CLEMENS U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Naval Research Unit No. 2, Jakarta, Indonesia; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt; International Vaccine Institute, Seoul, Korea

Search for other papers by JOHN D. CLEMENS in
Current site
Google Scholar
PubMed
Close
Restricted access

During the period from February 1995 to February 1998, the epidemiology of Shigella diarrhea was studied among children less than three years of age residing in Egypt’s Nile Delta. Children were visited twice a week and a stool sample was collected from any of them with diarrhea. The incidence of Shigella-associated diarrhea was 0.2 episodes/child-year, with S. flexneri being the most common serogroup isolated (55% of Shigella episodes). Younger age and the warm months increased the risk of developing Shigella-associated diarrhea, while breastfeeding was protective. Children with Shigella were ill for a mean of four days and passed a mean of six stools per day. Common symptoms included fever (35%), vomiting (19%), and dehydration (16%). Dysentery, however, was unusual, occurring in only 11% of the cases. In conclusion, Shigella-associated diarrhea remains relatively common in Egyptian children and supports the need for additional control measures including vaccine development.

Author Notes

  • 1

    Guerrant RL, Hughes JM, Lima NL, Crane J, 1990. Diarrhea in developed and developing countries: magnitude, special settings, and etiologies. Rev Infect Dis 12 (Suppl 1):S41–S50.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Juckett G, 1999. Prevention and treatment of traveler’s diarrhea. Am Fam Physician 60 :119–124, 135–136.

  • 3

    Shlim DR, Hoge CW, Rajah R, Scott RM, Pandy P, Echeverria P, 1999. Persistent high risk of diarrhea among foreigners in Nepal during the first 2 years of residence. Clin Infect Dis 29 :613–616.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Kotloff KL, Winickoff JP, Ivanoff B, Clemens JD, Swerdlow DL, Sansonetti PJ, Adak GK, Levine MM, 1999. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ 77 :651–666.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Mohle-Boetani JC, Stapleton M, Finger R, Bean NH, Poundstone J, Blake PA, Griffin PM, 1995. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers. Am J Public Health 85 :812–816.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hoffman RE, Shillam PJ, 1990. The use of hygiene, cohorting, and antimicrobial therapy to control an outbreak of shigellosis. Am J Dis Child 144 :219–221.

  • 7

    Pickering LK, Evans DG, DuPont HL, Vollet JJ 3rd, Evans DJ Jr, 1981. Diarrhea caused by Shigella, rotavirus, and Giardia in day-care centers: prospective study. J Pediatr 99 :51–56.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Baer JT, Vugia DJ, Reingold AL, Aragon T, Angulo FJ, Bradford WZ, 1999. HIV infection as a risk factor for shigellosis. Emerg Infect Dis 5 :820–823.

  • 9

    Germani Y, Minssart P, Vohito M, Yassibanda S, Glaziou P, Hocquet D, Berthelemy P, Morvan J, 1998. Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus. Am J Trop Med Hyg 59 :1008–1014.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Angulo FJ, Swerdlow DL, 1995. Bacterial enteric infections in persons infected with human immunodeficiency virus. Clin Infect Dis 21 (Suppl 1):S84–S93.

  • 11

    van Oosterhout JJ, van der Hoek W, 1994. Infection with HIV, a risk factor for epidemic dysentery? A case-control study from Zambia. AIDS 8 :1512–1513.

  • 12

    Mahoney FJ, Farley TA, Burbank DF, Leslie NH, McFarland LM, 1993. Evaluation of an intervention program for the control of an outbreak of shigellosis among institutionalized persons. J Infect Dis 168 :1177–1180.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Edwards BH, 1999. Salmonella and Shigella species. Clin Lab Med 19 :469–487.

  • 14

    DuPont HL, Levine MM, Hornick RB, Formal SB, 1989. Inoculum size in shigellosis and implications for expected mode of transmission. J Infect Dis 159 :1126–1128.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Replogle ML, Fleming DW, Cieslak PR, 2000. Emergence of antimicrobial-resistant shigellosis in Oregon. Clin Infect Dis 30 :515–519.

  • 16

    Cheasty T, Skinner JA, Rowe B, Threlfall EJ, 1998. Increasing incidence of antibiotic resistance in shigellas from humans in England and Wales: recommendations for therapy. Microb Drug Resist 4 :57–60.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P, 1998. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis 26 :341–345.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Sack RB, Rahman M, Yunus M, Khan EH, 1997. Antimicrobial resistance in organisms causing diarrheal disease. Clin Infect Dis 24 (Suppl 1):S102–S105.

  • 19

    WHO, 1997. Vaccine research and development. New strategies for accelerating Shigella vaccine development. Wkly Epidemiol Rec 72 :73–79.

  • 20

    Zaki AM, DuPont HL, el Alamy MA, Arafat RR, Amin K, Awad MM, Bassiouni L, Imam IZ, el Malih GS, el Marsafie A, Mohieldin MS, Naguib T, Rakha MA, Sidaros M, Wasef N, Wright CE, Wyatt RG, 1986. The detection of enteropathogens in acute diarrhea in a family cohort population in rural Egypt. Am J Trop Med Hyg 35 :1013–1022.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Naficy AB, Abu-Elyazeed R, Holmes JL, Rao MR, Savarino SJ, Kim Y, Wierzba TF, Peruski L, Lee YJ, Gentsch JR, Glass RI, Clemens JD, 1999. Epidemiology of rotavirus diarrhea in Egyptian children and implications for disease control. Am J Epidemiol 150 :770–777.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Naficy AB, Frenck RW, Abu-Elyazeed R, Kim Y, Rao MR, Savarino SJ, Wierzba TF, Hall E, Clemens JD, 2000. Seroepidemiology of Helicobacter pylori infection in a population of Egyptian children. Int J Epidemiol 29 :928–932.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Abu-Elyazeed R, Wierzba TF, Mourad AS, Peruski LF, Kay BA, Rao M, Churilla AM, Bourgeois AL, Mortagy AK, Kamal SM, Savarino SJ, Campbell JR, Murphy JR, Naficy A, Clemens JD, 1999. Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt. J Infect Dis 179 :382–389.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Farmer JJ III, 1999. Enterobacteriaceae: Introduction and Identification. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 442–458.

    • PubMed
    • Export Citation
  • 25

    Bopp CA, Brenner FW, Wells JG, Strockbine N, 1999. Escherichia, Shigella, and Salmonella. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 459–474.

    • PubMed
    • Export Citation
  • 26

    Tilson DL, 1999. Vibrio. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 497–506.

    • PubMed
    • Export Citation
  • 27

    Nachamkin I, 1999. Campylobacter and Arcobacter. Murray P, ed. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 716–726.

    • PubMed
    • Export Citation
  • 28

    Lefebvre J, Gosselin F, Ismail J, Lorange M, Lior H, Woodward D, 1995. Evaluation of commercial antisera for Shigella sero-grouping. J Clin Microbiol 33 :1997–2001.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Nathoo KJ, Porteous JE, Siziya S, Wellington M, Mason E, 1998. Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe. Cent Afr J Med 44 :272–276.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Saidi SM, Iijima Y, Sang WK, Mwangudza AK, Oundo JO, Taga K, Aihara M, Nagayama K, Yamamoto H, Waiyaki PG, Honda T, 1997. Epidemiological study on infectious diarrheal diseases in children in a coastal rural area of Kenya. Microbiol Immunol 41 :773–778.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Green MS, Block C, Cohen D, Slater PE, 1991. Four decades of shigellosis in Israel: epidemiology of a growing public health problem. Rev Infect Dis 13 :248–253.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Rawashdeh MO, Ababneh AM, Shurman AA, 1994. Shigellosis in Jordanian children: a clinico-epidemiologic prospective study and susceptibility to antibiotics. J Trop Pediatr 40 :355–359.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Albert MJ, Faruque AS, Faruque SM, Sack RB, Mahalanabis D, 1999. Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol 37 :3458–3464.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Khalil K, Khan SR, Mazhar K, Kaijser B, Lindblom GB, 1998. Occurrence and susceptibility to antibiotics of Shigella species in stools of hospitalized children with bloody diarrhea in Pakistan. Am J Trop Med Hyg 58 :800–803.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Ghosh AR, Sehgal SC, 1998. Shigella infections among children in Andaman–an archipelago of tropical islands in Bay of Bengal. Epidemiol Infect 121 :43–48.

  • 36

    Yurdakok K, Sahin N, Ozmert E, Berkman E, 1997. Shigella gastroenteritis: clinical and epidemiological aspects, and antibiotic susceptibility. Acta Paediatr Jpn 39 :681–684.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Lopez EL, Prado-Jimenez V, O’Ryan-Gallardo M, Contrini MM, 2000. Shigella and Shiga toxin-producing Escherichia coli causing bloody diarrhea in Latin America. Infect Dis Clin North Am 14 :41–65.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Prado V, Lagos R, Nataro JP, San Martin O, Arellano C, Wang JY, Borczyk AA, Levine MM, 1999. Population-based study of the incidence of Shigella diarrhea and causative serotypes in Santiago, Chile. Pediatr Infect Dis J 18 :500–505.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Townes JM, Quick R, Gonzales OY, Linares M, Damiani E, Bopp CA, Wahlquist SP, Hutwagner LC, Hanover E, Mintz ED, Tauxe RV, 1997. Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. Bolivian Dysentery Study Group. J Infect Dis 175 :1527–1530.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Baqui AH, Sack RB, Black RE, Haider K, Hossain A, Alim AR, Yunus M, Chowdhury HR, Siddique AK, 1992. Enteropathogens associated with acute and persistent diarrhea in Bangladeshi children less than 5 years of age. J Infect Dis 166 :792–796.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Oyofo BA, Subekti D, Tjaniadi P, Machpud N, Komalarini S, Setiawan B, Simanjuntak C, Punjabi N, Corwin AL, Wasfy M, Campbell JR, Lesmana M, 2002. Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta, Indonesia. FEMS Immunol Med Microbiol 34 :139–146.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Guerrero L, Calva JJ, Morrow AL, Velazquez FR, Tuz-Dzib F, Lopez-Vidal Y, Ortega H, Arroyo H, Cleary TG, Pickering LK, 1994. Asymptomatic Shigella infections in a cohort of Mexican children younger than two years of age. Pediatr Infect Dis J 13 :597–602.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Howard P, Alexander ND, Atkinson A, Clegg AO, Gerega G, Javati A, Kajoi M, Lupiwa S, Lupiwa T, Mens M, Saleu G, Sanders RC, West B, Alpers MP, 2000. Bacterial, viral and parasitic aetiology of paediatric diarrhoea in the highlands of Papua New Guinea. J Trop Pediatr 46 :10–14.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Lerman Y, Slepon R, Cohen D, 1994. Epidemiology of acute diarrheal diseases in children in a high standard of living rural settlement in Israel. Pediatr Infect Dis J 13 :116–122.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    VanDerslice J, Popkin B, Briscoe J, 1994. Drinking-water quality, sanitation, and breast-feeding: their interactive effects on infant health. Bull World Health Organ 72 :589–601.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Bennish ML, Wojtyniak BJ, 1991. Mortality due to shigellosis: community and hospital data. Rev Infect Dis 13 (Suppl 4):S245–S251.

Past two years Past Year Past 30 Days
Abstract Views 131 121 16
Full Text Views 329 3 1
PDF Downloads 136 0 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save