Molecular epidemiology of multidrug-resistant Shigella dysenteriae type 1 causing dysentery outbreaks in Central African Republic, 2003–2004

Abstract

Shigella dysenteriae type 1 (Sd1) represents a particular threat in developing countries because of the severity of the infection and its epidemic potential. Antimicrobial susceptibility testing and molecular subtyping by pulsed-field gel electrophoresis (PFGE) and plasmid profiling (PP) of Sd1 isolates collected during two dysentery outbreaks (2013 and 445 cases of bloody diarrhoea) in Central African Republic (CAR) during the period 2003-2004 were reported. Eleven Sd1 comparison strains (CS) acquired by travellers or residents of Africa (n=10) or Asia (n=1) between 1993 and 2003 were also analysed. The 19 Sd1 isolates recovered from CAR outbreaks were multidrug resistant, although susceptible to quinolones and fluoroquinolones. Molecular subtyping by PFGE was more discriminatory than PP. The PFGE using XbaI and NotI restriction enzymes indicated that the two outbreaks were due to two different clones and also revealed a genetic diversity among the CS recovered from outbreak or sporadic cases between 1993 and 2003. This study was the result of a fruitful collaboration between field physicians and microbiologists. The data collected will serve as the basis for establishing long-term monitoring of Sd1 in CAR.

Prevalence of shigellosis diarrhoea in a paediatrics population: hospital based survey in Bangui, Central African Republic

“…In 2003, 2004 and 2005, Shigella dysenteriae was responsible for two epidemic episodes in CAR [4,11], but in our hospital survey, Shigella flexineri was the only species isolated. Thus, Shigella flexineri is apparently endemic to the population as described in Tunisia, while Shigella dysenteriae would be mainly associated with outbreaks [3].…”

“…Shigella flexneri is the leading cause of shigellosis, particularly in the poor populations [3]. Shigellosis is endemic in Central African Republic (CAR), where an outbreak of Shigella dysenteriae type 1 was recently reported [4]. The present study was undertaken to determine the prevalence and the antimicrobial susceptibility patterns of Shigella serotypes in children hospitalized for diarrhoea in a paediatric unit in Bangui, CAR.…”

Antibiotic resistance among bacterial pathogens in Central Africa: a review of the published literature between 1955 and 2008

“…Several reports described the large outbreak of S. dysenteriae dysentery among Rwandese refugees after the 1994 civil war [36,40,42,52], reporting similar patterns of multidrug resistance including nalidixic acid and trimethoprim, leaving the newer fluoroquinolones as a treatment option. Bercion et al [38] and Cunin et al [44] described similar outbreaks in CAR and Cameroon, respectively. Even outside the epidemic context, the prevalence of multidrug-resistant strains was found to be >50% in recent reports from Kinshasa (DRC) [49] and Bangui (CAR) [53].…”

“…Shigella spp. [16,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Eighteen studies were found, mainly from rural DRC (12/18; 66.7%) and published between 1955 and 2006. Two-thirds reported on outbreak investigations, and Shigella dysenteriae type 1 was the predominant serotype (15/18 studies).…”

Diarrheagenic Escherichia coli in sub-Saharan Africa: Status, Uncertainties and Necessities

“…In the last decade, large Sh. dysenteriae type I outbreaks have been documented from the Central African Republic (2 outbreaks) [150], Cameroon [151], Sierria Leone [152], Zimbabwe [153], South Africa [154], and Kenya [155], in addition to numerous sporadic reports.…”