Systemic Shigellosis in South Africa

Keddy, Karen H.; Sooka, Arvinda; Crowther-Gibson, Penny; Quan, Vanessa; Meiring, Susan; Cohen, Cheryl; Nana, Trusha; Sriruttan, Charlotte; Seetharam, Sharona; Hoosen, Anwar A.; Naicker, Preneshni; Elliott, Eugenne; Haffejee, Sumayya; Whitelaw, Andrew; Klugman, Keith P.

doi:10.1093/cid/cis224

Cited by 44 publications

(35 citation statements)

References 43 publications

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“…Nationwide active laboratory-based surveillance for culture-confirmed typhoid fever, (isolation of Salmonella Typhi from a normally sterile site), was performed by the Centre for Enteric Diseases (CED) of the National Institute for Communicable Diseases in South Africa from 2003 through 2013, as previously described [15]. Specifically, we requested that all diagnostic laboratories in South Africa send all Salmonella Typhi isolates to CED and performed audits to identify additional laboratory-confirmed cases of typhoid fever for which Salmonella Typhi isolates were not received using the Central Data Warehouse (CDW), a national databank derived from the laboratory information system storing basic demographic and laboratory data for all typhoid fever cases diagnosed by the National Health Laboratory Service [15] (active case finding).…”

Section: Methodsmentioning

confidence: 99%

“…Specifically, we requested that all diagnostic laboratories in South Africa send all Salmonella Typhi isolates to CED and performed audits to identify additional laboratory-confirmed cases of typhoid fever for which Salmonella Typhi isolates were not received using the Central Data Warehouse (CDW), a national databank derived from the laboratory information system storing basic demographic and laboratory data for all typhoid fever cases diagnosed by the National Health Laboratory Service [15] (active case finding). Ethical approval for this study was granted by the Human Research Ethics Committee of the University of the Witwatersrand (M110601).…”

Section: Methodsmentioning

confidence: 99%

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Typhoid Fever in South Africa in an Endemic HIV Setting

Keddy

Sooka²,

Smith

et al. 2016

PLoS ONE

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BackgroundTyphoid fever remains an important disease in Africa, associated with outbreaks and the emerging multidrug resistant Salmonella enterica serotype Typhi (Salmonella Typhi) haplotype, H58. This study describes the incidence of, and factors associated with mortality due to, typhoid fever in South Africa, where HIV prevalence is high.Methods and FindingsNationwide active laboratory-based surveillance for culture-confirmed typhoid fever was undertaken from 2003–2013. At selected institutions, additional clinical data from patients were collected including age, sex, HIV status, disease severity and outcome. HIV prevalence among typhoid fever patients was compared to national HIV seroprevalence estimates. The national reference laboratory tested Salmonella Typhi isolates for antimicrobial susceptibility and haplotype. Unadjusted and adjusted logistic regression analyses were conducted determining factors associated with typhoid fever mortality. We identified 855 typhoid fever cases: annual incidence ranged from 0.11 to 0.39 per 100,000 population. Additional clinical data were available for 369 (46.8%) cases presenting to the selected sites. Among typhoid fever patients with known HIV status, 19.3% (29/150) were HIV-infected. In adult females, HIV prevalence in typhoid fever patients was 43.2% (19/44) versus 15.7% national HIV seroprevalence (P < .001); in adult males, 16.3% (7/43) versus 12.3% national HIV seroprevalence (P = .2). H58 represented 11.9% (22/185) of Salmonella Typhi isolates tested. Increased mortality was associated with HIV infection (AOR 10.7; 95% CI 2.3–50.3) and disease severity (AOR 9.8; 95% CI 1.6–60.0) on multivariate analysis.ConclusionsTyphoid fever incidence in South Africa was largely unchanged from 2003–2013. Typhoid fever mortality was associated disease severity. HIV infection may be a contributing factor. Interventions mandate improved health care access, including to HIV management programmes as well as patient education. Further studies are necessary to clarify relationships between HIV infection and typhoid fever in adults.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Typhoid Fever in South Africa in an Endemic HIV Setting

Keddy

Sooka²,

Smith

et al. 2016

PLoS ONE

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“…Keddy and others described that 70% of subjects that developed systemic shigellosis presented CD4 T-cell count < 50 cells/mm 3 . 25 Therefore, although HIV infection may contribute to disease expression, shigellosis can be limited to the intestinal tract if the HIV immunosuppression is not severe.…”

Section: Discussionmentioning

confidence: 99%

Shigellosis in Subjects with Traveler's Diarrhea Versus Domestically Acquired Diarrhea: Implications for Antimicrobial Therapy and Human Immunodeficiency Virus Surveillance

Toro¹,

Arroyo²,

Sarria³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. An increase of sexually transmitted shigellosis is currently being reported in developed countries. In addition, travel-related shigellosis can introduce resistant strains that could be disseminated within this new scenario. Epidemiological features and antimicrobial susceptibility of shigellosis depending on where infection was acquired were investigated. From 2008 to 2013, subjects with shigellosis were studied. Patients were classified according to acquisition of Shigella as traveler's diarrhea (TD) or domestically acquired diarrhea (DAD). Ninety cases of shigellosis were identified: 76 corresponding to the TD group and 14 to the DAD group. In the DAD group, most of patients were human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), being shigellosis associated to male sex (P = 0.007) and HIV infection (P < 0.0001). S. sonnei (47.8%) and S. flexneri (42.2%) were the predominant species. The highest resistance was detected for trimethoprim/sulfamethoxazole (SXT) (81.8%), followed by ampicillin (AMP) (37.8%) and ciprofloxacin (CIP) (23.3%). Resistant Shigella strains were more frequent in subjects with TD than those with DAD, although only for CIP the difference was significant (P = 0.034). Continuous monitoring of patients with shigellosis is necessary to control the spread of resistant Shigella strains and for effective therapy. Men with shigellosis who have not traveled to an endemic area should be screened for HIV infection.

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“…Los niños bajo 5 años de edad y los individuos con algún tipo de inmunodepresión constituyen los principales grupos de riesgo 1,2 . En personas infectadas con el virus de la inmunodeficiencia humana (VIH) la diarrea es una causa reconocida de morbilidad y mortalidad.…”

Section: Introductionunclassified

“…Se estima que anualmente ocurren alrededor de 163 millones de episodios de infección por Shigella spp. en países en vías de desarrollo, con un millón de muertes 2,6,7 . En personas con infección con VIH, Shigella spp.…”

Section: Introductionunclassified