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Chakraborty S, Dash S, Antara NA, Roy BR, Mamun SA, Ali M, Naz F, Johura FT, Lewis J, Afroze F, Hasan ABMA, Sack DA, Ram M, Tofail F, Ahmed T, Faruque ASG. The Impact of Non-Dysentery Shigella Infection on the Growth and Health of Children over Time (INSIGHT)-A Prospective Case-Control Study Protocol. Microorganisms 2024; 12:1677. [PMID: 39203519 PMCID: PMC11356629 DOI: 10.3390/microorganisms12081677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Shigella spp. (Shigella) is known for causing dysentery with blood in stool, but most children infected with Shigella have non-dysentery Shigella-associated diarrhea (NDSD). The World Health Organization recommends the use of antibiotics when diarrhea is bloody, leaving most NDSD cases untreated. The absence of dysentery may not indicate a low risk of death and severe morbidity. Rapid diagnosis and treatment of shigellosis in vulnerable, young children may be lifesaving. INSIGHT aims to determine the potential benefit of identifying NDSD cases (n = 296) and their outcomes compared to cases of Shigella dysentery [DS (n = 148)] and non-Shigella watery diarrhea [WD (n = 148)]. (2) Children seeking care at hospitals in Bangladesh will be enrolled and followed for 1 year (NDSD and DS) or 90 days (WD). We will determine the impact of NDSD on morbidity, mortality, gut health, nutritional status, and cognitive development compared to DS and WD in children and whether the simple "Rapid LAMP-based Diagnostic Test (RLDT)" can accelerate the detection and treatment of shigellosis in the clinical settings of rural Bangladesh. (3) INSIGHT will determine the impact of NDSD in children and determine if the treatment guidelines of shigellosis need to be revisited to improve clinical outcomes and the development of these children.
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Affiliation(s)
- Subhra Chakraborty
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Sampa Dash
- icddr,b, Dhaka 1212, Bangladesh; (S.D.); (N.A.A.); (F.N.)
| | | | | | | | - Mohammad Ali
- icddr,b, Dhaka 1212, Bangladesh; (S.D.); (N.A.A.); (F.N.)
| | - Farina Naz
- icddr,b, Dhaka 1212, Bangladesh; (S.D.); (N.A.A.); (F.N.)
| | - Fatema-Tuz Johura
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jade Lewis
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Farzana Afroze
- icddr,b, Dhaka 1212, Bangladesh; (S.D.); (N.A.A.); (F.N.)
| | - ABM Ali Hasan
- Kumudini Women’s Medical College Hospital, Mirzapur, Tangail 1940, Bangladesh
| | - David A. Sack
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Malathi Ram
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Fahmida Tofail
- icddr,b, Dhaka 1212, Bangladesh; (S.D.); (N.A.A.); (F.N.)
| | - Tahmeed Ahmed
- icddr,b, Dhaka 1212, Bangladesh; (S.D.); (N.A.A.); (F.N.)
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Chowdhury G, Ghosh D, Zhou Y, Deb AK, Mukhopadhyay AK, Dutta S, Chakraborty S. Field evaluation of a simple and rapid diagnostic test, RLDT to detect Shigella and enterotoxigenic E. coli in Indian children. Sci Rep 2024; 14:8816. [PMID: 38627472 PMCID: PMC11021469 DOI: 10.1038/s41598-024-59181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
The diagnostic assays currently used to detect Shigella spp. (Shigella) and enterotoxigenic Escherichia coli (ETEC) are complex or elaborate which make them difficult to apply in resource poor settings where these diseases are endemic. The simple and rapid nucleic acid amplification-based assay "Rapid LAMP-based Diagnostic Test (RLDT)" was evaluated to detect Shigella spp (Shigella) and enterotoxigenic Escherichia coli (ETEC) and determine the epidemiology of these pathogens in Kolkata, India. Stool samples (n = 405) from children under five years old with diarrhea seeking care at the hospitals were tested, and 85(21%) and 68(17%) by RLDT, 91(23%) and 58(14%) by quantitative PCR (qPCR) and 35(9%) and 15(4%) by culture, were positive for Shigella and ETEC, respectively. The RLDT showed almost perfect agreement with qPCR, Kappa 0.96 and 0.89; sensitivity 93% and 98%; specificity 100% and 97% for Shigella and ETEC, respectively. While RLDT detected additional 12% Shigella and 13% ETEC than culture, all culture positives for Shigella and ETEC except one each were also positive by the RLDT, sensitivity 97% and 93% respectively. RLDT is a simple, sensitive, and rapid assay that could be implemented with minimum training in the endemic regions to strengthen the disease surveillance system and rapid outbreak detection.
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Affiliation(s)
- Goutam Chowdhury
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33 CIT Road, Scheme XM, Beliaghata, Kolkata, 700010, India
| | - Debjani Ghosh
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33 CIT Road, Scheme XM, Beliaghata, Kolkata, 700010, India
| | - Yiyi Zhou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alok K Deb
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33 CIT Road, Scheme XM, Beliaghata, Kolkata, 700010, India
| | - Asish Kumar Mukhopadhyay
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33 CIT Road, Scheme XM, Beliaghata, Kolkata, 700010, India.
| | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33 CIT Road, Scheme XM, Beliaghata, Kolkata, 700010, India
| | - Subhra Chakraborty
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Diarra B, Guindo I, Koné B, Dembélé M, Cissé I, Thiam S, Konaté K, Tékété M, Maīga A, Maīga O, Timbiné L, Djimde A. High frequency of antimicrobial resistance in Salmonella and Escherichia coli causing diarrheal diseases at the Yirimadio community health facility, Mali. BMC Microbiol 2024; 24:35. [PMID: 38262985 PMCID: PMC10804725 DOI: 10.1186/s12866-024-03198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Diarrhoea is a public health problem, especially in developing countries where it is the second leading cause of child mortality. In Low Income Countries like in Mali, self-medication and inappropriate use of antibiotics due to the scarcity of complementary diagnostic systems can lead to the development of multidrug-resistant bacteria causing diarrhoea. The objective of this work was to determine the microorganisms responsible for diarrhoea in children under 15 years of age and to characterize their sensitivity to a panel of antibiotics used in a peri-urban community in Mali. The study involved outpatient children visiting the Yirimadio Community Health Centre and diagnosed with diarrhoea. Stool samples from those patients were collected and analysed by conventional stools culture and the susceptibility to antibiotics of detected bacteria was determined by the disc diffusion method in an agar medium. RESULT Overall, 554 patients were included. Children under the age of 3 years accounted for 88.8% (492 of 554) of our study population. Two bacterial species were isolated in this study, Escherichia coli 31.8% (176 of 554) and Salmonella 2.9% (16 of 554). In the 176, E. coli strains resistance to amoxicillin and to cotrimoxazole was seen in 93.8% (165 of 176) and 92.6% ( 163 of 176), respectively. The ESBL resistance phenotype accounted for 39,8% (70 of 176) of E. coli. Sixteen (16) strains of Salmonella were found, of which one strain (6.3%) was resistant to amoxicillin and to amoxicillin + clavulanic acid. Another one was resistant to chloramphenicol (6.3%). Two strains of Salmonella were resistant to cotrimoxazole (12.5%) and two others were resistant to cefoxitin (12.5%). CONCLUSIONS The data suggest that E. coli is frequently involved in diarrhoea in children under 3 years of age in this peri-urban setting of Bamako, Mali, with a high rate of resistance to amoxicillin and cotrimoxazole, the most widely used antibiotics in the management of diarrhoea in this setting.
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Affiliation(s)
- Bintou Diarra
- Pathogens genomic Diversity Network Africa (PDNA), Sotuba, Bamako, Mali
- African Association for research and control of Antimicrobial Resistance (AAAMR), Koulouba, Bamako, Mali
- Malaria Research and Training Center - University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibréhima Guindo
- National Institute for Public Health Research (INSP), Bamako, Mali
| | - Boī Koné
- Pathogens genomic Diversity Network Africa (PDNA), Sotuba, Bamako, Mali
- African Association for research and control of Antimicrobial Resistance (AAAMR), Koulouba, Bamako, Mali
- Malaria Research and Training Center - University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Maīmouna Dembélé
- National Institute for Public Health Research (INSP), Bamako, Mali
| | | | | | | | - Mamadou Tékété
- Pathogens genomic Diversity Network Africa (PDNA), Sotuba, Bamako, Mali
- African Association for research and control of Antimicrobial Resistance (AAAMR), Koulouba, Bamako, Mali
- Malaria Research and Training Center - University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Oumou Maīga
- Kumasi Centre for Collaborative Research in Tropical Medicine, BNITM, Kumasi, Ghana
| | | | - Abdoulaye Djimde
- Pathogens genomic Diversity Network Africa (PDNA), Sotuba, Bamako, Mali.
- African Association for research and control of Antimicrobial Resistance (AAAMR), Koulouba, Bamako, Mali.
- Malaria Research and Training Center - University of Science, Techniques and Technologies of Bamako, Bamako, Mali.
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Fleming JA, Gurley N, Knudson S, Kabore L, Bawa JT, Dapaah P, Kumar S, Uranw S, Tran T, Mai LTP, Odero C, Obong'o C, Aburam K, Wanjiru S, Hanh NTM, Dung LP, Hausdorff WP. Exploring Shigella vaccine priorities and preferences: Results from a mixed-methods study in low- and middle-income settings. Vaccine X 2023; 15:100368. [PMID: 37636544 PMCID: PMC10457597 DOI: 10.1016/j.jvacx.2023.100368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background Shigella is the leading bacterial cause of diarrheal mortality in children and can cause long-term effects on growth and development. No licensed Shigella vaccines currently exist but several promising candidates are in development and could be available in the next five years. Despite Shigella being a well-known public health target of the World Health Organization for decades, given current burden estimates and competing preventable disease priorities in low-income settings, whether the availability of an effective Shigella vaccine will lead to its prioritization and widespread introduction among countries at highest risk is unknown. Methods We conducted a mixed-methods study of national stakeholders and healthcare providers in five countries in Asia and Africa and regional stakeholders in the Pan American Health Organization to identify preferences and priorities for forthcoming Shigella vaccines. Results In our study of 89 individuals, diarrhea was the most frequently mentioned serious health concern for children under five years. Antimicrobial resistance (AMR) was more often considered very concerning than diarrhea or stunting. Shigella awareness was high but not considered a serious health concern by most stakeholders. Most participants were willing to consider adding a new vaccine to the routine immunization schedule but expressed reservations about a Shigella vaccine because of lower perceived burden relative to other preventable diseases and an already crowded schedule; interest was highest among national stakeholders in countries receiving more financial support for immunization. The priority of a Shigella vaccine rose when participants considered vaccine impacts on reducing stunting and AMR. Participants strongly preferred oral and combination vaccines compared to injectable and a single-antigen presentations, citing greater perceived community acceptability. Conclusions This study provides a critical opportunity to hear directly from country and regional stakeholders about health priorities and preferences around new vaccines. These findings should inform ongoing Shigella vaccine development efforts and eventual vaccine introduction and implementation planning.
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Affiliation(s)
| | - Nikki Gurley
- PATH, Seattle, 2201 Westlake Ave, Seattle, WA 98121, USA
| | - Sophia Knudson
- PATH, Seattle, 2201 Westlake Ave, Seattle, WA 98121, USA
| | - Lassane Kabore
- PATH, Senegal, Fann Résidence, Rue Saint John Perse X F, Dakar, Senegal
| | | | | | - Sandeep Kumar
- PATH, India, 15th Floor, Dr. Gopal Das Bhawan 28, Barakhamba Road, Connaught Place, New Delhi 110001, India
| | - Surendra Uranw
- B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan 56700, Nepal
| | - Thang Tran
- PATH, Viet Nam, #1101, 11th Floor, Hanoi Towers, 49 Hai Ba Trung, Hoan Kiem District, Hanoi, Viet Nam
| | - Le Thi Phuong Mai
- National Institute of Hygiene & Epidemiology, 1 P. Yec Xanh, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội 100000, Viet Nam
| | - Chris Odero
- PATH, Kenya, ACS Plaza, 4th Floor Lenana and Galana Road, P.O. Box 76634-00508, Nairobi, Kenya
| | - Christopher Obong'o
- PATH, Kenya, ACS Plaza, 4th Floor Lenana and Galana Road, P.O. Box 76634-00508, Nairobi, Kenya
| | - Kofi Aburam
- PATH, Ghana, PMB CT 307 Cantonments, Accra, Ghana
| | - Stella Wanjiru
- PATH, Kenya, ACS Plaza, 4th Floor Lenana and Galana Road, P.O. Box 76634-00508, Nairobi, Kenya
| | - Nguyen Thi My Hanh
- National Institute of Hygiene & Epidemiology, 1 P. Yec Xanh, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội 100000, Viet Nam
| | - Luu Phuong Dung
- National Institute of Hygiene & Epidemiology, 1 P. Yec Xanh, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội 100000, Viet Nam
| | - William P. Hausdorff
- PATH, Washington, DC, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USA
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Chowdhury G, Ghosh D, Zhou Y, Deb AK, Mukhopadhyay AK, Dutta S, Chakraborty S. Field evaluation of a simple and rapid diagnostic test, RLDT to detect Shigella and enterotoxigenic E. coli in Indian children. RESEARCH SQUARE 2023:rs.3.rs-3293791. [PMID: 37886599 PMCID: PMC10602125 DOI: 10.21203/rs.3.rs-3293791/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The diagnostic assays currently used to detect Shigella spp. (Shigella) and enterotoxigenic Escherichia coli (ETEC) are complex or elaborate which make them difficult to apply in resource poor settings where these diseases are endemic. The simple and rapid nucleic acid amplification-based assay "Rapid LAMP-based Diagnostic Test (RLDT)" was evaluated to detect Shigella spp (Shigella) and enterotoxigenic Escherichia coli (ETEC) and determine the epidemiology of these pathogens in Kolkata, India. Stool samples (n = 405) from children under five years old with diarrhea seeking care at the hospitals were tested, and 85(21%) and 68(17%) by RLDT, 91(23%) and 58(14%) by quantitative PCR (qPCR) and 35(9%) and 15(4%) by culture, were positive for Shigella and ETEC, respectively. The RLDT showed almost perfect agreement with qPCR, Kappa 0.96 and 0.89; sensitivity 93% and 98%; specificity 100% and 97% for Shigella and ETEC, respectively. While RLDT detected 12% more Shigella and 13% more ETEC than culture, all culture positives for Shigella and ETEC except one each were also positive by the RLDT, sensitivity 97% and 93% respectively. RLDT is a simple, sensitive, and rapid assay that could be implemented with minimum training in the endemic regions to strengthen the disease surveillance system and rapid outbreak detection.
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Affiliation(s)
| | - Debjani Ghosh
- ICMR-National Institute of Cholera and Enteric Diseases
| | - YiYi Zhou
- Johns Hopkins Bloomberg School of Public Health
| | - Alok K Deb
- ICMR-National Institute of Cholera and Enteric Diseases
| | | | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases
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Bagamian KH, Anderson IV JD, Blohm G, Scheele S. Shigella and childhood stunting: Evidence, gaps, and future research directions. PLoS Negl Trop Dis 2023; 17:e0011475. [PMID: 37699032 PMCID: PMC10497124 DOI: 10.1371/journal.pntd.0011475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Early childhood growth deficits have been shown to have lifelong health and economic impacts, yet their connection to one of their underlying causes, diarrheal diseases, has remained difficult to characterize. Identifying the processes and mechanisms that underlie this link has remained a challenge due to the complexity of the relationship and limitations in access to more advanced laboratory methods. In recent years, however, several large-scale, multisite studies have extensively investigated and reported the prevalence, etiology, and impacts of diarrheal diseases in children under 5 years (CU5) in low- to middle-income countries (LMICs). These studies, in combination with several single-site studies, have applied more advanced laboratory methods to uncover the etiology, true prevalence, infection mechanisms, and inflammation biomarkers of diarrheal disease. Of the multiple pathogens that have been shown to be strongly associated with diarrheal disease in CU5, Shigella is one of the more prevalent and impactful of these pathogens. In this narrative review, we highlight key insights from these studies and identify knowledge gaps and directions for future research. According to these studies, Shigella is most commonly detected in toddlers and young children; however, it can cause more severe disease and has a greater impact on linear growth for infants. Shigella often has a stronger relationship to linear growth faltering (LGF) than other enteropathogens, with higher Shigella loads resulting in greater growth deficits. Future studies should employ more Shigella-specific molecular assays and identify diarrheal etiologies using standardized diagnostics to improve child anthropometric and Shigella surveillance. Also, they should focus on uncovering the mechanisms of the relationship underlying Shigella and growth faltering to better characterize the role of asymptomatic infections and intestinal inflammation in this relationship.
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Affiliation(s)
- Karoun H. Bagamian
- Bagamian Scientific Consulting, LLC, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
| | - John D. Anderson IV
- Bagamian Scientific Consulting, LLC, Gainesville, Florida, United States of America
- Health Affairs Institute, West Virginia University, Morgantown, West Virginia, United States of America
| | - Gabriela Blohm
- Bagamian Scientific Consulting, LLC, Gainesville, Florida, United States of America
| | - Suzanne Scheele
- Center for Vaccine Innovation and Access, Washington, District of Columbia, United States of America
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Bejide OS, Odebode MA, Ogunbosi BO, Adekanmbi O, Akande KO, Ilori T, Ogunleye VO, Nwachukwu VU, Grey-Areben A, Akande ET, Okeke IN. Diarrhoeal pathogens in the stools of children living with HIV in Ibadan, Nigeria. Front Cell Infect Microbiol 2023; 13:1108923. [PMID: 36992685 PMCID: PMC10040677 DOI: 10.3389/fcimb.2023.1108923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction Diarrhoea can be debilitating in young children. Few aetiological investigations in Africans living with human immunodeficiency virus (HIV) have been performed since antiretrovirals became widely available. Methods Stool specimens from children with diarrhoea living with HIV, and HIV-uninfected controls, recruited at two hospitals in Ibadan, Nigeria, were screened for parasites and occult blood, and cultured for bacteria. Following biochemical identification of at least five colonies per specimen, diarrhoeagenic Escherichia coli and Salmonella were confirmed by PCR. Data were line-listed and comparisons were made using Fisher's Exact test. Results Only 10 children living with HIV could be enrolled during the 25-month study period and 55 HIV-uninfected children with diarrhoea were included for comparison. The most common pathogens overall were enteroaggregative E. coli (18/65, 27.7%), enteroinvasive E. coli (10/65, 15.4%), Cryptosporidium parvum (8/65, 12.3%) and Cyclospora cayetanensis (7/65, 10.8%). At least one pathogen was detected from seven of ten children living with HIV and 27 (49.1%) HIV-uninfected children. Parasite detection was associated with HIV positive status (p=0.03) with C. parvum specifically recovered more commonly from children living with HIV (p=0.01). Bacterial-parasite pathogen combinations were detected in specimens from four of ten children living with HIV but only 3(5.5%) HIV-uninfected children (p=0.009). Stools from five of ten children living with HIV and 7(12.7%) HIV-negative children (p = 0.014) contained occult blood. Discussion Even though children living with HIV present infrequently to Ibadan health facilities with diarrhoea, their greater propensity for mixed and potentially invasive infections justifies prioritizing laboratory diagnosis of their stools.
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Affiliation(s)
- Oyeniyi S. Bejide
- Department of Microbiology, Chrisland University, Abeokuta, Ogun State, Nigeria
- Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Mariam A. Odebode
- Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Babatunde O. Ogunbosi
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Kolawole O. Akande
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Temitope Ilori
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Veronica O. Ogunleye
- Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Victoria U. Nwachukwu
- Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Aghogho Grey-Areben
- Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Elizabeth T. Akande
- Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Iruka N. Okeke
- Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Oyo State, Nigeria
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Choy RKM, Bourgeois AL, Ockenhouse CF, Walker RI, Sheets RL, Flores J. Controlled Human Infection Models To Accelerate Vaccine Development. Clin Microbiol Rev 2022; 35:e0000821. [PMID: 35862754 PMCID: PMC9491212 DOI: 10.1128/cmr.00008-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The timelines for developing vaccines against infectious diseases are lengthy, and often vaccines that reach the stage of large phase 3 field trials fail to provide the desired level of protective efficacy. The application of controlled human challenge models of infection and disease at the appropriate stages of development could accelerate development of candidate vaccines and, in fact, has done so successfully in some limited cases. Human challenge models could potentially be used to gather critical information on pathogenesis, inform strain selection for vaccines, explore cross-protective immunity, identify immune correlates of protection and mechanisms of protection induced by infection or evoked by candidate vaccines, guide decisions on appropriate trial endpoints, and evaluate vaccine efficacy. We prepared this report to motivate fellow scientists to exploit the potential capacity of controlled human challenge experiments to advance vaccine development. In this review, we considered available challenge models for 17 infectious diseases in the context of the public health importance of each disease, the diversity and pathogenesis of the causative organisms, the vaccine candidates under development, and each model's capacity to evaluate them and identify correlates of protective immunity. Our broad assessment indicated that human challenge models have not yet reached their full potential to support the development of vaccines against infectious diseases. On the basis of our review, however, we believe that describing an ideal challenge model is possible, as is further developing existing and future challenge models.
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Affiliation(s)
- Robert K. M. Choy
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | - A. Louis Bourgeois
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | | | - Richard I. Walker
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | | | - Jorge Flores
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
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Phalipon A, Mulard LA. Toward a Multivalent Synthetic Oligosaccharide-Based Conjugate Vaccine against Shigella: State-of-the-Art for a Monovalent Prototype and Challenges. Vaccines (Basel) 2022; 10:403. [PMID: 35335035 PMCID: PMC8954881 DOI: 10.3390/vaccines10030403] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 02/04/2023] Open
Abstract
This review focuses on the molecular glycovaccine concept, a promising option to develop a Shigella glycoconjugate vaccine. Subsequent to original developments involving, as main vaccine component, the detoxified Shigella lipopolysaccharide randomly conjugated at multiple sites to a carrier protein, novelty stems from the use of rationally designed, well-defined chemically synthesized oligosaccharide haptens conceived as functional surrogates of the main surface antigen, linked via single-point attachment onto a carrier. The concept and design of such a fine-tuned Shigella glycovaccine are presented by way of SF2a-TT15, a neoglycoprotein featuring a synthetic 15-mer oligosaccharide, which constitutes an original vaccine prototype targeting Shigella flexneri 2a, one of the predominant circulating strains in endemic settings. The clinical testing of SF2a-TT15 is summarized with the first-in-human phase I trial in young healthy adults showing a good safety profile and tolerability, while inducing bactericidal antibodies towards S. flexneri 2a bacteria. The proof-of-concept of this novel approach being established, an ongoing phase IIa clinical study in the nine-month-old infant target population in endemic area was launched, which is also outlined. Lastly, some challenges to move forward this original approach toward a multivalent cost-effective Shigella synthetic glycan conjugate vaccine are introduced.
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Grants
- Institut Pasteur (Grants PTR 99, GPH-FlexBiVac, Roux Cantarini and Pasteur Roux Cantarini Postdoctoral Fellowships, COMED-SF2a, INNOV-42-19) Institut Pasteur
- ANR, Grants ANR-06-EMPB-013, ANR-05-BLAN-0022, ANR-08-PCVI-0002, ANR-15-CE07-0019 Agence Nationale de la Recherche
- PF7-Health ID 261472-STOPENTERICS European Union Seventh Framework Program
- Grant agreement Investment ID OPP1191130, OPP1198140, OPP1201194 Bill and Melinda Gates Foundation
- Contract ID: Collaboration & License Agreement (Institut Pasteur, Gates MRI), December 2019 Bill and Melinda Gates Medical Research Institute
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Affiliation(s)
- Armelle Phalipon
- Institut Pasteur, Innovation Lab. Vaccines, F-75015 Paris, France
| | - Laurence A. Mulard
- Institut Pasteur, Université de Paris, CNRS UMR3523, Unité Chimie des Biomolécules, F-75015 Paris, France
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10
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Cohen D, Atsmon J, Artaud C, Meron-Sudai S, Gougeon ML, Bialik A, Goren S, Asato V, Ariel-Cohen O, Reizis A, Dorman A, Hoitink CWG, Westdijk J, Ashkenazi S, Sansonetti P, Mulard LA, Phalipon A. Safety and immunogenicity of a synthetic carbohydrate conjugate vaccine against Shigella flexneri 2a in healthy adult volunteers: a phase 1, dose-escalating, single-blind, randomised, placebo-controlled study. THE LANCET. INFECTIOUS DISEASES 2021; 21:546-558. [DOI: 10.1016/s1473-3099(20)30488-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/11/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022]
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11
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Anderson JD, Bagamian KH, Muhib F, Amaya MP, Laytner LA, Wierzba T, Rheingans R. Burden of enterotoxigenic Escherichia coli and shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: a modelling analysis. LANCET GLOBAL HEALTH 2020; 7:e321-e330. [PMID: 30784633 PMCID: PMC6379821 DOI: 10.1016/s2214-109x(18)30483-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/08/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022]
Abstract
Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that cause moderate-to-severe diarrhoea in children younger than 5 years. Diarrhoea is associated with an increased risk of stunting, which puts children at risk of death due to other infectious diseases. Methods We modelled ETEC-related and shigella-related mortality and the effect of moderate-to-severe diarrhoea episodes to determine the number of children with stunting due to these infections in 79 low-income and lower middle-income countries. We applied population attributable risk for increased number of deaths due to other infectious diseases in children who are stunted. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In children younger than 5 years, we estimate 196 million (95% UI 135–269) episodes of ETEC and shigella diarrhoea occur annually, resulting in 3·5 million (0·8–5·4) cases of moderate-to-severe stunting and 44 400 (29 400–59 800) total ETEC deaths and 63 100 (44 000–81 900) total shigella deaths in 2015. Additional infectious disease mortality due to stunting resulted in increases of 24% (8–34; for ETEC) and 28% (10–39; for shigella) over direct deaths due to diarrhoeal episodes. The distribution of mortality and morbidity varied geographically, with African Region and Eastern Mediterranean Region countries bearing the greatest burden. Interpretation The expanded effects of non-fatal ETEC and shigella-related diarrhoeal episodes can have lasting consequences. Prevention of these infections could reduce the risk of direct death and stunting and deaths due to other infectious diseases. Understanding the countries and populations with the highest disease risk helps to target interventions for the most vulnerable populations. Funding The Bill & Melinda Gates Foundation.
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Affiliation(s)
- John D Anderson
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USA; Emerging Pathogens Institute, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA.
| | - Karoun H Bagamian
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA; Bagamian Scientific Consulting, Gainesville, FL, USA
| | | | - Mirna P Amaya
- Emerging Pathogens Institute, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | - Lindsey A Laytner
- Emerging Pathogens Institute, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | | | - Richard Rheingans
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USA; Emerging Pathogens Institute, Gainesville, FL, USA
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12
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Diarrhea in under Five Year-Old Children in Nepal: A Spatiotemporal Analysis Based on Demographic and Health Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062140. [PMID: 32210171 PMCID: PMC7142451 DOI: 10.3390/ijerph17062140] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/20/2020] [Indexed: 01/05/2023]
Abstract
Background: Diarrhea in children under five years of age remains a challenge in reducing child mortality in Nepal. Understanding the spatiotemporal patterns and influencing factors of the disease is important for control and intervention. Methods: Data regarding diarrhea prevalence and its potential influencing factors were extracted from the Demographic and Health Surveys in Nepal and other open-access databases. A Bayesian logistic regression model with district-specific spatio-temporal random effects was applied to explore the space and time patterns of diarrhea risk, as well as the relationships between the risk and the potential influencing factors. Results: Both the observed prevalence and the estimated spatiotemporal effects show a decreasing diarrhea risk trend from 2006 to 2016 in most districts of Nepal, with a few exceptions, such as Achham and Rasuwa. The disease risk decreased with mothers’ years of education (OR 0.93, 95% Bayesian Credible Interval (BCI) 0.87, 0.997). Compared to spring, autumn and winter had lower risks of diarrhea. The risk firstly increased and then decreased with age and children under 12–24 months old were the highest risk group (OR 1.20, 95% BCI 1.04, 1.38). Boys had higher risk than girls (OR 1.24, 95% BCI 1.13, 1.39). Even though improved sanitation wasn’t found significant within a 95% BCI, there was 93.2% of chance of it being a protective factor. There were no obvious spatiotemporal clusters among districts and each district tended to have its own spatiotemporal diarrhea prevalence pattern. Conclusions: The important risk factors identified by our Bayesian spatial-temporal modeling provide insights for control and intervention on children diarrhea in Nepal. Special attention should be paid to high risk groups of children and high risk seasons, as well as districts with high risk or increased trend of risk. Effective actions should be implemented to improve sanitation and women’s education level. District-specific control planning is recommended for local governments for effective control of children diarrhea in Nepal.
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13
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van den Beld MJC, Warmelink E, Friedrich AW, Reubsaet FAG, Schipper M, de Boer RF, Notermans DW, Petrignani MWF, van Zanten E, Rossen JWA, Friesema IHM, Kooistra-Smid AMDM. Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016-2017. BMC Infect Dis 2019; 19:1037. [PMID: 31818261 PMCID: PMC6902317 DOI: 10.1186/s12879-019-4659-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Shigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations. Methods In this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to 15 MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were cultured to discriminate between the two pathogens. We compared risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases. Results In 2016–2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between Shigella spp. and EIEC, and culture-negative and culture-positive cases. Conclusions No convincing evidence was found to support the current guidelines that employs different measures based on species or detection method. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.
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Affiliation(s)
- Maaike J C van den Beld
- Infectious Disease Research, Diagnostics and laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | | | - Alexander W Friedrich
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Frans A G Reubsaet
- Infectious Disease Research, Diagnostics and laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Maarten Schipper
- Department of Statistics, Informatics and Mathematical Modeling, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Richard F de Boer
- Certe, Department of Medical Microbiology, Groningen, the Netherlands
| | - Daan W Notermans
- Infectious Disease Research, Diagnostics and laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mariska W F Petrignani
- Public health service GGD Amsterdam, Amsterdam, the Netherlands.,National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Evert van Zanten
- Certe, Department of Medical Microbiology, Groningen, the Netherlands
| | - John W A Rossen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ingrid H M Friesema
- Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - A M D Mirjam Kooistra-Smid
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Certe, Department of Medical Microbiology, Groningen, the Netherlands
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14
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Foysal MJ, Momtaz F, Robiul Kawser AQM, Chaklader MR, Siddik MAB, Lamichhane B, Tay ACY, Rahman MM, Fotedar R. Microbiome patterns reveal the transmission of pathogenic bacteria in hilsa fish (Tenualosa ilisha) marketed for human consumption in Bangladesh. J Appl Microbiol 2019; 126:1879-1890. [PMID: 30888695 DOI: 10.1111/jam.14257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/22/2019] [Accepted: 03/10/2019] [Indexed: 12/11/2022]
Abstract
AIMS This study conducted bacterial community, virulence and antibiogram profiling inside the hindgut and skin of freshly caught hilsa fish and those sold at markets. METHODS AND RESULTS The results of 16S rRNA-based high-throughput sequencing showed a higher number of bacterial genera in marketed fish samples than in fresh fish samples. The total operational taxonomic units, genus counts and diversity index were significantly higher (P > 0·05) in marketed fish, which also had abundant pathogenic bacterial groups. Skin samples had a lower profusion of pathogenic bacteria than gut samples. A total of 52 bacterial isolates from nine species were identified in this study, of which 25 were from a Chittagong market and 22 were from a Dhaka market, whereas only five were from fresh hilsa. The polymerase chain reaction amplification of 12 species-specific virulence genes in the 52 isolates, namely, aer, hly, chxA, toxB, rtxC, sfa, uge, norB, trx, toxA, ipaH, sigA and coa, indicated a high number of positive samples containing Vibrio cholerae, Aeromonas spp., Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus. Antibiogram profiling of these bacteria against 10 commercial antibiotics showed high-resistance patterns of the isolates against sulfamethoxazole, kanamycin, neomycin, ampicillin and tetracycline. CONCLUSION The results reveal the spread of multidrug-resistant bacteria in hilsa fish marketed for human consumption in Bangladesh. SIGNIFICANCE AND IMPACT OF THE STUDY This study highlights the risk of spreading environmentally and clinically pathogenic bacteria in fish sold for human consumption in Bangladesh. Such bacteria come from aquatic pollution and poor handling, storage and transportation practices that may predispose fish to major outbreaks of infectious and waterborne diseases.
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Affiliation(s)
- M J Foysal
- School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia.,Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - F Momtaz
- Department of Microbiology, Chittagong University, Chittagong, Bangladesh
| | - A Q M Robiul Kawser
- Department of Aquaculture, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - M R Chaklader
- School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
| | - M A B Siddik
- School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia.,Department of Fisheries Biology and Genetics, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - B Lamichhane
- Helicobacter Research Laboratory, Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - A C Y Tay
- Helicobacter Research Laboratory, Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - M M Rahman
- Department of Biotechnology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - R Fotedar
- School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
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15
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Q.S. Medeiros PH, Ledwaba SE, Bolick DT, Giallourou N, Yum LK, Costa DV, Oriá RB, Barry EM, Swann JR, Lima AÂM, Agaisse H, Guerrant RL. A murine model of diarrhea, growth impairment and metabolic disturbances with Shigella flexneri infection and the role of zinc deficiency. Gut Microbes 2019; 10:615-630. [PMID: 30712505 PMCID: PMC6748602 DOI: 10.1080/19490976.2018.1564430] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Shigella is one of the major enteric pathogens worldwide. We present a murine model of S. flexneri infection and investigate the role of zinc deficiency (ZD). C57BL/6 mice fed either standard chow (HC) or ZD diets were pretreated with an antibiotic cocktail and received S. flexneri strain 2457T orally. Antibiotic pre-treated ZD mice showed higher S. flexneri colonization than non-treated mice. ZD mice showed persistent colonization for at least 50 days post-infection (pi). S. flexneri-infected mice showed significant weight loss, diarrhea and increased levels of fecal MPO and LCN in both HC and ZD fed mice. S. flexneri preferentially colonized the colon, caused epithelial disruption and inflammatory cell infiltrate, and promoted cytokine production which correlated with weight loss and histopathological changes. Infection with S. flexneri ΔmxiG (critical for type 3 secretion system) did not cause weight loss or diarrhea, and had decreased stool shedding duration and tissue burden. Several biochemical changes related to energy, inflammation and gut-microbial metabolism were observed. Zinc supplementation increased weight gains and reduced intestinal inflammation and stool shedding in ZD infected mice. In conclusion, young antibiotic-treated mice provide a new model of oral S. flexneri infection, with ZD promoting prolonged infection outcomes.
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Affiliation(s)
- Pedro Henrique Q.S. Medeiros
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA,Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil,CONTACT Pedro Henrique Q.S. Medeiros Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, 345 Crispell Drive, MR6 Room 2711, Charlottesville, VA, USA
| | - Solanka E. Ledwaba
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - David T. Bolick
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Natasa Giallourou
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lauren K. Yum
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, USA
| | - Deiziane V.S. Costa
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA,Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil
| | - Reinaldo B. Oriá
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA,Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil
| | - Eileen M. Barry
- Center for Vaccine Development, University of Maryland, Baltimore, USA
| | - Jonathan R. Swann
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hervé Agaisse
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, USA
| | - Richard L. Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
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16
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Vubil D, Acácio S, Quintò L, Ballesté-Delpierre C, Nhampossa T, Kotloff K, Levine MM, Alonso P, Nataro JP, Farag TH, Vila J, Mandomando I. Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by Shigella in children less than 5 years in Manhiça District, rural Mozambique. Infect Drug Resist 2018; 11:2095-2106. [PMID: 30464552 PMCID: PMC6219103 DOI: 10.2147/idr.s177579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by Shigella was studied among children <5 years of age residing in Manhiça District, Southern Mozambique. MATERIALS AND METHODS Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with Shigella positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome. RESULTS A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. Shigella was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. Shigella was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (P=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (P<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86-9.24) among children aged 12-23 months. Clinical symptoms associated to Shigella among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby's food, and mother as caretaker were the protective factors against acquiring diarrhea caused by Shigella. Antibiotic treatment on admission was associated with a positive children outcome. CONCLUSION Shigella remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to Shigella.
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Affiliation(s)
- Delfino Vubil
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
| | - Sozinho Acácio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
- Instituto Nacional de Saúde (INS), Maputo, Mozambique,
| | - Llorenç Quintò
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
- Instituto Nacional de Saúde (INS), Maputo, Mozambique,
| | - Karen Kotloff
- Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Myron M Levine
- Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Pedro Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Tamer H Farag
- Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Microbiology, Centre for Biomedical Diagnosis, Hospital Clinic, Barcelona, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
- Instituto Nacional de Saúde (INS), Maputo, Mozambique,
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17
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Reid G, Kort R, Alvarez S, Bourdet-Sicard R, Benoit V, Cunningham M, Saulnier D, van Hylckama Vlieg J, Verstraelen H, Sybesma W. Expanding the reach of probiotics through social enterprises. Benef Microbes 2018; 9:707-715. [DOI: 10.3920/bm2018.0015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The rapid rise in microbiome and probiotic science has led to estimates of product creation and sales exceeding $50 billion within five years. However, many people do not have access to affordable products, and regulatory agencies have stifled progress. The objective of a discussion group at the 2017 meeting of the International Scientific Association for Probiotics and Prebiotics was to identify mechanisms to confer the benefits of probiotics to a larger portion of the world’s population. Three initiatives, built around fermented food, were discussed with different methods of targeting populations that face enormous challenges of malnutrition, infectious disease, poverty and violent conflict. As new candidate probiotic strains emerge, and the market diversifies towards more personalised interventions, manufacturing processes will need to evolve. Information dissemination through scientific channels and social media is projected to provide consumers and healthcare providers with rapid access to clinical results, and to identify the nearest location of sites making new and affordable probiotic food and supplements. This rapid translation of science to individual well-being will not only expand the beneficiaries of probiotics, but also fuel new social enterprises and economic business models.
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Affiliation(s)
- G. Reid
- Canadian Research and Development Centre for Probiotics, Microbiology & Immunology, and Surgery, University of Western Ontario, Room F3-106, P.O. Box 5777, STN B, London, N6A 4V2 Ontario, Canada
| | - R. Kort
- Yoba for Life foundation, Hunzestraat 133-A, 1079 WB Amsterdam, the Netherlands
- TNO Microbiology and Systems Biology, P.O. Box 360, 3700 AJ Zeist, the Netherlands
- VU University Amsterdam; Micropia, Natura Artis Magistra, Plantage Kerklaan 38-40, 1018 CZ Amsterdam, the Netherlands
| | - S. Alvarez
- Reference Centre for Lactobacilli (CERELA-CONICET), Chacabuco 145, Tucuman 4000, Argentina
| | - R. Bourdet-Sicard
- Danone Access, Africa & India, Danone Nutricia Research, Avenue de la Vauve, 91767 Palaiseau, France
| | - V. Benoit
- General Mills, Nutrition and Technology Solutions, 9000 Plymouth Avenue N, Minneapolis, MN 55427, USA
| | - M. Cunningham
- Research and Development, Metagenics (Aust) Pty Ltd., P.O. Box 675, Virginia BC, Queensland 4014, Australia
| | - D.M. Saulnier
- Novozymes A/S, Hillerødgade 42, 2200 Frederiksberg, Denmark
| | | | - H. Verstraelen
- Vulvovaginal Disease Clinic, Dept. of Obstetrics & Gynaecology, Ghent University Hospital 0P4, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - W. Sybesma
- Yoba for Life foundation, Hunzestraat 133-A, 1079 WB Amsterdam, the Netherlands
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18
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Dhakal R, Wang Q, Lan R, Howard P, Sintchenko V. Novel multiplex PCR assay for identification and subtyping of enteroinvasive Escherichia coli and differentiation from Shigella based on target genes selected by comparative genomics. J Med Microbiol 2018; 67:1257-1264. [PMID: 29969087 DOI: 10.1099/jmm.0.000784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Both Shigella and enteroinvasive Escherichia coli (EIEC) can cause enterocolitis, but they have a distinct epidemiology and public health relevance. Current culture-independent testing (CIT) methods to identify Shigella in faecal samples rely on the ipaH gene as the target, which is also found in EIEC genomes. The aim of this study was to design an assay that can identify EIEC in cultures from CIT ipaH-positive samples. METHODOLOGY Shigella and EIEC genomes were screened to find unique regions present in EIEC genomes using a comparative genomics approach and differentiating genetic loci that are suitable PCR targets were identified. The primers for these loci were designed and tested in 6501 and 104 genomes of Shigella and EIEC, respectively. RESULTS An assay with two sets of multiplex PCR reactions that differentiates Shigella and EIEC based on the presence/absence of at least two out of six loci was developed and evaluated. The majority of Shigella genomes lacked all six loci, while at least two loci were present in most EIEC genomes. This assay successfully differentiated clinical EIEC from Shigella with a limit of detection of 105 cells ml-1. The sensitivity and specificity were over 95 and 99%, respectively. The assay can further subtype EIEC genomes into their genetic lineages. CONCLUSION This new highly specific assay can assist in the identification of EIEC in ipaH PCR-positive samples and augment the public health laboratory surveillance of EIEC and shigellosis.
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Affiliation(s)
- Rajat Dhakal
- 1Centre for Infectious Diseases and Microbiology - Public Health, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Qinning Wang
- 1Centre for Infectious Diseases and Microbiology - Public Health, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ruiting Lan
- 2School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Howard
- 1Centre for Infectious Diseases and Microbiology - Public Health, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Vitali Sintchenko
- 1Centre for Infectious Diseases and Microbiology - Public Health, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- 3Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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19
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Burden of diarrhea in the Eastern Mediterranean Region, 1990-2015: Findings from the Global Burden of Disease 2015 study. Int J Public Health 2018; 63:109-121. [PMID: 28776239 PMCID: PMC5973974 DOI: 10.1007/s00038-017-1008-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Diarrheal diseases (DD) are an important cause of disease burden, especially in children in low-income settings. DD can also impact children's potential livelihood through growth faltering, cognitive impairment, and other sequelae. METHODS As part of the Global Burden of Disease study, we estimated DD burden, and the burden attributable to specific risk factors and etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2015. We calculated disability-adjusted life-years (DALYs)-the sum of years of life lost and years lived with disability-for both sexes and all ages. RESULTS We estimate that over 103,692 diarrhea deaths occurred in the EMR in 2015 (95% uncertainty interval: 87,018-124,692), and the mortality rate was 16.0 deaths per 100,000 persons (95% UI: 13.4-19.2). The majority of these deaths occurred in children under 5 (63.3%) (65,670 deaths, 95% UI: 53,640-79,486). DALYs per 100,000 ranged from 304 (95% UI 228-400) in Kuwait to 38,900 (95% UI 25,900-54,300) in Somalia. CONCLUSIONS Our findings will guide evidence-based health policy decisions for interventions to achieve the ultimate goal of reducing the DD burden.
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20
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Direct Detection of Shigella in Stool Specimens by Use of a Metagenomic Approach. J Clin Microbiol 2018; 56:JCM.01374-17. [PMID: 29118177 PMCID: PMC5786726 DOI: 10.1128/jcm.01374-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/02/2017] [Indexed: 02/04/2023] Open
Abstract
The underestimation of Shigella species as a cause of childhood diarrhea disease has become increasingly apparent with quantitative PCR (qPCR)-based diagnostic methods versus culture. We sought to confirm qPCR-based detection of Shigella via a metagenomics approach. Three groups of samples were selected from diarrheal cases from the Global Enteric Multicenter Study: nine Shigella culture-positive and qPCR-positive (culture+ qPCR+) samples, nine culture-negative but qPCR-positive (culture− qPCR+) samples, and nine culture-negative and qPCR-negative (culture− qPCR−) samples. Fecal DNA was sequenced using paired-end Illumina HiSeq, whereby 3.26 × 108 ± 5.6 × 107 high-quality reads were generated for each sample. We used Kraken software to compare the read counts specific to “Shigella” among the three groups. The proportions of Shigella-specific nonhuman sequence reads between culture+ qPCR+ (0.65 ± 0.42%) and culture− qPCR+ (0.55 ± 0.31%) samples were similar (Mann-Whitney U test, P = 0.627) and distinct from the culture− qPCR− group (0.17 ± 0.15%, P < 0.05). The read counts of sequences previously targeted by Shigella/enteroinvasive Escherichia coli (EIEC) qPCR assays, namely, ipaH, virA, virG, ial, ShET2, and ipaH3, were also similar between the culture+ qPCR+ and culture− qPCR+ groups and distinct from the culture− qPCR− groups (P < 0.001). Kraken performed well versus other methods: its precision and recall of Shigella were excellent at the genus level but variable at the species level. In summary, metagenomic sequencing indicates that Shigella/EIEC qPCR-positive samples are similar to those of Shigella culture-positive samples in Shigella sequence composition, thus supporting qPCR as an accurate method for detecting Shigella.
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21
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Medeiros PHQS, Lima AÂM, Guedes MM, Havt A, Bona MD, Rey LC, Soares AM, Guerrant RL, Weigl BH, Lima IFN. Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil. Diagn Microbiol Infect Dis 2017; 90:198-205. [PMID: 29217418 DOI: 10.1016/j.diagmicrobio.2017.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/08/2017] [Accepted: 11/01/2017] [Indexed: 12/28/2022]
Abstract
Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.
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Affiliation(s)
| | - Aldo Ângelo Moreira Lima
- Institute of Biomedicine for Brazilian Semi-Arid (IBISAB), Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil; Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Marjorie Moreira Guedes
- Institute of Biomedicine for Brazilian Semi-Arid (IBISAB), Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Alexandre Havt
- Institute of Biomedicine for Brazilian Semi-Arid (IBISAB), Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Mariana Duarte Bona
- Institute of Biomedicine for Brazilian Semi-Arid (IBISAB), Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Luís Carlos Rey
- Department of Mother and Child Health, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Alberto Melo Soares
- Institute of Biomedicine for Brazilian Semi-Arid (IBISAB), Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Richard Littleton Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Bernhard H Weigl
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA
| | - Ila Fernanda Nunes Lima
- Institute of Biomedicine for Brazilian Semi-Arid (IBISAB), Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil
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22
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Shigella Vaccine Development: Finding the Path of Least Resistance. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:904-907. [PMID: 27707764 DOI: 10.1128/cvi.00444-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Shigella spp. represent the second most common etiologic pathogen causing childhood diarrhea in developing countries. There are no licensed Shigella vaccines, and progress for such vaccines has been limited. In this issue of Clinical and Vaccine Immunology, Riddle and colleagues (M. S. Riddle, R. W. Kaminski, C. Di Paolo, C. K. Porter, R. L. Gutierrez, et al., Clin Vaccine Immunol 23:908-917, 2016, http://dx.doi.org/10.1128/CVI.00224-16) report results from a phase I study of a parenterally administered monovalent O-polysaccharide "bioconjugate" directed against Shigella flexneri 2a. Ultimately, the goal is to develop a broad-spectrum Shigella vaccine to address this public health concern. A parenteral Shigella vaccine capable of eliciting protection in children of developing countries would be an important tool to reach this goal.
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23
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Khalil I, Colombara DV, Forouzanfar MH, Troeger C, Daoud F, Moradi-Lakeh M, Bcheraoui CE, Rao PC, Afshin A, Charara R, Abate KH, Razek MMAE, Abd-Allah F, Abu-Elyazeed R, Kiadaliri AA, Akanda AS, Akseer N, Alam K, Alasfoor D, Ali R, AlMazroa MA, Alomari MA, Al-Raddadi RMS, Alsharif U, Alsowaidi S, Altirkawi KA, Alvis-Guzman N, Ammar W, Antonio CAT, Asayesh H, Asghar RJ, Atique S, Awasthi A, Bacha U, Badawi A, Barac A, Bedi N, Bekele T, Bensenor IM, Betsu BD, Bhutta Z, Abdulhak AAB, Butt ZA, Danawi H, Dubey M, Endries AY, Faghmous IDA, Farid T, Farvid MS, Farzadfar F, Fereshtehnejad SM, Fischer F, Fitchett JRA, Gibney KB, Ginawi IAM, Gishu MD, Gugnani HC, Gupta R, Hailu GB, Hamadeh RR, Hamidi S, Harb HL, Hedayati MT, Hsairi M, Husseini A, Jahanmehr N, Javanbakht M, Jibat T, Jonas JB, Kasaeian A, Khader YS, Khan AR, Khan EA, Khan G, Khoja TAM, Kinfu Y, Kissoon N, Koyanagi A, Lal A, Latif AAA, Lunevicius R, Razek HMAE, Majeed A, Malekzadeh R, Mehari A, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Misganaw A, Mohamed LAI, Nachega JB, Nguyen QL, Nisar MI, Peprah EK, Platts-Mills JA, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Rahman SU, Rai RK, Rana SM, Ranabhat CL, Rao SR, Refaat AH, Riddle M, Roshandel G, Ruhago GM, Saleh MM, Sanabria JR, Sawhney M, Sepanlou SG, Setegn T, Sliwa K, Sreeramareddy CT, Sykes BL, Tavakkoli M, Tedla BA, Terkawi AS, Ukwaja K, Uthman OA, Westerman R, Wubshet M, Yenesew MA, Yonemoto N, Younis MZ, Zaidi Z, Zaki MES, Rabeeah AAA, Wang H, Naghavi M, Vos T, Lopez AD, Murray CJL, Mokdad AH. Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013. Am J Trop Med Hyg 2016; 95:1319-1329. [PMID: 27928080 PMCID: PMC5154365 DOI: 10.4269/ajtmh.16-0339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/03/2016] [Indexed: 12/22/2022] Open
Abstract
Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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Affiliation(s)
- Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Maziar Moradi-Lakeh
- Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Raghid Charara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | | | | | | | - Aliasghar Ahmad Kiadaliri
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Nadia Akseer
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Khurshid Alam
- University of Sydney, Sydney, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Raghib Ali
- University of Oxford, Oxford, United Kingdom
| | | | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Shirina Alsowaidi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | | | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, College of Public Health, University of the Philippines, Manila, Philippines
| | - Hamid Asayesh
- Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
| | | | - Suleman Atique
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Ashish Awasthi
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, Canada
| | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | | | | | - Zulfiqar Bhutta
- Medical Center, Aga Khan University, Karachi, Pakistan.,The Hospital for Sick Children, Toronto, Canada
| | | | - Zahid A Butt
- Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Manisha Dubey
- International Institute for Population Sciences, Mumbai, India
| | | | - Imad D A Faghmous
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Talha Farid
- University of Louisville, Louisville, Kentucky
| | - Maryam S Farvid
- Institute for Health Policy, Boston, Massachusetts.,University of Louisville, Louisville, Kentucky
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Katherine B Gibney
- Melbourne Health, Parkville, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Melkamu Dedefo Gishu
- Kersa Health and Demographic Surveillance System, Harar, Ethiopia.,Haramaya University, Dire Dawa, Ethiopia
| | - Harish Chander Gugnani
- Department of Epidemiology and Biostatistics, Saint James School of Medicine, Anguilla, British West Indies.,Department of Microbiology, Saint James School of Medicine, Anguilla, British West Indies
| | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston, West Virginia
| | - Gessessew Bugssa Hailu
- Kilte Awlaelo Health and Demographic Surveillance System, Ethiopia.,Mekelle University, Mekelle, Ethiopia
| | | | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Mohammad T Hedayati
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohamed Hsairi
- Department of Epidemiology, Salah Azaiz Institute, Tunis, Tunisia
| | | | - Nader Jahanmehr
- Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tariku Jibat
- Wageningen University, Wageningen, Netherlands.,Addis Ababa University, Debre Zeit, Ethiopia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Yohannes Kinfu
- Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain
| | - Aparna Lal
- Australian National University, Canberra, Australia
| | | | - Raimundas Lunevicius
- School of Medicine, University of Liverpool, Liverpool, United Kingdom.,Aintree University Hospital, National Health Service Foundation Trust, Liverpool, United Kingdom
| | | | | | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alem Mehari
- Howard University College of Medicine, Washington, District of Columbia
| | | | - Yohannes Adama Melaku
- School of Medicine, University of Adelaide, Adelaide, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Saudi Ministry of Health, Riyadh, Saudi Arabia
| | | | - Awoke Misganaw
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Jean B Nachega
- Stellenbosch University, Cape Town, Western Cape, South Africa.,University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Quyen Le Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | | | | | | | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Anwar Rafay
- Contech School of Public Health, Lahore, Pakistan.,Contech International Health Consultants, Lahore, Pakistan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Saleem M Rana
- Contech School of Public Health, Lahore, Pakistan.,Contech International Health Consultants, Lahore, Pakistan
| | - Chhabi L Ranabhat
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea.,Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Sowmya R Rao
- Department of Surgery, School of Medicine, Boston University, Boston, Massachusetts
| | - Amany H Refaat
- Suez Canal University, Ismailia, Egypt.,Walden University, Minneapolis, Minnesota
| | - Mark Riddle
- Naval Medical Research Center, Silver Spring, Maryland
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.,Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Juan R Sanabria
- Case Western Reserve University, Cleveland, Ohio.,Department of Surgery and Comprehensive Cancer Center, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | | | - Sadaf G Sepanlou
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | | | - Bryan L Sykes
- Departments of Criminology, Law and Society, Sociology, and Public Health, University of California-Irvine, Irvine, California
| | | | - Bemnet Amare Tedla
- James Cook University, Cairns, Australia.,University of Gondar, Gondar, Ethiopia
| | - Abdullah S Terkawi
- Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Kingsley Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Olalekan A Uthman
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ronny Westerman
- German National Cohort Consortium, Heidelberg, Germany.,Federal Institute for Population Research, Wiesbaden, Germany
| | - Mamo Wubshet
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,University of Gondar, Gondar, Ethiopia
| | | | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | | | | | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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24
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Keddy KH, Smith AM, Page NA. GEMS extend understanding of childhood diarrhoea. Lancet 2016; 388:1252-4. [PMID: 27673454 DOI: 10.1016/s0140-6736(16)31664-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases, 2131 Sandringham, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases, 2131 Sandringham, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola A Page
- Centre for Enteric Diseases, National Institute for Communicable Diseases, 2131 Sandringham, Johannesburg, South Africa; Department of Medical Virology, Faculty of Health Sciences, Pretoria, South Africa
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25
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Nataro J, Stine OC. In Response. Am J Trop Med Hyg 2016; 94:482. [PMID: 26843612 PMCID: PMC4751943 DOI: 10.4269/ajtmh.15-0777b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- James Nataro
- Department of Pediatrics, University of Virginia, Charlottesville, VA. E-mail:
| | - O. Colin Stine
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD. E-mail:
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26
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Okeke IN, Aboderin AO, Opintan JA. Enteroinvasive Escherichia coli May Account for Uncultured Shigella. Am J Trop Med Hyg 2016; 94:480-481. [PMID: 26843611 PMCID: PMC4751958 DOI: 10.4269/ajtmh.15-0777a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Iruka N Okeke
- Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria. E-mail:
| | - Aaron O Aboderin
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. E-mail:
| | - Japheth A Opintan
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana. E-mail:
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