Epidemiology of shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings

Authors

Fariha Shaheen, Aga Khan UniversityFollow
Furqan Kabir, Aga Khan UniversityFollow
Arjumand Rizvi, Aga Khan UniversityFollow
Fatima Aziz, Aga Khan UniversityFollow
Adil Kalam, Aga Khan UniversityFollow
Shahida Qureshi, Aga Khan UniversityFollow
Sadia Shakoor, Aga Khan UniversityFollow
Ali Turab, Aga Khan University
Sajid Bashir Soofi, Aga Khan UniversityFollow
Zulfiqar Ahmed Bhutta, The Aga Khan UniversityFollow
Najeeha Talat Iqbal, Aga Khan UniversityFollow

Document Type

Article

Department

Paediatrics and Child Health; Pathology and Laboratory Medicine; Biological and Biomedical Sciences

Abstract

Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. We further characterized the epidemiology of Shigella in the first two years of life in a multisite birth cohort. We tested 41,405 diarrheal and monthly non-diarrheal stools from 1,715 children for Shigella by quantitative PCR. To assess risk factors, clinical factors related to age and culture positivity, and associations with inflammatory biomarkers, we used log-binomial regression with generalized estimating equations. The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. The sensitivity of culture compared to qPCR was 6.6% and increased to 27.8% in Shigella-attributable dysentery. Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (<10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella. There was a linear dose-response between Shigella quantity and myeloperoxidase concentrations. The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. Culture missed most clinically relevant cases of severe diarrhea and dysentery.

Comments

Pagination are not provided by the author/publisher

Publication (Name of Journal)

PLOS Neglected Tropical Diseases

Recommended Citation

Shaheen, F., Kabir, F., Rizvi, A., Aziz, F., Kalam, A., Qureshi, S., Shakoor, S., Turab, A., Soofi, S., Bhutta, Z. A., Iqbal, N. (2020). Epidemiology of shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings. PLOS Neglected Tropical Diseases, 14(8), e0008536.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/930