Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/45674
Title: Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 lowresource settings
Authors: McQuade, Elizabeth T. Rogawski
Shaheen, Fariha
Kabir, Furqan
Rizvi, Arjumand
Platts-Mills, James A.
Aziz, Fatima
Kalam, Adil
Qureshi, Shahida
Elwood, Sarah
Liu, Jie
Lima, Aldo A. M.
Kang, Gagandeep
Bessong, Pascal
Samie, Amidou
Haque, Rashidul
Mduma, Estomih R.
Kosek, Margaret N.
Shrestha, Sanjaya
Leite, José Paulo G.
Bodhidatta, Ladaporn
Page, Nicola
Kiwelu, Ireen
Shakoor, Sadia
Turab, Ali
Soofi, Sajid Bashir
Ahmed, Tahmeed
Houpt, Eric R.
Bhutta, Zulfiqar
Iqbal, Najeeha Talat
Affilliation: Department of Public Health Sciences, University of Virginia. Charlottesville, Virginia, USA / Division of Infectious Diseases & International Health. University of Virginia. Charlottesville, Virginia, USA.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Division of Infectious Diseases & International Health. University of Virginia. Charlottesville, Virginia, USA.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Division of Infectious Diseases & International Health. University of Virginia. Charlottesville, Virginia, USA.
Division of Infectious Diseases & International Health. University of Virginia. Charlottesville, Virginia, USA.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
Christian Medical College. Vellore, India.
University of Venda. Thohoyandou, South Africa.
University of Venda. Thohoyandou, South Africa.
International Centre for Diarrheal Disease Research. Bangladesh, Dhaka, Bangladesh.
Haydom Global Health Research Centre. Haydom, Tanzania.
Division of Infectious Diseases & International Health. University of Virginia. Charlottesville, Virginia, USA / Asociación Benéfica PRISMA. Iquitos, Peru.
Walter Reed/AFRIMS Research Unit, Nepal. Kathmandu, Nepal.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Armed Forces Research Institute of Medical Sciences (AFRIMS. Bangkok, Thailand.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Kilimanjaro Clinical Research Institute. Moshi, Tanzania.
Department of Pathology and Laboratory Medicine. Aga Khan University. Karachi, Pakistan.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
International Centre for Diarrheal Disease Research. Bangladesh, Dhaka, Bangladesh.
Division of Infectious Diseases & International Health. University of Virginia. Charlottesville, Virginia, USA.
Department of Pediatrics and Child Health. Aga Khan University. Karachi, Pakistan.
Department of Pediatrics and Child Health and Biological & Biomedical Sciences. Aga Khan University. Karachi, Pakistan.
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.
Keywords: Epidemiology
Shigella infections
Diarrhea
Children
Diagnostics
keywords: Epídemiologia
Diarréia infantil
Infecções por Shigella
Diagnóstico
Issue Date: 2020
Publisher: Public Library of Science
Citation: McQuade, Elizabeth T Rogawski et al. Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 lowresource settings. Plos Negl Trop Dis., v. 14, n. 8, e0008536, 17p, Aug. 2020.
DOI: 10.1371/ journal.pntd.0008536
ISSN: 1935-2727
Copyright: open access
Appears in Collections:IOC - Artigos de Periódicos
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