학술논문
Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings.
Document Type
article
Author
Elizabeth T Rogawski McQuade; Fariha Shaheen; Furqan Kabir; Arjumand Rizvi; James A Platts-Mills; Fatima Aziz; Adil Kalam; Shahida Qureshi; Sarah Elwood; Jie Liu; Aldo A M Lima; Gagandeep Kang; Pascal Bessong; Amidou Samie; Rashidul Haque; Estomih R Mduma; Margaret N Kosek; Sanjaya Shrestha; Jose Paulo Leite; Ladaporn Bodhidatta; Nicola Page; Ireen Kiwelu; Sadia Shakoor; Ali Turab; Sajid Bashir Soofi; Tahmeed Ahmed; Eric R Houpt; Zulfiqar Bhutta; Najeeha Talat Iqbal
Source
PLoS Neglected Tropical Diseases, Vol 14, Iss 8, p e0008536 (2020)
Subject
Language
English
ISSN
1935-2727
1935-2735
1935-2735
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 (