Epidemiology of shigellosis among children exposed to cases Shigella dysentery: A multivariate assessment
Epidemiology of shigellosis among children exposed to cases Shigella dysentery: A multivariate assessment
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DOI：
10.4269/ajtmh.1997.56.258
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发表时间：
1997-03-01
影响因子：
3.3
通讯作者：
Haque, E
中科院分区：
文献类型：
--
作者：
Ahmed, F;Clemens, JD;Haque, E
我们跟踪了1,756名5岁以下的孟加拉国农村儿童，在他们的社区发现志贺氏菌哨兵患者后一个月。219名（12%）儿童发生志贺氏菌腹泻（志贺氏菌病），227名（13%）儿童发生培养阴性痢疾。福氏志贺菌（60%）和志贺菌（60%）;志贺菌病以1型沙门氏菌（15%）最常见。在个别社区内，从哨点患者和监测期间检测到的其他病例中分离出的志贺菌种类之间的一致性较差（Kappa = 0.21）。婴儿期后志贺氏菌病的风险大幅增加，并在生命的第二年达到高峰。根据年龄别身高评估，严重发育迟缓与志贺氏菌病风险增加相关（校正比值比[ORa] = 1.67，95%置信区间[CI] = 1.09-2.57，P < 0.05），而母乳喂养与此相关（ORa = 0.40，95% CI = 0.24-0.69，P < 0.001）。只有43%的志贺菌病病例报告血便; 1感染率高于S.福氏杆菌感染（ORa = 5.04，95% CI = 1.76-14.48，P < 0.01），并与严重发育迟缓相关（ORa = 2.16，95% CI = 1.01-4.58，P < 0.05）。我们的研究结果表明，在孟加拉国儿童的高风险的志贺菌感染的结果，多个志贺菌菌株同时在同一个街区内循环;表明，风险显着修改主机的年龄，营养状况和饮食模式：并说明，痢疾的经典图片是相对罕见的，是与感染的物种和主机的营养状况。
We followed 1,756 young, rural Bangladeshi children less than five years of age for one month after identification of sentinel Shigella patients in their neighborhoods. Two hundred nineteen (12%) children developed Shigella diarrhea (shigellosis) and 227 (13%) developed culture-negative dysentery. Shigella flexneri (60%) and S. dysenteriae, type 1 (15%) were the most common isolates among shigellosis cases. Within individual neighborhoods, there was poor agreement (Kappa = 0.21) between Shigella species isolated from sentinel patients and from additional cases detected during surveillance. The risk of shigellosis increased substantially after infancy and peaked in the second year of life. Severe stunting, as assessed by height-for-age, was associated with an increased risk of shigellosis (adjusted odds ratio [ORa] = 1.67, 95% confidence interval [CI] = 1.09-2.57, P < 0.05), while breast-feeding was protectively associated (ORa = 0.40, 95% CI = 0.24-0.69, P < 0.001). Only 43% of the shigellosis cases reported bloody stools; frank dysentery occurred more frequently in S. dysenteriae 1 infections than in S. flexneri infections (ORa = 5.04, 95% CI = 1.76-14.48, P < 0.01), and was also associated with severe stunting (ORa = 2.16, 95% CI = 1.01-4.58, P < 0.05). Our findings show that the high risk of shigellosis in residentially exposed Bangladeshi children results from multiple Shigella strains circulating concurrently within the same neighborhood; demonstrate that the risk is notably modified by host age, nutritional status, and dietary patterns: and illustrate that the classic picture of dysentery is relatively infrequent and is correlated with the infecting species and with host nutritional status.