Evidence for re-infection and persistent carriage of Shigella species in adult males reporting domestically acquired infection in England
Evidence for re-infection and persistent carriage of Shigella species in adult males reporting domestically acquired infection in England
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DOI：
10.1016/j.cmi.2020.03.036
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发表时间：
2021-01-01
影响因子：
14.2
通讯作者：
Jenkins, C.
中科院分区：
文献类型：
--
作者：
Allen, H.;Mitchell, H. D.;Jenkins, C.
目的：我们分析了从国内获得性感染的成年男性（主要由男性与男性发生性关系（MSM）组成的队列）中分离的志贺菌的国家监测分型数据，以确定随着时间的推移，来自同一个人的多个菌株是否代表持续携带或再感染。福氏志贺菌和志贺菌多次分离之间的中位时间间隔。索尼进行了比较。全基因组测序数据的分析提供了单核苷酸水平上的菌株区分，并用于量化分离株之间的遗传距离。构建最大似然系统发育分析，以确定持续携带（以同一菌株的多次分离为特征）或再感染（以不同菌株的多次分离为特征）是否得到系统发育分析的最佳支持。使用与成年女性与国内获得的志贺氏菌ligellosus.Results的数据进行比较分析：报告志贺氏菌多种分离的男性人数为165/4733（3.5%），而女性为31/2423（1.3%）（p < 0.001）。对于来自持续携带相关男性的分离株对，分离时间间隔范围为6-176天（中位数23.5; IQR 8-70），单核苷酸多态性（SNP）距离范围为0-7个SNP（中位数0.5; IQR 0-2）。对于那些与再感染，隔离时间间隔为34-2636天（中位数732; IQR 191-1258）和SNP距离为10-1462 SNPs（中位数120; IQR 29-377）。在感染的急性期之后，携带可以持续数月，并且感染可以在数月内复发，即使是属于相同物种和相同血清型的菌株。多个性伴侣、感染急性期后持续携带以及反复再感染的证据相结合，很可能导致这一人群中的持续传播。Crown版权所有（C）2020由Elsevier Ltd代表欧洲临床微生物学和传染病学会发布。All rights reserved.
Objectives: We analysed national surveillance typing data of Shigella isolated from adult males with domestically acquired infection (a cohort largely consisting of men who have sex with men (MSM)) to establish whether multiple isolates from the same individual over time represented persistent carriage or re-infection.Methods: We carried out a retrospective cohort study of adult males diagnosed with Shigella from 2004 to 2018. Median time intervals between multiple isolations of Shigella flexneri and S. sonnei were compared. Analysis of whole genome sequencing data provided strain discrimination at the single nucleotide level and was used to quantify the genetic distance among isolates. Maximum likelihood phylogenies were constructed to determine whether persistent carriage (characterized by multiple isolations of the same strain) or re-infection (characterized by multiple isolations of different strains) was best supported by the phylogenetic analysis. A comparison analysis was carried out using data linked to adult females with domestically acquired shigellosis.Results: The number of men reporting multiple isolations of Shigella species was 165/4733 (3.5%) compared with 31/2423 (1.3%) females (p < 0.001). For isolate pairs from men associated with persistent carriage, the isolation time interval range was 6-176 days (median 23.5; IQR 8-70) and single nucleotide polymorphism (SNP) distance range was 0-7 SNPs (median 0.5; IQR 0-2). For those associated with reinfection, the isolation time interval was 34-2636 days (median 732; IQR 191-1258) and the SNP distance was 10-1462 SNPs (median 120; IQR 29-377).Discussion: Multiple Shigella isolations in individuals with domestically acquired infections was more frequently observed in adult males than in adult females. Following the acute phase of infection, carriage can persist for months, and infection can recur within months, even with strains belonging to the same species and the same serotype. A combination of multiple sexual partners, persistent carriage following the acute phase of infection and evidence of recurrent re-infection is likely to contribute to sustained transmission in this population. Crown Copyright (C) 2020 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.