title: Epidemic Shigella dysenteriae type 1 in Burundi: panresistance and implications for prevention.
abstract: An epidemic of Shigella dysenteriae type 1 infections has affected Africa since 1979. Reported dysentery cases increase sharply in Burundi during September through December. Of stool samples from 189 patients reporting bloody diarrhea in November 1990, a pathogen was identified in 123 (65%). The pathogen was S. dysenteriae type 1 in 82 (67%). All S. dysenteriae type 1 isolates were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Thirty-two specimens (26%) yielded other Shigella species. Patients with S. dysenteriae type 1 were more likely than those with other Shigella infections to have abdominal pain, "lots of blood" in the stool, blood in the stool specimen examined by the interviewer, recent contact with a person with dysentery, or recent antimicrobial treatment. Thus, the seasonal increase in dysentery was due largely to multidrug-resistant S. dysenteriae type 1, clinical and epidemiologic features may predict such infection, and efforts to control this epidemic must focus on preventing transmission.
authors.affiliation: Foodborne and Diarrheal Diseases Branches, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: A A
authors.initials: AA
authors.lastname: Ries
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
authors.forename: D
authors.initials: D
authors.lastname: Olivola
authors.forename: M
authors.initials: M
authors.lastname: Ntakibirora
authors.forename: S
authors.initials: S
authors.lastname: Nyandwi
authors.forename: M
authors.initials: M
authors.lastname: Ntibakivayo
authors.forename: C B
authors.initials: CB
authors.lastname: Ivey
authors.forename: K D
authors.initials: KD
authors.lastname: Greene
authors.forename: F C
authors.initials: FC
authors.lastname: Tenover
authors.forename: S P
authors.initials: SP
authors.lastname: Wahlquist
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002063:Burundi / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012621:Seasons; D012762:Shigella dysenteriae / Q000145:classification / Q000187:drug effects