A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation.
BACKGROUND
Shigellosis remains considerable public health problem in some developing countries. The nature of Shigellae suggests that they are highly adaptable when placed under selective pressure in a human population. This is demonstrated by variation and fluctuations in serotypes and antimicrobial resistance profile of organisms circulating in differing setting in endemic locations. Antimicrobial resistance in the genus Shigella is a constant threat, with reports of organisms in Asia being resistant to multiple antimicrobials and new generation therapies.


METHODS
Here we compare microbiological, clinical and epidemiological data from patients with shigellosis over three different periods in southern Vietnam spanning 14 years.


RESULTS
Our data demonstrates a shift in dominant infecting species (S. flexneri to S. sonnei) and resistance profile of the organisms circulating in southern Vietnam. We find that there was no significant variation in the syndromes associated with either S. sonnei or S. flexneri, yet the clinical features of the disease are more severe in later observations.


CONCLUSIONS
Our findings show a change in clinical presentation of shigellosis in this setting, as the disease may be now more pronounced, this is concurrent with a change in antimicrobial resistance profile. These data highlight the socio-economic development of southern Vietnam and should guide future vaccine development and deployment strategies.


BACKGROUND
Current Controlled Trials ISRCTN55945881.
Vinh
Ha
H
The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. vinhh@oucru.org
Nhu
Nguyen Thi Khanh
NT
Nga
Tran Vu Thieu
TV
Duy
Pham Thanh
PT
Campbell
James I
JI
Hoang
Nguyen Van Minh
NV
Boni
Maciej F
MF
My
Phan Vu Tra
PV
Parry
Christopher
C
Nga
Tran Thi Thu
TT
Van Minh
Pham
P
Thuy
Cao Thu
CT
Diep
To Song
TS
Phuong
Le Thi
le T
Chinh
Mai Thu
MT
Loan
Ha Thi
HT
Tham
Nguyen Thi Hong
NT
Lanh
Mai Ngoc
MN
Mong
Bui Li
BL
Anh
Vo Thi Cuc
VT
Bay
Phan Van Be
PV
Chau
Nguyen Van Vinh
NV
Farrar
Jeremy
J
Baker
Stephen
S
D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D012621:Seasons; D012703:Serotyping; D012763:Shigella flexneri / Q000145:classification / Q000187:drug effects / Q000472:pathogenicity; D012764:Shigella sonnei / Q000145:classification / Q000187:drug effects / Q000472:pathogenicity; D014744:Vietnam / Q000453:epidemiology