title: A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation.
abstract: 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.
authors.affiliation: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. vinhh@oucru.org
authors.forename: Ha
authors.initials: H
authors.lastname: Vinh
authors.forename: Nguyen Thi Khanh
authors.initials: NT
authors.lastname: Nhu
authors.forename: Tran Vu Thieu
authors.initials: TV
authors.lastname: Nga
authors.forename: Pham Thanh
authors.initials: PT
authors.lastname: Duy
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Nguyen Van Minh
authors.initials: NV
authors.lastname: Hoang
authors.forename: Maciej F
authors.initials: MF
authors.lastname: Boni
authors.forename: Phan Vu Tra
authors.initials: PV
authors.lastname: My
authors.forename: Christopher
authors.initials: C
authors.lastname: Parry
authors.forename: Tran Thi Thu
authors.initials: TT
authors.lastname: Nga
authors.forename: Pham
authors.initials: P
authors.lastname: Van Minh
authors.forename: Cao Thu
authors.initials: CT
authors.lastname: Thuy
authors.forename: To Song
authors.initials: TS
authors.lastname: Diep
authors.forename: Le Thi
authors.initials: le T
authors.lastname: Phuong
authors.forename: Mai Thu
authors.initials: MT
authors.lastname: Chinh
authors.forename: Ha Thi
authors.initials: HT
authors.lastname: Loan
authors.forename: Nguyen Thi Hong
authors.initials: NT
authors.lastname: Tham
authors.forename: Mai Ngoc
authors.initials: MN
authors.lastname: Lanh
authors.forename: Bui Li
authors.initials: BL
authors.lastname: Mong
authors.forename: Vo Thi Cuc
authors.initials: VT
authors.lastname: Anh
authors.forename: Phan Van Be
authors.initials: PV
authors.lastname: Bay
authors.forename: Nguyen Van Vinh
authors.initials: NV
authors.lastname: Chau
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: 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