title: Systemic shigellosis in South Africa.
abstract: BACKGROUND
  Systemic disease due to shigellae is associated with human immunodeficiency virus (HIV), malnutrition, and other immunosuppressed states. We examined the clinical and microbiologic characteristics of systemic shigellosis in South Africa, where rates of HIV infection are high.
  
  
  METHODS
  From 2003 to 2009, 429 cases of invasive shigellosis were identified through national laboratory-based surveillance. At selected sites, additional information was captured on HIV serostatus and outcome. Isolates were serotyped and antimicrobial susceptibility testing performed.
  
  
  RESULTS
  Most cases of systemic shigellosis were diagnosed on blood culture (408 of 429 cases; 95%). HIV prevalence was 67% (80 of 120 cases), highest in patients aged 5-54 years, and higher among females (55 of 70 cases; 79%) compared with males (25 of 48 cases; 52%; P = .002). HIV-infected people were 4.1 times more likely to die than HIV-uninfected cases (case-fatality ratio, 29 of 78 HIV-infected people [37%] vs 5 of 40 HIV-uninfected people [13%]; P = .008; 95% confidence interval [CI], 1.5-11.8). The commonest serotype was Shigella flexneri 2a (89 of 292 serotypes [30.5%]). Pentavalent resistance occurred in 120 of 292 isolates (41.1%). There was no difference in multidrug resistance between HIV-infected patients (33 of 71 [46%]) and uninfected patients (12 of 33 [36%]; 95% CI, .65--3.55).
  
  
  CONCLUSIONS
  Systemic shigellosis is associated with HIV-infected patients, primarily in older girls and women, potentially due to the burden of caring for sick children in the home; interventions need to be targeted here. Death rates are higher in HIV-infected versus uninfected individuals.
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. karenk@nicd.ac.za
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.forename: Arvinda
authors.initials: A
authors.lastname: Sooka
authors.forename: Penny
authors.initials: P
authors.lastname: Crowther-Gibson
authors.forename: Vanessa
authors.initials: V
authors.lastname: Quan
authors.forename: Susan
authors.initials: S
authors.lastname: Meiring
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.forename: Trusha
authors.initials: T
authors.lastname: Nana
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sriruttan
authors.forename: Sharona
authors.initials: S
authors.lastname: Seetharam
authors.forename: Anwar
authors.initials: A
authors.lastname: Hoosen
authors.forename: Preneshni
authors.initials: P
authors.lastname: Naicker
authors.forename: Eugenne
authors.initials: E
authors.lastname: Elliott
authors.forename: Sumayya
authors.initials: S
authors.lastname: Haffejee
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012760:Shigella / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents