Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children.
Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case-control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28-0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24-35 months of age (OR = 8.2, 95% CI = 4.3-15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3-23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Brianna
B
Lindsay
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Debasish
D
Saha
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Doh
D
Sanogo
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Sumon Kumar
SK
Das
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Richard
R
Omore
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Tamer H
TH
Farag
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Dilruba
D
Nasrin
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Shan
S
Li
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Sandra
S
Panchalingam
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Myron M
MM
Levine
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Karen
K
Kotloff
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
James P
JP
Nataro
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Laurence
L
Magder
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Laura
L
Hungerford
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
A S G
AS
Faruque
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Joseph
J
Oundo
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
M Anowar
MA
Hossain
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
Mitchell
M
Adeyemi
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh ostin001@umaryland.edu.
Oscar Colin
OC
Stine
D017954:Africa South of the Sahara / Q000453:epidemiology; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D004405:Dysentery, Bacillary / Q000150:complications* / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012760:Shigella / Q000302:isolation & purification*