Shigella Lawyer & Attorney : Marler Clark : Shigella Blog

The Allegheny County Health Department today reported that a growing number of county residents are being diagnosed with a diarrheal illness known as shigellosis.

A news release said 60 shigellosis cases have been reported countywide since October -- 34 so far this year -- compared to just 12 cases of the disease in all of 2008 and five in 2007. Nearly half of the 60 cases were children 5 or younger and about one-third of the cases had contact with a family member or someone in a school or day care center who had diarrheal illness.

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Risk Factors for Sporadic Shigellosis, FoodNet 2005

Clinton C. Haley, Kanyin L. Ong, Katrina Hedberg, Paul R. Cieslak, Elaine Scallan, Ruthanne Marcus, Sanghyuk Shin, Alicia Cronquist, Jennifer Gillespie, Timothy F. Jones, Beletshachew Shiferaw, Candace Fuller, Karen Edge, Shelley M. Zansky, Patricia A. Ryan, Robert M. Hoekstra, Eric Mintz.

Foodborne Pathogens and Disease Abstract

Background: An estimated 450,000 cases of shigellosis occur annually in the United States. Outbreaks have been associated with food, water, child daycare centers, and men who have sex with men. However, for sporadic infections, which account for the majority of cases, risk exposures are poorly characterized.

Methods: Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, laboratory-based shigellosis surveillance in 10 US sites. We interviewed cases with illness onset during 2005 about exposures during the week before symptom onset using a standardized questionnaire. The proportion of patients who denied nonfood risks was used to estimate the burden attributable to foodborne transmission.

Results: Overall, 1494 cases were identified. The approximate incidence was 3.9/100,000, with the highest rates among children aged 1–4 years (16.4) and Hispanics (8.4). Of the 929 cases interviewed, 223 (24%) reported international travel in the week before symptom onset. Of the 626 nontraveling cases with complete risk factor information, 298 (48%) reported exposure to daycare or a household member with diarrhea; 99 (16%) reported drinking untreated water or recreational exposure to water; and 16 (3%) reported sexual contact with a person with diarrhea. Two hundred and fifty-nine (41%) denied all nonfood exposures examined.

Conclusions: Sporadic shigellosis is most common among young children and Hispanics. Common exposures include international travel and contact with ill persons or daycare. However, more than one-third of US shigellosis cases annually might be due to food consumed in the United States.

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About Shigella and its companion Shigella Blog were updated once again after extensive revisions by experts in the field and the staff and lawyers at Marler Clark, LLP PS, the only law firm in the United States that focuses its entire practice on foodborne illness litigation.

Shigella is a family of bacteria that can cause sudden and severe diarrhea (gastroenteritis) in humans. Shigellosis – the illness caused by the ingestion of Shigella bacteria – is also known as bacillary dysentery. It can occur after ingestion of fewer than 100 bacteria, making Shigella one of the most communicable and severe forms of the bacterial-induced diarrheas.

Shigella thrives in the human intestine and is commonly spread both through food and by person-to-person contact. Most Shigella infections are passed through the fecal-oral route. This happens when basic hygiene and handwashing habits are inadequate and can happen during certain types of sexual activity. Transmission is particularly likely to occur among toddlers who are not fully toilet-trained. Family members and playmates of such children are at high risk of becoming infected.

Food may become contaminated by infected food handlers who don’t wash their hands with soap after using the bathroom. Vegetables can become contaminated if they are harvested from a field with sewage in it. Flies can breed in infected feces and then contaminate food.

Water may become contaminated with Shigella bacteria if sewage goes into it or if someone with shigellosis swims in or plays with the water (especially in splash tables, untreated wading pools, or shallow play fountains used by daycare centers). Shigella infections can then be acquired by drinking, swimming in, or playing with the contaminated water.

The number of shigellosis cases reported annually to the Centers for Disease Control and Prevention (CDC) has varied over the past several years, from more than 17,000 during 1978–2003, to an all-time low of 14,000 in 2004, to almost 20,000 in 2007. Many cases go undiagnosed and/or unreported, however. The CDC estimates that 450,000 total cases of shigellosis occur in the U.S. every year.

Shigella is the third most common pathogen transmitted through food. During 2006, a total of 1,270 foodborne-related outbreaks from 48 states in the U.S. were reported. Although Shigella was responsible for only 10 (1%) of those outbreaks, 183 confirmed cases of shigellosis were reported. This contrasts with an average of 659 cases annually in the previous five years. Shigella has also responsible for a substantial portion of foodborne outbreaks on cruise ships.

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According to the Post-Dispatch, for the second time in two months, St. Louis city health officials have issued an alert about outbreaks of highly contagious intestinal bacteria that are usually spread by children.

There have been 148 cases of shigellosis in 2009, compared with 11 cases by this date last year, according to the St. Louis City Department of Health. Missouri reports 647 cases this year compared with the yearly average of 604. Illinois has not reported any shigellosis outbreaks this year.

Shigellosis infection is marked by fever, stomach cramps and diarrhea that can be bloody. Most infections resolve without treatment within a week, although antibiotics may be effective in treating severe cases.

Most of the illnesses are linked to day-care centers and schools, health officials reported. Children ages 4 and younger are most commonly infected.

Shigella can live in feces and is typically spread when people don't wash their hands properly after using the bathroom or changing diapers.

Health officials recommend washing hands frequently and thoroughly with warm water and soap. Children should be supervised when washing hands. Disinfecting toys, eating surfaces and toilets or diaper changing areas can also help prevent the spread of the bacteria.

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Enforcing simple hygiene strategies in childcare centers can help limit Shigellosis transmission and may combat growing antimicrobial-resistance patterns among these organisms, according to CDC and Missouri State Department of Health and Senior Services officials who investigated a Shigella sonnei outbreak that affected 693 people and spanned 44 licensed daycare facilities in northwest Missouri from May to October 2005.

Surveillance data revealed that 300 of the 639 people who became ill reported childcare-center exposure, with 176 patients reporting either employment or attendance at a childcare center, and 112 reporting household contact with a childcare-center employee or attendee.

Childcare centers that lacked a hand-washing station in every room, and those that enrolled diapered children without providing a diapering station in every room were at greater risk for spreading the disease among attendees, according to a case-control comparison.

Current state regulations do not permit the use of alcohol-based hand sanitizers in Missouri childccare centers, according to the researchers, despite evidence that these products can decrease enteric illness and complement hand-washing policies.

Several additional Missouri health requirements also have officials concerned. School exclusion policies require two consecutive negative cultures for children to return to childcare, rather than a single negative culture or symptom resolution. The researchers believe this policy may “implicitly encourage antimicrobial treatment in children who attend daycare centers and may result in unnecessary adverse drug events in children and increase antimicrobial resistance among enteric and respiratory pathogens.”

Among the 31 outbreak isolates tested for antimicrobial susceptibility, 95% were resistant to ampicillin, 90% were resistant to trimethroprim-sulfamethoxazole (TMP/SMX) and 90% were resistant to both antibiotics — the two most commonly recommended for empiric treatment in children until recently.

During this outbreak azithromycin was used most often, administered to 44% (n=92) of the 210 children aged 18 or younger who were prescribed an antibiotic. Cephalosporin was the next most commonly prescribed (27%, n=57), followed by fluoroquinolones (5%, n=11), ampicillin (2%, n=3) and an unknown antimicrobial (7%, n=15).

“Given the current frequency of resistance to ampicillin and trimethroprim sulfamethoxazole among S. sonnei strains, the uncertain safety of administering fluoroquinolones to children, the difficulties in monitoring azithromycin resistance and the lack of an appropriate vaccine, public health measures should focus on prevention of shigellosis outbreaks through appropriate hygiene practices and, where possible and allowed by state regulations cohorting convalescing children in daycare centers,” the researchers wrote.

Arvelo W. Pediatr Infect Dis J. 2009;28:976-980.

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An émigré scientist from the former Soviet Union is working to develop a new treatment for diarrhea based on a century-old remedy commonly used in his former homeland. Alexander Sulakvelidze, chief scientist for privately held Baltimore biotech Intralytix, says the bacteriophage-based probiotic preparation shows promise for managing shigella infections, a "significant worldwide cause of diarrheal disease" — and apparently the U.S. Army agrees. Bacteriophages — highly specific viruses that infect bacteria — may be used to target "problem" bacterial species in the human gastrointestinal tract, according to Sulakvelidze.

The company recently received a $100,000 phase 1 Small Business Technology Transfer grant from the Pentagon to develop the treatment, an alternative to antibiotics. Shigella are "major gastrointestinal tract pathogens of particular concern" to the Army because U.S. troops are often stationed in countries where the disease is widespread, said Sulakvelidze, the company's principal investigator for the contract, in a statement.

There are about 164.7 million cases of shigellosis worldwide, almost entirely in developing nations, according to the World Health Organization. About half a million visitors from industrialized nations to developing nations contract the infection annually, and about 1.1 million people die from it each year, 61 percent of whom are children younger than 5. There is no vaccine for shigellosis, and some strains of it have developed resistance to antibiotics, according to the federal Centers for Disease Control and Prevention.
 

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St. Louis city health officials on Wednesday reported a sharp increase in cases of a highly contagious intestinal bacteria that is typically spread by children.  There have been 67 cases of shigellosis from July 1 through Monday, compared to nine cases for all of 2008, according to the St. Louis City Department of Health.

Health officials said four day care centers and one school clustered in south St. Louis city reported illnesses. Officials did not offer other specifics except to say that children ages 4 and younger are most commonly infected.

Shigellosis infection is marked by fever, stomach cramps and diarrhea that can be bloody.  Most infections resolve without treatment within a week. Some antibiotics may be effective in treating more severe cases, although health officials warned that specimens from the St. Louis cases were shown in labs to be resistant to two antibiotics, trimethoprim-sulfamethoxazole and ampicillin.

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NIH has awarded a group of researchers $2.87 million for preclinical development of an oral drug to treat C. difficile and Shigella.

The consortium is led by Brigham Young University (BYU) and includes SRI International, Southwest Research Institute (SwRI), and McMaster University. CSA-13 is based on Ceragenin™ technology, which is a class of antimicrobial compounds that mimic functions of the body’s own innate immune system.

The technology was invented by Paul B. Savage, Ph.D., Reed Izatt professor at BYU, and was exclusively licensed to Ceragenix. The company is using the Ceragenin platform to formulate Cerashield™ antimicrobial coatings for medical devices. In March the firm reported that the NIH had granted the University of Utah $1.66 million to evaluate a Cerashield coating to reduce orthopedic implant infections.

“We are very pleased that the NIH sees potential in our technology as an oral drug to treat these dangerous infections,” says Steve Porter, chairman and CEO of Ceragenix. “We believe that the NIH funded research activities will be synergistic with our development efforts on antimicrobial medical device coatings.”

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Thirty people have died in Papua New Guinea (PNG) from the severe form of dysentery called Shigella that has infected 700 others.

While PNG’s limited health system is dealing with Shigella, to the north in Wasu, 13 people have died amid the country's first outbreak of cholera and 200 others have contracted the water-borne disease.

PNG health officials are combating simultaneous outbreaks of the Flu, Shigella, and Cholera.

All totaled 120 people are dead and the diseases, mostly in the Morobe province on the country’s north coast, have infected thousands.

It is Papua New Guinea's first cholera outbreak and medics fear the situation will get much worse before it gets better.

Radio New Zealand is monitoring this medical emergency.

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