CDC warns of rise in nearly incurable Shigella bacterial infections

The Centers for Disease Control and Prevention warns of a rise in extensively drug-resistant Shigella bacterial infection, which is a leading cause of inflammatory diarrhea.

The agency is calling a new form of E. coli that causes diarrhea known as shigellosis a “serious public health threat.” Evidence suggests that the disease is spreading among gay and bisexual men in particular, apparently through sexual contact both in the US and abroad.

On Tuesday, the CDC held a phone call with the Colorado Department of Public Health and the Environment and the UK Health Safety Agency to alert doctors to the spread of a form of the bacterium that is resistant to all commonly recommended antibiotics.

“We don’t have all the answers today,” Dr. Louise. François Watkins, a medical officer at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said over the phone. The agency cannot make official recommendations on alternatives to antibiotics, she said.

The parallel ongoing outbreak of nearly 200 recent cases of extensively drug-resistant shigella in the UK, which the UK health agency announced last month, was most likely caused by a single initial infection, British health officials said by telephone on Tuesday. This highlights how widely individual drug-resistant strains of infection can spread and the importance of infection control.

The CDC said in Friday’s health alert that the proportion of approximately 450,000 annual US shigella cases resistant to all known antibiotic treatments rose from zero in 2015 to 0.4% in 2019 and to 5% last year. , which is indicative of potentially greater distribution.

Shigella, which is highly contagious, is spread by ingesting infected feces into the mouth or nose, including through sexual activity or poor handwashing after changing diapers, unhygienic food handling, or swimming in contaminated water. The infection is usually seen in young children.

On Friday, the European Center for Disease Prevention and Control issued an alert of 221 confirmed and 37 possible cases among people who have traveled to Cape Verde off the coast of West Africa since September and returned home to about a dozen countries, including the US.

During a CDC call on Tuesday, UK health agency officials said they had analyzed all but four of the 185 cases of infection in the UK since the last day. 2021. Half require antibiotic treatment. Shigella samples remained sensitive to four antibiotics: carbapenems, chloramphenicol, fosfomycin, and temocillin.

Eighty-seven percent of the cases were in men alleged to have had sex with men.

Dr. Stephanie Cohen, director of HIV and STI prevention at the San Francisco Department of Public Health, told NBC News that shigella is “a really important and serious pathogen.”

“It can cause very severe diarrhea, sometimes bloody diarrhea, cramping and abdominal pain,” she said.

Shigellosis usually goes away without treatment. But doctors may prescribe antibiotics to speed up recovery or otherwise prevent complications in more vulnerable patients.

The infection can cause a long and debilitating illness, with about 6,400 patients in the US requiring hospitalization each year.

Death from shigellosis is rare, although it is more likely among people who are immunocompromised, such as from untreated HIV or cancer chemotherapy.

Shigella is considered extensively drug resistant if it is not susceptible to any of the recommended first-line or alternative antibiotics, including azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin.

From May 2014 to February 2015, the CDC identified 243 cases of travel-associated shigella in the US that were resistant to most, but not all, of these antibiotics.

Doctors now face the daunting task of caring for patients with this form of shigella. Examining an extensive list of potential antibiotic alternatives on Tuesday, Watkins noted that the drugs are heavily burdened by one or more restrictions, such as unavailability in the US, lack of clinical trial data, resistance to a pathogen, or the fact that they are ingested. the intestinal mucosa is poorly developed.

The CDC urged health care providers to be vigilant for potential Shigella infections and report suspected cases to state and local health departments while educating people most at risk of shigella infection.

In addition to gay and bisexual men, antibiotic-resistant shigella infections are on the rise among the homeless, international travelers, and people living with HIV.

Of the 232 cases reported from 2016 onwards for which CDC data is available, 197, or 85%, were in men. The child had only one. Of the 41 people who answered questions about recent sexual activity, 88% were men reporting recent sexual contact with men.

Meanwhile, in recent years, the incidence of gonorrhea, chlamydia and syphilis, sexually transmitted diseases, has been steadily increasing, and they are especially common among gay and bisexual men. The CDC is issuing increasingly urgent warnings that gonorrhea risks losing susceptibility to the last remaining simple and effective antibiotic to treat the infection.

Enterobacteriaceae contains over a hundred species including Shigella, Klebsiella, Salmonella and Escherichia coli.
The Enterobacteriaceae include over a hundred species including Shigella, Klebsiella, Salmonella and Escherichia coli.Stephanie Rossow/Science Photo Library via Getty Images

The CDC advises people who have shigellosis to stay at home if they work in healthcare, food service, or childcare. The agency also advises people during illness and for two weeks afterward to avoid cooking for others, wash their hands frequently, refrain from swimming, and abstain from sexual intercourse, or at least practice strict hygiene before and after sexual activity.

The World Health Organization lists drug-resistant pathogens, which are largely caused by the misuse and overuse of antibiotics in humans and livestock, as one of the top 10 global public health threats facing humanity.

“Clinical development, drugs that are being tested in humans are fragile and not enough,” said Kevin Autterson, executive director of CARB-X, a Boston-based nonprofit group that seeks to drive innovation in early antibiotic research. and development.

There are encouraging signs in antibiotic development, at least in the early stages, Autterson said.

“If you need a drug that will work against this disease or any other bacteria in 2033, we have to work on it today,” he said.

The new shigella is of concern due to a global outbreak of smallpox (formerly monkeypox), which is overwhelmingly spread through sexual contact between men. Cases of the virus, first identified in the UK in mid-May, peaked in the US and worldwide in early August and have largely subsided.

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