Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Abstract

Introduction: Diarrhoea remains a major cause of illness in Papua New Guinea (PNG); however, little is known about its aetiology. As a result of the cholera outbreak that spread throughout PNG in 2009-2011, we conducted diarrhoeal surveillance in Eastern Highlands Province. Methodology: Following informed consent and a brief questionnaire, participants provided a stool sample or duplicate rectal swabs. Samples were tested for common bacterial pathogens Salmonella spp., Shigella spp., Vibrio spp., Campylobacter spp. and Yersinia enterocolitica using established culture methods. Enteric parasites were detected using microscopy. Results: A total of 216 participants were enrolled; where age was recorded, 42% were under 5 years of age, 6.7% were 5 to 17 years of age and 51.3% ≥18 years of age. One or more pathogens were detected in 68 (31.5%) participants, with Shigella (primarily S. flexneri) being the most commonly isolated (47 of 216 participants). Enteric parasites were detected in 23 of the 216 participants, occurring as a co-infection with another pathogen in 12 of 23 cases. No Vibrio cholerae was detected. Shigella isolates were commonly resistant to ampicillin, tetracycline, co-trimoxazole and chloramphenicol. Conclusions: Shigellae, specifically S. flexneri, are important pathogens in the highlands of PNG. While most studies in low-income settings focus on childhood aetiology, we have demonstrated the importance of Shigella in both children and adults. Enteric parasites remain present and presumably contribute to the burden of gastrointestinal illness. While improvements in sanitation and hygiene would help lower the burden of all aetiologies of infectious diarrhoea, additional control strategies targeting Shigella may also be warranted.

Detection of enteric viral and bacterial pathogens associated with paediatric diarrhoea in Goroka, Papua New Guinea

“…These results support our recently published findings in the same setting investigating the prevalence and epidemiology of rotavirus in children, 6 and the high prevalence of Shigella detected by culture in adults and children seeking outpatient medical assistance. 9 The findings are also consistent with global trends, with a recent multicentre case-controlled study finding Shigella, rotavirus, and ETEC to be commonly associated with moderate to severe childhood diarrhoea. 10 We did not speciate Shigella in this study; however, our recent study in adults and children showed Shigella flexneri to be the most commonly isolated species.…”

“…10 We did not speciate Shigella in this study; however, our recent study in adults and children showed Shigella flexneri to be the most commonly isolated species. 9 Other studies in this setting have shown that antimicrobial resistance in Shigella strains is a major concern, with multidrug resistance detected in the majority of samples. 8,9 The World Health Organization now recommends ciprofloxacin as the drug of choice for all patients with dysentery; 11 to date resistance to ciprofloxacin has not been reported in Papua New Guinea.…”

A large outbreak of shigellosis commencing in an internally displaced population, Papua New Guinea, 2013

“…11 These findings are of great importance given the lack of a vaccine to prevent infection with Shigella and the increasing antibiotic resistance of Shigella globally, including Papua New Guinea. 9,12 In this study, the low isolation and detection rates of Shigella from outbreak samples were probably due to the extended time between sample collection and laboratory testing (more than a week). The logistical issues of transporting clinical material in Papua New Guinea have been noted previously during recent outbreaks of cholera, 13 shigellosis 11 and chikungunya.…”

Shigella in baby bottles of a Brazilian newborn nursery

“…Baby bottles can be considered a potential route of Shigellas pp. transmission and a significant factor in the epidemiology of shigellosis, since poor sanitation and inadequate hygiene practices may facilitate the spread of enteric pathogens [4,7,8].…”