The Role of Shigella spp., Enteroinvasive Escherichia coli, and Other Enteropathogens as Causes of Childhood Dysentery in Thailand

Taylor, David N.; Echeverria, Peter; Pál, Tibor; Sethabutr, Orntipa; S, Saiborisuth; S, Sricharmorn; Rowe, B.; Cross, John H.

doi:10.1093/infdis/153.6.1132

Cited by 103 publications

(65 citation statements)

References 26 publications

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“…Indeed, in mild cases, only watery diarrhea may occur, leading to a clinical picture indistinguishable from enterotoxigenic E. coli infection (29,30).…”

Section: Discussionmentioning

confidence: 99%

Shigella enterotoxin 1: an enterotoxin of Shigella flexneri 2a active in rabbit small intestine in vivo and in vitro.

Fasano¹,

Noriega²,

Maneval³

et al. 1995

J. Clin. Invest.

145

108

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Culture filtrates of Shigellaflexneri 2a strain M4243 grown in iron-depleted medium, caused significant fluid accumulation in rabbit ileal loops. Also, when tested in Ussing chambers, a greater rise in potential difference and short circuit current was seen with such filtrates compared with the medium control. Analogous filtrates from two M4243 derivatives lacking the 140-MD invasiveness plasmid (either M4243avir or BS103) retained 60-65% of the wild-type enterotoxic activity. Ultrafiltration and gel exclusion size fractionation of M4243 filtrate revealed that the activity was 60 kD. SDS-PAGE performed on this fraction showed 18 bands, 5 of which reacted with human convalescent sera. Genes encoding this enterotoxin, named ShET1 for Shigella enterotoxin 1, were cloned from the S. flexneri 2a chromosome, and two separate open reading frames of 534 and 186 bp were sequenced. These observations suggest that S. flexneri 2a elaborates two distinct enterotoxins: ShET1, encoded by genes located on the chromosome, and ShET2, encoded by a gene on the 140-MD invasiveness plasmid. ShET1, which is composed of two distinct subunits and is elaborated in vivo, where it elicits an immune response, may be important in the pathogenesis of diarrheal illness due to S. flexneri 2a. (J. Clin. Invest. 1995Invest. . 95:2853Invest. -2861

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“…Indeed, in mild cases, only watery diarrhea may occur, leading to a clinical picture indistinguishable from enterotoxigenic E. coli infection (29,30).…”

Section: Discussionmentioning

confidence: 99%

Shigella enterotoxin 1: an enterotoxin of Shigella flexneri 2a active in rabbit small intestine in vivo and in vitro.

Fasano¹,

Noriega²,

Maneval³

et al. 1995

J. Clin. Invest.

145

108

View full text Add to dashboard Cite

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“…Shigellosis remains a serious and common disease (16,19,23,26,28,38,46,55,56). In addition to causing watery diarrhea, shigellae are a major cause of dysentery (fever, cramps, and blood and/or mucus in the stool) (19,46,49,55,56).…”

mentioning

confidence: 99%

“…In addition to causing watery diarrhea, shigellae are a major cause of dysentery (fever, cramps, and blood and/or mucus in the stool) (19,46,49,55,56). Not commonly appreciated is that dysentery, not watery diarrhea, retards growth in children (7,9,19,30,38,46,49,55,56).…”

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confidence: 99%

Safety and Immunogenicity of ImprovedShigellaO-Specific Polysaccharide-Protein Conjugate Vaccines in Adults in Israel

et al. 2001

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Data suggest that the O-specific polysaccharide (O-SP) domain of the lipopolysaccharide (LPS) ofShigella species is both an essential virulence factor and a protective antigen and that a critical level of serum immunoglobulin G (IgG) to this antigen will confer immunity to shigellosis. Because covalent attachment of polysaccharides to proteins increases their immunogenicity, especially in infants and in young children, the O-SP of Shigella species were bound to medically useful proteins, and the safety and immunogenicity of the resultant conjugates were confirmed in adults and 4-to 7-year-old children. Succinylation of the carrier protein improved the immunogenicity of Shigella conjugates in mice and increased their yield. Based on these results, a clinical trial of O-SP conjugates of Shigella sonnei and Shigella flexneri 2a bound to succinylated mutant Pseudomonas aeruginosa exotoxin A (rEPA succ ) or native or succinylated Corynebacterium diphtheriae toxin mutant (CRM9 or CRM9 succ ) was conducted in healthy adults. The conjugates were safe and immunogenic. S. sonnei-CRM9, S. sonnei-CRM9 succ , and S. sonnei-rEPA succ elicited significant rises of geometric mean (GM) IgG anti-LPS within 1 week of injection (P < 0.001). At 26 weeks, the GM anti-LPS levels elicited by these three conjugates were similar and higher than their prevaccination levels (P < 0.0001). GM IgG anti-LPS levels elicited by S. flexneri 2a-rEPA succ were significantly higher than those elicited by S. flexneri 2a-rCRM9 succ at all intervals after injection. At 26 weeks, the levels of IgG anti-LPS in vaccinees were higher than their prevaccination levels (P < 0.0001). The serum antibody responses were specific, as there was no significant rise of anti-LPS to the heterologous O-SP in any vaccinee. Both conjugates elicited statistically significant rises of serum antibodies to the injected carrier protein. At 6 months, these five Shigella conjugates elicited higher fold rises than similar conjugates (D. N. Taylor et al., Infect. Immun. 61:3678-3687, 1993). Based on these data, we chose S. sonnei-CRM9 and S. flexneri 2a-rEPA succ for evaluation in children.

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“…Taylor et al enfatizam que a Shigella sp, pelo baixo inóculo necessário para a ocorrência de infecção sintomá-tica, determina surtos epidêmicos de diarréia em várias comunidades, com rápida disseminação e alto número de indivíduos infectados 32 .…”

Section: Discussionunclassified

Acute diarrhea in children less than 3 years of age: Enteropathogens isolated in patients’ stools, compared with a control group

Toporovski¹,

Mimica²,

Chieffi³

et al. 1999

J Pediatr (Rio J)

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Objectives: To observe the occurrence of different etiological agents of acute diarrhea (AD) in stool specimens of patients and children in a control group.Material and Methods: 100 children less than three years of age with AD were studied as well as 100 controls, between November 1993 and May 1994. Stool specimens were collected in both groups and the following enteropathogens were searched for: Rotavirus, Escherichia coli (EPEC, ETEC, EIEC, EHEC), Salmonella sp, Shigella sp, Campylobacter jejuni, Campylobacter coli, Yersinia enterocolitica, Cryptosporidium sp, Giardia lamblia, Entamoeba histolytica. Statistical analysis using the exact Fisher test (at significance level p<0,05) was done. The mean age was 12,5 months, with more cases in patients less than 6 months (35%). Children were seen at the emergency section on an average fifth day after the start of the diarrhea. Most came from homes with basical sanitary conditions. Watery diarrhea was more frequent than bloody diarrhea with mucus, at a proportion of 4:1.Results: Rotavirus was the most frequent agent: 21% in the AD group and 3% in the control group (p= 0,0001). Shigella sp was isolated in 7% of the AD group and none of the control group (p= 0,0140). EPEC was detected in 13% of AD cases and 7% in the control group (p= 0,2381) but the classical subgroups O55, O111, O119 were only isolated from the patients with AD. The other enteropathogens were infrequently detected or in equal proportion in both groups. Rotavirus and EPEC were the more frequently isolated agents in watery diarrhea, while Shigella sp was the predominant agent found in bloody stools with mucus.Conclusions: Rotavirus was the most common causative agent in AD. The detection of Rotavirus and Shigella sp nearly exclusively in patients with AD confirms the high patogenicity of these etiological agents when compared to the others. Escherichia coli (EPEC) diagnosed by polyvalent sera does not confirm its respective diarrheogenic property due to isolation in the same proportion among patients with AD and controls. Monovalent antisera made possible the detection of classical subgroups of EPEC O111, O119, O55 isolated only from AD patients, confirming the already known high patogenicity of these strains. Resultados: O Rotavirus foi o agente mais detectado, 21% no grupo com diarréia e 3% nos controles (p = 0,0001). A Shigela sp foi isolada em 7% no grupo com diarréia e em nenhum caso nos controles (p = 0,0140). A Escherichia coli enteropatogênica (EPEC) foi detectada em 13% dos casos de DA e em 7% nos controles (p = 0,2381), porém os sorogrupos clássicos O55,0111,0119 foram isolados apenas nos portadores de diarréia. Os demais enteropatógenos não atingiram freqüências elevadas, ou foram detectados na mesma proporção em ambos os grupos. O Rotavirus e EPEC foram os agentes mais detectados nas diarréias aquosas, enquanto a Shigella sp foi o agente predominante nas diarréias mucossanguinolentas. J. pediatr. (Rio J.Conclusões: O Rotavirus foi o agente mais comum determinante de DA. A detecção de...

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The Role of Shigella spp., Enteroinvasive Escherichia coli, and Other Enteropathogens as Causes of Childhood Dysentery in Thailand

Cited by 103 publications

References 26 publications

Shigella enterotoxin 1: an enterotoxin of Shigella flexneri 2a active in rabbit small intestine in vivo and in vitro.

Shigella enterotoxin 1: an enterotoxin of Shigella flexneri 2a active in rabbit small intestine in vivo and in vitro.

Safety and Immunogenicity of ImprovedShigellaO-Specific Polysaccharide-Protein Conjugate Vaccines in Adults in Israel

Acute diarrhea in children less than 3 years of age: Enteropathogens isolated in patients’ stools, compared with a control group

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