Thursday, March 9, 2023

HIV & Shigella: What Patients Need to Know

By: Ranier Simons, ADAP Blog Guest Contributor

Another microscopic threat to public health has come to light. The Centers for Disease Control & Prevention (CDC) recently warned about the evolution of the common bacterial infection, Shigella. Public health officials are alarmed because of a reported increase in the number of Shigella infections in adults that are drug-resistant. Shigella bacteria cause a condition called Shigellosis, an infection of the intestines. 

Shigella
Photo Source: Health Jade

Shigellosis can cause bloody diarrhea, stomach pain, cramping, fever, nausea, or vomiting.[1] Infection occurs when someone ingests minimal amounts of the bacteria from the stool of an infected person. Pathways to infection include eating infected food prepared by someone with shigella, swimming in or drinking unsafe water, and having sexual contact.

Shigella is very contagious. Typically, it is seen in children under the age of five, although people of any age can be infected. Adults commonly are infected by poor handwashing after handling diapers or helping small children with toilet training. Adult transmission also happens due to direct or indirect oral-anal contact during sexual activity.[1] Usually, Shigella infection clears up without the need for medical intervention. However, physicians prescribe antibiotics when necessary to speed up recovery or avoid more severe complications in vulnerable patients such as those with compromised immune systems.[2] Complications include dehydration, seizures, rectal prolapse, reactive arthritis, and bloodstream infections.[1]

Annually the United States has about 450,000 cases of Shigella infection. The CDC is alarmed because the percentage of antibiotic-resistant strains has increased from zero in 2015, to 0.4 percent in 2019, to 5 percent in 2022.[2] A pathogen is considered antibiotic resistant when it does not respond to any recommended first-line or alternative antibiotics.[2] The most troubling trait of drug-resistant Shigella is its ability to transfer its drug-resistant genes to other forms of bacteria that infect the intestines.[3] 

Antibiotic Resistance
Photo Source: Labtoo

The CDC notes that the increase in adult drug-resistant Shigella includes men who have sex with men (MSM), international travelers, homeless populations, and people living with HIV.[4] Between January 2015 and January 2023, the CDC documented 239 drug-resistant cases. Patient information was available for 232 of them, indicating 82% were men, 13% were women, and 5% were children. Forty-one of the patients responded to questions about sexual activity, with 88% of those disclosing male-to-male sexual contact.[4] 

The United Kingdom also reports the spread of drug-resistant shigella among men who have sex with men.[2] This trend is reminiscent of what was written about meningococcal disease and MPOX last year. Both had a notable spread among MSM. Unfortunately, unlike meningococcal disease and MPOX, Shigella has no vaccine.

Because it is so easily transmitted, the CDC emphasizes the importance of shigella infection control. Healthcare professionals are urged to be vigilant in documenting drug-resistant cases of shigella to prevent global spread. As with all infectious diseases, the first defense is prevention.

[1] Mayo Clinic. (2023). Shigella infection. Retrieved from https://www.mayoclinic.org/diseases-conditions/shigella/symptoms-causes/syc-20377529

[2] Ryan, B. (2023, March 1). CDC warns about the rise in almost untreatable Shigella bacterial infections. Retrieved from https://www.nbcnews.com/health/health-news/drug-resistant-stomach-bug-cdc-warns-shigella-outbreak-rcna72784

[3] Radcliffe, S. (2023, February 28). CDC warns about drug-resistant shigella: What to know. Retrieved from https://www.healthline.com/health-news/cdc-warns-about-drug-resistant-shigella-what-to-know#:~:text=Limited%20antibiotics%20are%20available%20to,the%20intestines%2C%20the%20agency%20said

[4] Murez, C. (2023, February 27). Drug-resistant shigella infections on the rise, CDC warns. Retrieved from https://www.msn.com/en-us/health/medical/drug-resistant-shigella-infections-on-the-rise-cdc-warns/ar-AA180ims

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

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