CDC warns about the rise in almost untreatable Shigella bacterial infections

The drug-resistant stomach bug, a major cause of inflammatory diarrhea, is a “serious public health threat.”

March 1, 2023, 5:30 AM ESTBy Benjamin Ryan

The Centers for Disease Control and Prevention is warning about a rise in extensively drug-resistant cases of the bacterial infection Shigella, a major cause of inflammatory diarrhea.

The agency calls the new form of the stomach bug, which causes the diarrheal condition known as shigellosis, a “serious public health threat.” Evidence suggests the illness is spreading among gay and bisexual men in particular, apparently through sexual contact, both in the U.S. and abroad. 

The CDC held a call Tuesday with the Colorado Department of Public Health and Environment and the U.K. Health Security Agency to alert doctors about the spread of a form of the bacterium that is resistant to all typically recommended antibiotic treatments.

“We do not have all the answers today,” Dr. Louise Francois Watkins, a medical officer at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said on the call. The agency, she said, could make no official recommendations for antibiotic alternatives.

A parallel outbreak in the U.K., first announced in January 2022, most likely stemmed from an initial single infection, British health officials said on the call Tuesday. That speaks to how widely individual drug-resistant strains can spread and to the importance of infection control.

The CDC said in a health alert Friday that the proportion of the approximately 450,000 annual U.S. Shigella infections that were resistant to all known antibiotic treatments rose from zero in 2015 to 0.4% in 2019 to 5% last year, an indicator of potential greater spread.

Shigella, which is highly infectious, spreads when infected fecal matter enters the mouth or the nose, including through sexual activity or because of poor hand-washing after diaper changes, unsanitary food handling or swimming in contaminated water. The infection is typically seen in young children.

The European Centre for Disease Prevention and Control issued an alert Friday about 221 confirmed and 37 possible cases among people who traveled to Cabo Verde off West Africa since September and returned home to about a dozen nations, including the U.S.

During the CDC call Tuesday, officers from the U.K. health agency reported they had analyzed all but four of 185 cases of the infection in Britain since late 2021. Half required antibiotic treatment. The Shigella samples retained susceptibility to four antibiotics: carbapenems, chloramphenicol, fosfomycin and temocillin.

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

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

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

Shigellosis usually goes away without treatment. But physicians may prescribe antibiotics to hasten recovery or otherwise avert complications in more vulnerable patients.

The infection can cause prolonged and debilitating illness, with about 6,400 U.S. patients needing hospitalization each year.

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

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