CDC warns of Shigella outbreak

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

The agency calls the new form of stomach flu, which causes the diarrheal condition known as shigellosis, a “serious threat to public health.” Evidence shows that the disease is spreading among gay and bisexual men, apparently through sexual contact, both in the US and abroad.

The CDC held a call Tuesday with the Colorado Department of Public Health and Environment and the UK Health Security Administration to alert doctors about the spread of a form of the bacteria that is resistant to all standard antibiotic treatments.

“We don’t have all the answers today,” Dr. Louise Francois Watkins, a physician at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said on the call. The agency, he said, could not make formal recommendations for alternative antibiotics.

A parallel ongoing outbreak of nearly 200 recent extensively drug-resistant Shigella cases in Britain that the U.K. health service announced last month likely stemmed from a single initial infection, British health officials said on the call Tuesday. This speaks to how widely individual drug-resistant strains of the infection can spread and the importance of infection control.

The CDC said in a health alert Friday that the percentage of the roughly 450,000 annual Shigella infections in the U.S. 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 possible more widespread.

Shigella, which is highly contagious, is spread when contaminated feces enter the mouth or nose, including through sexual activity or through poor hand washing after changing diapers, unsanitary food handling, or swimming in contaminated water. The infection usually occurs in young children.

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

During the CDC’s call on Tuesday, officials from the UK health service said they had analyzed all but four of Britain’s 185 cases of infection since late. 2021. Half antibiotic treatment required. Shigella samples retained sensitivity to four antibiotics: carbapenems, chloramphenicol, fosfomycin, and temocillin.

Eighty-seven percent of the cases were in men who allegedly had sex with men.

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

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

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

The infection can cause prolonged 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 in immunocompromised people, such as from untreated HIV or chemotherapy for cancer.

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

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

Now, doctors face a major challenge in caring for patients with this form of Shigella. Reviewing an extensive list of potential antibiotic alternatives on Tuesday’s call, Watkins noted that the drugs are largely burdened by one or more limitations, such as unavailability in the U.S., lack of clinical trial data, resistance to the pathogen or the fact that penetrate the lining of the intestine poorly.

The CDC urged health care providers to be vigilant for possible Shigella infections and to report suspected cases to state and local health departments, while also educating those most at risk for shigellosis.

In addition to gay and bisexual men, antibiotic-resistant Shigella infections have increased among people experiencing homelessness, international travelers, and people living with HIV.

Of the 232 cases reported since 2016 for which the CDC has data, 197, or 85 percent, involved men. Only one was in a child. Of the 41 subjects who answered questions about recent sexual activity, 88% were men who reported recent sexual contact with men.

Meanwhile, sexually transmitted gonorrhea, chlamydia and syphilis have been steadily increasing in recent years and are particularly prevalent among gay and bisexual men. The CDC has issued increasingly urgent warnings that gonorrhea is at risk of losing sensitivity to the last remaining simple and effective antibiotic to treat the infection.

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

People with shigellosis, the CDC advises, should stay home if they work in health care, feeding or child care. The agency also advises that during the illness and for two weeks afterward, people should avoid preparing food for others, wash their hands frequently, avoid swimming, and refrain from sexual contact, or at least observe strict hygiene before and after sexual activity.

The World Health Organization lists drug-resistant pathogens, the emergence of which is largely due to the misuse and overuse of antibiotics in humans and animals, as one of the top 10 global public health threats facing humanity.

“The clinical pipeline, the drugs that are in human trials, is fragile and there aren’t enough of them,” said Kevin Outterson, executive director of CARB-X, a Boston-based nonprofit group that seeks to spur early-stage innovation. research on antibiotics. and development.

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

“If you want 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 raises concerns in the wake of the global mpox (formerly monkeypox) epidemic, which has been spread overwhelmingly through sex between men. Cases of the virus, first identified in Britain in mid-May, peaked in the US and internationally in early August and have largely subsided.

Similar to cases of shigella, mpox infections, which can be serious, usually resolve without the need for treatment and are rarely fatal. However, a paper published Feb. 21 in The Lancet found a death rate from mpox as high as 15 percent among people who are effectively immunosuppressed from HIV.

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