Wilmer A, Romney M G, Gustafson R, Sandhu J, Chu T, Ng C, Hoang L, Champagne S, Hull M W
Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
HIV Med. 2015 Mar;16(3):168-75. doi: 10.1111/hiv.12191.
Outbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with interpersonal transmission and underlying HIV infection. We observed a rise in Shigella flexneri isolates identified in a downtown tertiary-care hospital laboratory located within the city centre community health area (CHA-1) of Vancouver, Canada. The objectives of this study were to evaluate clinical outcomes of shigellosis cases among MSM admitted to hospital and to evaluate trends in Shigella cases within Vancouver, Canada.
Adult rates of shigellosis were analysed by gender and health region, from 2005 to 2011, followed by retrospective chart review of all hospital laboratory-identified S. flexneri cases from 2008 to 2012. Serotyping and pulsed-field gel electrophoresis (PFGE) were performed on these isolates.
Although shigellosis rates in men within CHA-1 did not change from 2005 to 2011 (range 33.4-68.5 per 100 000; P = 0.74), they were significantly higher than in other regions within the city of Vancouver (P ≤ 0.001) and the province of British Columbia (P ≤ 0.001). Shigella flexneri rates in men within CHA-1 increased significantly (range 2.3-51.4 per 100 000; P < 0.001), starting in 2008, and were higher than in other regions within Vancouver (P ≤ 0.01). Seventy-nine isolates of S. flexneri from 72 patients were identified by a single hospital laboratory. All patients were male and predominantly MSM (91.7%) and HIV-infected (86.1%), with most (92.6%) demonstrating CD4 counts ≥ 200 cells/μL. In total, 38.0% required hospitalization. Most (87.3%) had S. flexneri serotype 1 infection, with 72.9% of these representing a single PFGE pattern.
We identified high levels of transmission of a primarily clonal strain of S. flexneri serotype 1 in our local MSM population, resulting in a substantial burden of illness and health care resource use secondary to hospital admissions.
已记录到男男性行为者（MSM）中发生志贺氏菌病暴发，与人际传播及潜在的HIV感染相关。我们观察到加拿大温哥华市中心社区卫生区（CHA - 1）内一家市中心三级护理医院实验室中鉴定出的福氏志贺氏菌分离株有所增加。本研究的目的是评估住院的MSM中志贺氏菌病病例的临床结局，并评估加拿大温哥华市志贺氏菌病例的趋势。
分析了2005年至2011年按性别和卫生区域划分的志贺氏菌病成人发病率，随后对2008年至2012年所有医院实验室鉴定的福氏志贺氏菌病例进行回顾性病历审查。对这些分离株进行血清分型和脉冲场凝胶电泳（PFGE）分析。
尽管CHA - 1内男性的志贺氏菌病发病率在2005年至2011年期间没有变化（范围为每100,000人33.4 - 68.5例；P = 0.74），但显著高于温哥华市其他区域（P≤0.001）和不列颠哥伦比亚省（P≤0.001）。CHA - 1内男性的福氏志贺氏菌发病率自2008年起显著上升（范围为每100,000人2.3 - 51.4例；P < 0.001），且高于温哥华市其他区域（P≤0.01）。一家医院实验室鉴定出72例患者的79株福氏志贺氏菌分离株。所有患者均为男性，主要是MSM（91.7%）且感染了HIV（86.1%），大多数（92.6%）的CD4细胞计数≥200个/μL。总共有38.0%的患者需要住院治疗。大多数（87.3%）感染的是福氏志贺氏菌1型，其中72.9%表现为单一的PFGE模式。
我们在当地MSM人群中发现了福氏志贺氏菌1型主要克隆菌株的高水平传播，导致因住院而产生的大量疾病负担和医疗资源使用。
