Lindsay Brianna, Saha Debasish, Sanogo Doh, Das Sumon Kumar, Omore Richard, Farag Tamer H, Nasrin Dilruba, Li Shan, Panchalingam Sandra, Levine Myron M, Kotloff Karen, Nataro James P, Magder Laurence, Hungerford Laura, Faruque A S G, Oundo Joseph, Hossain M Anowar, Adeyemi Mitchell, Stine Oscar Colin
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh.
University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
Am J Trop Med Hyg. 2015 Nov;93(5):918-24. doi: 10.4269/ajtmh.14-0319. Epub 2015 Aug 31.
Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case-control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28-0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24-35 months of age (OR = 8.2, 95% CI = 4.3-15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3-23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.
侵袭质粒抗原H（ipaH）基因的分子鉴定已成为检测志贺氏菌属的一种有用机制。全球肠道多中心研究（GEMS）采用病例对照研究和传统培养技术，确定了撒哈拉以南非洲和南亚地区中重度腹泻（MSD）的病因及负担。在此，我们运用定量聚合酶链反应（qPCR）对GEMS研究中的2611份粪便标本进行志贺氏菌属鉴定，并将结果与培养法的结果进行比较。对人口统计学和营养特征进行评估，作为可能的风险因素。qPCR检测出的志贺氏菌病病例比培养法更多；然而，两种方法所确定的人口统计学特征分布相似。在针对志贺氏菌数量、年龄和地点进行校正的回归模型中，纯母乳喂养的儿童患MSD的几率显著低于非母乳喂养的儿童（优势比[OR]=0.47，95%置信区间[CI]=0.28 - 0.81）。志贺氏菌数量与MSD之间的关联随年龄增长而增加，在24 - 35个月大的儿童中达到峰值（OR = 8.2，95% CI = 4.3 - 15.7），且在孟加拉国，志贺氏菌数量与疾病之间的关系最为显著（OR = 13.2，95% CI = 7.3 - 23.8）。本研究发现，qPCR检测出更多志贺氏菌病例，年龄、地点和母乳喂养状况是MSD的重要风险因素。
