Aggarwal Prabhav, Uppal Beena, Ghosh Roumi, Krishna Prakash Subramaniam, Chakravarti Anita, Rajeshwari Krishnan
Department of Microbiology, Maulana Azad Medical College, Bahadur Shah Zafar Road, New Delhi-110002, India.
Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, Bahadur Shah Zafar Road, New Delhi-110002, India.
J Res Health Sci. 2016 Winter;16(1):11-6.
Shigella is responsible for high morbidity and mortality among children, yet its true prevalence remains inconclusive. The aim of this study was to determine the actual prevalence of Shigella infection in childhood diarrhea and dysentery cases and assess the applicability of ipaH gene PCR in Indian settings.
This study was conducted at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India during 2011-12. A total of 385 children (207 with diarrhea, 118 with dysentery, and 60 matched controls) were enrolled. Stool samples were cultured, and the suspected colonies were analyzed using biochemical reactions and serotyping. Antimicrobial susceptibility testing was done using disc diffusion method. ipaH-gene PCR was performed directly on stool samples collected from 180 randomly selected patients (60 from each group).
Shigella was isolated using conventional culture methods in 8.2% (95% CI: 5.1%, 12.8%), 33.1% (95% CI: 25.2%, 42.0%), and 0% in the diarrhea, dysentery and control cases, respectively. High resistance was seen towards co-trimoxazole, nalidixic acid, fluoroquinolones, doxycycline and several beta-lactams drugs. Actual prevalence of shigellosis was determined using ipaH gene PCR to be 18.3% (95% CI: 10.4% - 30.1%) diarrhea cases and 56.7% (95% CI: 44.1, 68.4%) dysentery cases. One (1.7%, 95% CI: 0.01%, 9.7%) control specimen also yielded positive result in PCR.
Correct diagnosis of shigellosis is essential to start antimicrobial therapy in selected cases. The prevalence of Shigella / EIEC infection in children is much higher than previously estimated. Despite its high costs and other limitations, we recommend the use of ipaH-gene PCR as a routine tool in the management of childhood acute gastroenteritis cases.
志贺氏菌是导致儿童高发病率和死亡率的原因，但它的实际流行率仍无定论。本研究的目的是确定儿童腹泻和痢疾病例中志贺氏菌感染的实际流行率，并评估ipaH基因PCR在印度环境中的适用性。
本研究于2011 - 12年在印度新德里的莫拉纳·阿扎德医学院及相关的洛克·奈亚克医院进行。共招募了385名儿童（207名腹泻儿童、118名痢疾儿童和60名匹配对照）。对粪便样本进行培养，使用生化反应和血清分型对疑似菌落进行分析。采用纸片扩散法进行药敏试验。对从180名随机选择的患者（每组60名）采集的粪便样本直接进行ipaH基因PCR检测。
使用传统培养方法，腹泻、痢疾和对照病例中志贺氏菌的分离率分别为8.2%（95%置信区间：5.1%，12.8%）、33.1%（95%置信区间：25.2%，42.0%）和0%。观察到对复方新诺明、萘啶酸、氟喹诺酮类、多西环素和几种β - 内酰胺类药物的高耐药性。使用ipaH基因PCR确定的志贺氏菌病实际流行率在腹泻病例中为18.3%（95%置信区间：10.4% - 30.1%），在痢疾病例中为56.7%（95%置信区间：44.1，68.4%）。一份对照样本（1.7%，95%置信区间：0.01%，9.7%）在PCR检测中也呈阳性结果。
正确诊断志贺氏菌病对于在特定病例中开始抗菌治疗至关重要。儿童志贺氏菌/肠侵袭性大肠杆菌感染的流行率远高于先前估计。尽管成本高昂且存在其他局限性，但我们建议将ipaH基因PCR作为儿童急性肠胃炎病例管理中的常规工具使用。
