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Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by Shigella in children less than 5 years in Manhiça District, rural Mozambique

Authors Vubil D, Acácio S, Quintó L, Ballesté-Delpierre C, Nhampossa T, Kotloff K, Levine MM, Alonso P, Nataro JP, Farag TH, Vila J, Mandomando I

Received 18 June 2018

Accepted for publication 7 September 2018

Published 31 October 2018 Volume 2018:11 Pages 2095—2106

DOI https://doi.org/10.2147/IDR.S177579

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Joachim Wink


Delfino Vubil,1 Sozinho Acácio,1,2 Llorenç Quintò,3 Clara Ballesté-Delpierre,3 Tacilta Nhampossa,1,2 Karen Kotloff,4 Myron M Levine,4 Pedro Alonso,1 James P Nataro,5 Tamer H Farag,4 Jordi Vila,3,6 Inacio Mandomando1,2

1Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; 2Instituto Nacional de Saúde (INS), Maputo, Mozambique; 3ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; 4Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA; 5Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA; 6Department of Clinical Microbiology, Centre for Biomedical Diagnosis, Hospital Clinic, Barcelona, Spain

Objectives: During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by Shigella was studied among children <5 years of age residing in Manhiça District, Southern Mozambique.
Materials and methods: Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with Shigella positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome.
Results: A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. Shigella was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. Shigella was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (P=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (P<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86–9.24) among children aged 12–23 months. Clinical symptoms associated to Shigella among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby’s food, and mother as caretaker were the protective factors against acquiring diarrhea caused by Shigella. Antibiotic treatment on admission was associated with a positive children outcome.
Conclusion: Shigella remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to Shigella.

Keywords: Shigella, moderate-to-severe diarrhea, less severe diarrhea, epidemiology

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