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Title: Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional study.
Austin Authors: Baker, Kate S;Dallman, Timothy J;Ashton, Philip M;Day, Martin;Hughes, Gwenda;Crook, Paul D;Gilbart, Victoria L;Zittermann, Sandra;Allen, Vanessa G;Howden, Benjamin P ;Tomita, Takehiro;Valcanis, Mary;Harris, Simon R;Connor, Thomas R;Sintchenko, Vitali;Howard, Peter;Brown, Jeremy D;Petty, Nicola K;Gouali, Malika;Thanh, Duy Pham;Keddy, Karen H;Smith, Anthony M;Talukder, Kaisar A;Faruque, Shah M;Parkhill, Julian;Baker, Stephen;Weill, François-Xavier;Jenkins, Claire;Thomson, Nicholas R
Affiliation: NSW Enteric Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research-Pathology West, Sydney, NSW, Australia
Department of Microbiology, Monash University, Clayton, Victoria, Australia
Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
The London School of Hygiene & Tropical Medicine, London, UK
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme and Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
Department of HIV and STIs, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
Gastrointestinal Bacteria Reference Unit, Public Health England, London, UK
Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, UK
Public Health Ontario Laboratories, Toronto, ON, Canada
Cardiff School of Biosciences, Sir Martin Evans Building, Museum Avenue, Cardiff, UK
Field Epidemiology Services, Public Health England, London, UK
The ithree institute, University of Technology Sydney, Sydney, NSW, Australia
Centre for Infectious Diseases and Microbiology-Public Health, Institute of Clinical Pathology and Medical Research-Pathology West, Westmead Hospital, Sydney, NSW, Australia
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa.
International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Paris, France.
Issue Date: 27-Apr-2015
Publication information: The Lancet. Infectious Diseases 2015; 15(8): 913-21
Abstract: Shigellosis is an acute, severe bacterial colitis that, in high-income countries, is typically associated with travel to high-risk regions (Africa, Asia, and Latin America). Since the 1970s, shigellosis has also been reported as a sexually transmitted infection in men who have sex with men (MSM), in whom transmission is an important component of shigellosis epidemiology in high-income nations. We aimed to use sophisticated subtyping and international sampling to determine factors driving shigellosis emergence in MSM linked to an outbreak in the UK.We did a large-scale, cross-sectional genomic epidemiological study of shigellosis cases collected from 29 countries between December, 1995, and June 8, 2014. Focusing on an ongoing epidemic in the UK, we collected and whole-genome sequenced clinical isolates of Shigella flexneri serotype 3a from high-risk and low-risk regions, including cases associated with travel and sex between men. We examined relationships between geographical, demographic, and clinical patient data with the isolate antimicrobial susceptibility, genetic data, and inferred evolutionary relationships.We obtained 331 clinical isolates of S flexneri serotype 3a, including 275 from low-risk regions (44 from individuals who travelled to high-risk regions), 52 from high-risk regions, and four outgroup samples (ie, closely related, but genetically distinct isolates used to determine the root of the phylogenetic tree). We identified a recently emerged lineage of S flexneri 3a that has spread intercontinentally in less than 20 years throughout regions traditionally at low risk for shigellosis via sexual transmission in MSM. The lineage had acquired multiple antimicrobial resistance determinants, and prevailing sublineages were strongly associated with resistance to the macrolide azithromycin. Eight (4%) of 206 isolates from the MSM-associated lineage were obtained from patients who had previously provided an isolate; these serial isolations indicated atypical infection patterns (eg, reinfection).We identified transmission-facilitating behaviours and atypical course(s) of infection as precipitating factors in shigellosis-affected MSM. The intercontinental spread of antimicrobial-resistant shigella through established transmission routes emphasises the need for new approaches to tackle the public health challenge of sexually transmitted infections in MSM.Wellcome Trust (grant number 098051).
Gov't Doc #: 25936611
DOI: 10.1016/S1473-3099(15)00002-X
Journal: The Lancet. Infectious diseases
Type: Journal Article
Appears in Collections:Journal articles

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