Multidrug-Resistant Atypical Variants of Shigella flexneri in China - Vol. 19 No. 7 - July 2013 - Emerging Infectious Disease journal - CDC
Volume 19, Number 7—July 2013
Multidrug-Resistant Atypical Variants of Shigella flexneri in China
), which is of particular concern in developing countries. Shigella spp. are leading bacterial causes of diarrhea, responsible for >80 million cases of bloody diarrhea and 700,000 deaths each year (2), and S. flexneri serotype 2a has been recognized as the most prevalent serotype in China for many years (3). To better understand the etiology of bacterial diarrhea in China and to determine if S. flexneri serotype 2a is still the most prevalent serotype in China, we conducted a study during May 2008–December 2010.
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AbstractWe identified 3 atypical Shigella flexneri varieties in China, including 92 strains with multidrug resistance, distinct pulse types, and a novel sequence type. Atypical varieties were prevalent mainly in developed regions, and 1 variant has become the dominant Shigella spp. serotype in China. Improved surveillance will help guide the prevention and control of shigellosis.
A total of 10,021 fecal samples were obtained from patients with diarrhea or dysentery at hospitals in 8 provinces within the eastern, southern, western, northern, and central regions of China: Liaoning, Shandong, Jiangsu, Guangdong, Gansu, Sichuan, Xinjiang, and Hebei Provinces. Samples were screened for the presence of Shigella spp. by using API 20E strips (bioMérieux, Marcy l’Etoile, France). Serotyping was performed by using 1) an antisera kit specific for all type- and group-factor antigens (Denka Seiken, Tokyo, Japan) and 2) a panel of monoclonal antibodies against S. flexneri (MASF; Reagensia AB, Stockholm, Sweden). Antimicrobial susceptibility testing was performed by the disk diffusion method as described (4). Genetic relationships were estimated by using multilocus sequence typing, as described (5), and pulsed-field gel electrophoresis (PFGE) (6).