#Morbidity and #mortality due to #shigella and enterotoxigenic #Ecoli diarrhoea: the Global Burden of Disease Study 1990–2016 (Lancet Infect Dis., abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990–2016

Ibrahim A Khalil, Christopher Troeger, Brigette F Blacker, Puja C Rao, Alexandria Brown, Deborah E Atherly, Thomas G Brewer, Cyril M Engmann, Eric R Houpt, Gagandeep Kang, Karen L Kotloff, Myron M Levine, Stephen P Luby, Calman A MacLennan, William K Pan, Patricia B Pavlinac, James A Platts-Mills, Firdausi Qadri, Mark S Riddle, Edward T Ryan, David A Shoultz, A Duncan Steele, Judd L Walson, John W Sanders, Ali H Mokdad, Christopher J L Murray, Simon I Hay, Robert C Reiner Jr

Lancet Infect Dis 2018 / Published Online September 25, 2018 / DOI: http://dx.doi.org/10.1016/S1473-3099(18)30475-4




Shigella and enterotoxigenic Escherichia coli (ETEC) are bacterial pathogens that are frequently associated with diarrhoeal disease, and are a significant cause of mortality and morbidity worldwide. The Global Burden of Diseases, Injuries, and Risk Factors study 2016 (GBD 2016) is a systematic, scientific effort to quantify the morbidity and mortality due to over 300 causes of death and disability. We aimed to analyse the global burden of shigella and ETEC diarrhoea according to age, sex, geography, and year from 1990 to 2016.


We modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We used a compartmental meta-regression tool to model the incidence of shigella and ETEC, which enforces an association between incidence, prevalence, and remission on the basis of scientific literature, population representative surveys, and health-care data. We calculated 95% uncertainty intervals (UIs) for the point estimates.


Shigella was the second leading cause of diarrhoeal mortality in 2016 among all ages, accounting for 212438 deaths (95% UI 136979–326 913) and about 13·2% (9·2–17·4) of all diarrhoea deaths. Shigella was responsible for 63 713 deaths (41 191–93 611) among children younger than 5 years and was frequently associated with diarrhoea across all adult age groups, increasing in elderly people, with broad geographical distribution. ETEC was the eighth leading cause of diarrhoea mortality in 2016 among all age groups, accounting for 51 186 deaths (26 757–83064) and about 3·2% (1·8–4·7) of diarrhoea deaths. ETEC was responsible for about 4·2% (2·2–6·8) of diarrhoea deaths in children younger than 5 years.


The health burden of bacterial diarrhoeal pathogens is difficult to estimate. Despite existing prevention and treatment options, they remain a major cause of morbidity and mortality globally. Additional emphasis by public health officials is needed on a reduction in disease due to shigella and ETEC to reduce disease burden.

Funding Bill & Melinda Gates Foundation.

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.

Keywords: Shigella spp.; E. Coli; ETEC; Worldwide.


#NYC House #Mice (Mus musculus) as Potential #Reservoirs for Pathogenic #Bacteria and #Antimicrobial Resistance Determinants (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

New York City House Mice (Mus musculus) as Potential Reservoirs for Pathogenic Bacteria and Antimicrobial Resistance Determinants

Simon H. Williams a,  Xiaoyu Che a,  Ashley Paulick b, Cheng Guo a, Bohyun Lee a, Dorothy Muller a, Anne-Catrin Uhlemann c, Franklin D. Lowy c, Robert M. Corrigan d, W. Ian Lipkin a

a Center for Infection and Immunity, Columbia University, New York, New York, USA; b Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; c Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York, USA; d RMC Pest Management Consulting, Briarcliff Manor, New York, USA

Claire M. Fraser, Editor

Author Affiliations: University of Maryland, School of Medicine

Address correspondence to W. Ian Lipkin, wil2001@cumc.columbia.edu.



House mice (Mus musculus) thrive in large urban centers worldwide. Nonetheless, little is known about the role that they may play in contributing to environmental contamination with potentially pathogenic bacteria. Here, we describe the fecal microbiome of house mice with emphasis on detection of pathogenic bacteria and antimicrobial resistance genes by molecular methods. Four hundred sixteen mice were collected from predominantly residential buildings in seven sites across New York City over a period of 13 months. 16S rRNA sequencing identified Bacteroidetes as dominant and revealed high levels of Proteobacteria. A targeted PCR screen of 11 bacteria, as indicated by 16S rRNA analyses, found that mice are carriers of several gastrointestinal disease-causing agents, including Shigella, Salmonella, Clostridium difficile, and diarrheagenic Escherichia coli. Furthermore, genes mediating antimicrobial resistance to fluoroquinolones (qnrB) and β-lactam drugs (blaSHV and blaACT/MIR) were widely distributed. Culture and molecular strain typing of C. difficile revealed that mice harbor ribotypes associated with human disease, and screening of kidney samples demonstrated genetic evidence of pathogenic Leptospira species. In concert, these findings support the need for further research into the role of house mice as potential reservoirs for human pathogens and antimicrobial resistance in the built environment.



Mice are commensal pests often found in close proximity to humans, especially in urban centers. We surveyed mice from seven sites across New York City and found multiple pathogenic bacteria associated with febrile and gastrointestinal disease as well as an array of antimicrobial resistance genes.

KEYWORDS: antimicrobial resistance –  bacteriome –  mice –  New York City



Citation Williams SH, Che X, Paulick A, Guo C, Lee B, Muller D, Uhlemann A-C, Lowy FD, Corrigan RM, Lipkin WI. 2018. New York City house mice (Mus musculus) as potential reservoirs for pathogenic bacteria and antimicrobial resistance determinants. mBio 9:e00624-18. https://doi.org/10.1128/mBio.00624-18.

For a companion article on this topic, see https://doi.org/10.1128/mBio.01354-17.

Received 19 March 2018  – Accepted 22 March 2018  – Published 17 April 2018

Copyright © 2018 Williams et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: USA; New York City; House Mice; Antibiotics; Drugs Resistance; Clostridium difficile; Leptospira spp.; Shigella spp.; Salmonella spp.; E. Coli.


#Azithromycin #resistance in #Shigella spp. in Southeast #Asia (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Azithromycin resistance in Shigella spp. in Southeast Asia

Thomas C Darton1,2,  Ha Thanh Tuyen1,  Hao Chung The1,  Paul N Newton3,4, David A. B. Dance3,4,5,  Rattanaphone Phetsouvanh3,  Viengmon Davong3, James I Campbell1,  Nguyen Van Minh Hoang1,  Guy E Thwaites1,4, Christopher M Parry6,7,  Duy Pham Thanh1 and  Stephen Baker1,4,8*

Author Affiliations: 1 The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; 2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom; 3 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos; 4 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom; 5 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; 6 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; 7 School of Tropical Medicine and Global Health, Nagasaki University, Japan; 8 The Department of Medicine, The University of Cambridge, Cambridge, United Kingdom



Infection by Shigella spp. is a common cause of dysentery in Southeast Asia. Antimicrobials are thought to be beneficial for treatment, however antimicrobial resistance in Shigella spp. is becoming widespread. We aimed to assess the frequency and mechanisms associated with decreased susceptibility to azithromycin in Southeast Asian Shigella isolates and use these data to assess appropriate susceptibility breakpoints. Shigella isolated in Vietnam and Laos were screened for susceptibility against azithromycin (15μg) by disc diffusion and minimum inhibitory concentration (MIC). Phenotypic resistance was confirmed by PCR amplification of macrolide resistance loci. We compared the genetic relationships and plasmid contents of azithromycin resistant S. sonnei using whole genome sequences. From 475 available Shigella spp. isolated in Vietnam and Laos between 1994 and 2012, 6/181 S. flexneri (3.3%, MIC≥16g/L) and 16/294 S. sonnei (5.4%, MIC≥32g/L) were phenotypically resistant to azithromycin. PCR amplification confirmed a resistance mechanism in 22/475 (4.6%) isolates (19 mphA and 3 ermB). Susceptibility data demonstrated the acceptability of S. flexneri(MIC≥16g/L, zone≤15mm) and S. sonnei (MIC≥32g/L, zone≤11mm) breakpoints with <3% discrepancy. Phylogenetic analysis demonstrated that decreased susceptibility has arisen sporadically in Vietnamese S. sonnei on at least seven occasions between 2000 and 2009, but failed to become established. While the proposed susceptibility breakpoints may allow better recognition of resistant isolates, additional studies are required to assess the impact on clinical outcome. The potential emergence of azithromycin resistance highlights the need for alternative management options for Shigella infections in endemic countries.



*Corresponding author: Professor Stephen Baker, the Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. Tel: +84 89241761 Fax: +84 89238904 sbaker@oucru.org

Copyright © 2018 Darton et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Antibiotics; Drugs Resistance; Shigella spp.; Azithromycin; Asian Region.