Azithromycin Resistance in Shigella spp. in Southeast Asia.

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 isolates recovered in Vietnam and Laos were screened for susceptibility to azithromycin (15 µg) by disc diffusion and MIC. Phenotypic resistance was confirmed by PCR amplification of macrolide resistance loci. We compared the genetic relationships and plasmid contents of azithromycin-resistant Shigella sonnei isolates using whole-genome sequences. From 475 available Shigella spp. isolated in Vietnam and Laos between 1994 and 2012, 6/181 S. flexneri isolates (3.3%, MIC ≥ 16 g/liter) and 16/294 S. sonnei isolates (5.4%, MIC ≥ 32 g/liter) were phenotypically resistant to azithromycin. PCR amplification confirmed a resistance mechanism in 22/475 (4.6%) isolates (mphA in 19 isolates and ermB in 3 isolates). The susceptibility data demonstrated the acceptability of the S. flexneri (MIC ≥ 16 g/liter, zone diameter ≤ 15 mm) and S. sonnei (MIC ≥ 32 g/liter, zone diameter ≤ 11 mm) breakpoints with a <3% discrepancy. Phylogenetic analysis demonstrated that decreased susceptibility has arisen sporadically in Vietnamese S. sonnei isolates 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 the clinical outcome. The potential emergence of azithromycin resistance highlights the need for alternative options for management of Shigella infections in countries where Shigella is endemic.

The Shigella ProU system is required for osmotic tolerance and virulence.

To cope with hyperosmotic stress encountered in the environments and in the host, the pathogenic as well as non-pathogenic microbes use diverse transport systems to obtain osmoprotectants. To study the role of Shigella sonnei ProU system in response to hyperosmotic stress and virulence, we constructed deletion and complementation strains of proV and used an RNAi approach to silence the whole ProU operon. We compared the response between wild type and the mutants to the hyperosmotic pressure in vitro, and assessed virulence properties of the mutants using gentamicin protection assay as well as Galleria mellonella moth larvae model. In response to osmotic stress by either NaCl or KCl, S. sonnei highly up-regulates transcription of proVWX genes. Supplementation of betaine greatly elevates the growth of the wild type S. sonnei but not the proV mutants in M9 medium containing 0.2 M NaCl or 0.2 M KCl. The proV mutants are also defective in intracellular growth compared with the wild type. The moth larvae model of G. mellonella shows that either deletion of proV gene or knockdown of proVWX transcripts by RNAi significantly attenuates virulence. ProU system in S. sonnei is required to cope with osmotic stress for survival and multiplication in vitro, and for infection.

Changing trends in the prevalence of Shigella species: emergence of multi-drug resistant Shigella sonnei biotype g in Bangladesh.

Shigellosis, caused by Shigella species, is a major public health problem in Bangladesh. To determine the prevalence and distribution of different Shigella species, we analyzed 10,827 Shigella isolates from patients between 2001 and 2011. S. flexneri was the predominant species isolated throughout the period. However, the prevalence of S. flexneri decreased from 65.7% in 2001 to 47% in 2011, whereas the prevalence of S. sonnei increased from 7.2% in 2001 to 25% in 2011. S. boydii and S. dysenteriae accounted for 17.3% and 7.7% of the isolates respectively throughout the period. Of 200 randomly selected S. sonnei isolates for extensive characterization, biotype g strains were predominant (95%) followed by biotype a (5%). Resistance to commonly used antibiotics including trimethoprim-sulfamethoxazole, nalidixic acid, ciprofloxacin, mecillinam and ampicillin was 89.5%, 86.5%, 17%, 10.5%, and 9.5%, respectively. All isolates were susceptible to ceftriaxone, cefotaxime, ceftazidime and imipenem. Ninety-eight percent of the strains had integrons belonging to class 1, 2 or both. The class 1 integron contained only dfrA5 gene, whereas among class 2 integron, 16% contained dhfrAI-sat1-aadA1-orfX gene cassettes and 84% harbored dhfrA1-sat2 gene cassettes. Plasmids of ∼5, ∼1.8 and ∼1.4 MDa in size were found in 92% of the strains, whereas only 33% of the strains carried the 120 MDa plasmid. PFGE analysis showed that strains having different integron patterns belonged to different clusters. These results show a changing trend in the prevalence of Shigella species with the emergence of multidrug resistant S. sonnei. Although S. flexneri continues to be the predominant species albeit with reduced prevalence, S. sonnei has emerged as the second most prevalent species replacing the earlier dominance by S. boydii and S. dysenteriae in Bangladesh.

[A morphological evaluation of the protective properties of noninvasive recombinant strains of Shigella]. / Morfologicheskaia otsenka protektivnosti neinvazivnykh rekombinantnykh shtammov shigell.

In 2-3 weeks after the oral immunization of rabbits, made in one or two administrations, with attenuated two-marker S. dysenteriae 1 strain VS-12 and recombinant S. dysenteriae VS-12/S. sonnei NR-18 and S. flexneri y433/S. sonnei NR-18 pronounced immunological reaction developed in the mucous membrane of the small intestine: blast transformation follicles of Peyer's patches, an increase in the number of lymphoblasts and plasmocytes in the cupolae of follicles and in intestinal villi, and an increase in the number of lymphocytes and macrophages in the intestinal epithelium with their release into the lumen of the intestine after challenge with virulent shigellae. The protective potency of these recombinants after challenge with massive doses of virulent shigellae was found to be high, which was shown by quantitative evaluation of the decrease of adhesion, invasiveness and cytotoxicity, suppression of epithelial lesions and development of inflammation in the intestinal mucosa.

[The effect of the synergistic action of enterotoxin on the specific protective complex of Shigella sonnei]. / Effekt sinergentnogo deistviia énterotoksina na spetsificheskii protektivnyi kompleks Shigella sonnei.

The study has first established that enterotoxin enhances the protective potency of S. sonnei specific protective complex. This effect has been revealed both in experiments of the oral immunization of mice and in experiments of the conjunctival immunization of guinea pigs and depends on the dose of enterotoxin used in the experiment. The increase of protection has a specific character. These observations open prospects for further enhancement for the protective properties of S. sonnei specific protective complex, which should be taken into consideration in developing the vaccinal preparation.

[Comparative immunomorphological study of the immunogenic activity of dysentery vaccines produced by different methods]. / Sravnitel'noe immunomorfologicheskoe izuchenie immunogennoi aktivnosti dizenteriinykh vaktsin razlichnogo sposoba izgotovleniia.

The morphological study of the ophthalmic mucosa of guinea pigs immunized locally with different dysentery vaccines has demonstrated the advantages of live dysentery vaccine prepared from Shigella sonnei 6S over heated vaccine and Shigella antigen extracts. The protective properties of dysentery vaccines, their capacity for protecting the mucous membrane from the penetration and intracellular multiplication of shigellae correlates with the degree of the manifestation of vaccine-induced plasmatocellular reaction in the epithelial and subepithelial zones. The importance of the virulence of the strains used for the preparation of vaccines, as well as the method of their preparation, for the immunogenic potency of vaccines is shown.

[Enteric dysentery vaccines and their effectiveness in a rabbit intestinal loop model. I. The residual virulence of attenuated vaccinal strains of Shigella administered into the intestinal loops]. / Izuchenie énteral'nykh dizenteriinykh vaktsin i ikh éffektivnosti na modeli kishechnykh petel' krolika. Soobshchenie I. Ostatochnaia virulentnost' attenuirovannykh vaktsinnykh shtammov shigell pri vvedenii v kishechnye petli.

Virulent Sh. flexneri strain 2a, Sh. sonnei strain, attenuated Sh. flexneri vaccine strain 2a 516M, and Sh. sonnei vaccine strain 6S (isolated by Yu. A. Belaya), as well as streptomycin-dependent Sh. flexneri strain 2a 1605/3 (isolated by V. V. Sergeev) were introduced into the ligated loops of the rabbit ileum. The use of light and immunofluorescent microscopy, the measurement of the volume of the fluid in the intestinal loops and the quantitative inoculation of their contents resulted in revealing the differences in the properties of the virulent and vaccine strains. The vaccine strains, in contrast to the virulent strains, did not proliferate in the lumen and did not cause the accumulation of fluid in the intestinal loops. They retained sharply limited, especially in the streptomycin-dependent bacteria, ability to penetrate into enterocytes and, via their cytoplasm, into the basement membrane, but lost their ability to proliferate in the cytoplasm of enterocytes (and probably even deteriorated there) and to cause plurulent ulcerous inflammation. This indicates that vaccine strains have insignificant residual virulence and suggests that the intestinal loop models, together with other models, may be used for testing the safety of vaccines prepared from Shigella strains.