Epidemic Shigella dysenteriae type 1 in Burundi: panresistance and implications for prevention.

An epidemic of Shigella dysenteriae type 1 infections has affected Africa since 1979. Reported dysentery cases increase sharply in Burundi during September through December. Of stool samples from 189 patients reporting bloody diarrhea in November 1990, a pathogen was identified in 123 (65%). The pathogen was S. dysenteriae type 1 in 82 (67%). All S. dysenteriae type 1 isolates were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Thirty-two specimens (26%) yielded other Shigella species. Patients with S. dysenteriae type 1 were more likely than those with other Shigella infections to have abdominal pain, "lots of blood" in the stool, blood in the stool specimen examined by the interviewer, recent contact with a person with dysentery, or recent antimicrobial treatment. Thus, the seasonal increase in dysentery was due largely to multidrug-resistant S. dysenteriae type 1, clinical and epidemiologic features may predict such infection, and efforts to control this epidemic must focus on preventing transmission.

Foodborne disease outbreaks, 5-year summary, 1983-1987.

This report summarizes data from foodborne disease outbreaks reported to CDC from 1983 through 1987. With a few exceptions, an outbreak is defined as an incident in which two or more persons experience a similar illness and food is implicated. During this period, 2,397 outbreaks of foodborne disease were reported, representing 91,678 cases. Among outbreaks in which the etiology was determined, bacterial pathogens caused the largest number of outbreaks (66%) and cases (92%). Chemical agents caused 26% of outbreaks and 2% of cases. Parasites caused 4% of outbreaks and less than 1% of cases, and viruses caused 5% of outbreaks and 5% of cases. The discrepancies between the number of outbreaks and the number of cases attributed to each etiologic agent emphasizes the importance of evaluating both numbers before drawing conclusions. The etiologic agent was not determined in 62% of outbreaks, reflecting the need for improved investigative skills. The number of outbreaks reported by this surveillance system is only a small fraction of the true number that occur. The likelihood of an outbreak's being reported depends on many factors, such as ease of recognition and ease of laboratory confirmation. Sporadic foodborne illness is far more common and is not included in this report.