The Centers for Disease Control and Prevention is warning of an increase in cases of the bacterial infection Shigella, a leading cause of drug-resistant, inflammatory diarrhea.
The agency calls the new form of the stomach virus, which causes the diarrheal condition known as shigellosis, a «serious threat to public health.» Evidence suggests that the disease is spreading among gay and bisexual men in particular, apparently through sexual contact, both in the US and abroad.
the cdc made a call on Tuesday with the Colorado Department of Public Health and Environment and the UK Health Security Agency to alert doctors to the spread of a form of the bacteria that is resistant to all normally recommended antibiotic treatments.
“Today we do not have all the answers”, Dr. Louise Francois Watkins, medical officer with CDC’s National Center for Emerging and Zoonotic Infectious Diseases, on the call. The agency, he said, could not make official recommendations on alternatives to antibiotics.
An ongoing parallel outbreak of nearly 200 recent cases of widely drug-resistant Shigella in Britain that the UK health agency announced last month it was most likely due to a single initial infection, British health officials said on Tuesday’s call. That speaks to how widely individual drug-resistant strains of infection can spread and the importance of infection control.
The CDC said in a health alert on Friday that the proportion of the roughly 450,000 annual Shigella infections in the US that were resistant to all known antibiotic treatments rose from zero in 2015 to 0.4% in 2019 and to 5% last year, an indicator of a possible further spread.
Shigella, which is highly infectious, extends when infected fecal matter enters the mouth or nose, including through sexual activity or due to poor hand washing after changing diapers, unsanitary handling of food, or swimming in contaminated water. The infection is typically seen in young children.
The European Center for Disease Prevention and Control issued an alert on Friday about 221 confirmed cases and 37 possible among people who traveled to Cape Verde off West Africa since September and returned home to a dozen countries, including the US.
During the CDC call on Tuesday, officials from the UK health agency said they had tested all but four of the 185 cases of infection in Britain since the end of the week. 2021. Half required antibiotic treatment. Shigella samples retained susceptibility to four antibiotics: carbapenems, chloramphenicol, fosfomycin, and temocillin.
Eighty-seven percent of the cases were in men presumed to have sex with men.
Dr. Stephanie Cohen, director of the HIV and STI prevention section at the San Francisco Department of Public Health, told NBC News that Shigella is «a really important and serious pathogen.»
“It can cause really severe diarrhea, sometimes bloody diarrhea, cramps and abdominal pain,” he said.
Shigellosis usually it goes away without treatment. But doctors can prescribe antibiotics to speed recovery or prevent complications in more vulnerable patients.
The infection can cause a prolonged and debilitating illness, with about 6,400 US patients requiring hospitalization each year.
Death from shigellosis is rare, although it is more likely among immunocompromised people, such as from untreated HIV or cancer chemotherapy.
Shigella is considered extremely drug resistant when it is not susceptible to any of the recommended first-line or alternative antibiotics, including azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin.
From May 2014 to February 2015, the Centers for Disease Control and Prevention identified 243 US cases of travel-associated Shigella that were resistant to most, but not all, of these antibiotics.
Clinicians now face a considerable challenge in caring for patients with this form of Shigella. Reviewing a lengthy list of potential alternative antibiotics on Tuesday’s call, Watkins noted that the drugs largely have one or more limitations, including lack of availability in the US, lack of clinical trial data, lack of resistance to the pathogen or the fact that they penetrate the intestinal lining is poor.
The CDC has asked health care providers to be vigilant for possible Shigella infections and to report suspected cases to state and local health departments, while also educating those most at risk about shigellosis.
In addition to gay and bisexual men, antibiotic-resistant Shigella infections have been on the rise among the homeless, international travelers, and people living with HIV.
Of the 232 reported cases as of 2016 for which the CDC has data, 197, or 85%, were in men. Only one was in a child. Of the 41 of those people who responded to questions about recent sexual activity, 88% were men who reported recent sexual contact with men.
Meanwhile, sexually transmitted gonorrhea, chlamydia, and syphilis have risen steadily in recent years and are particularly frequent between gay and bisexual men. The CDC has increasingly issued urgent warnings that gonorrhea is at risk of lose susceptibility down to the last simple and effective antibiotic left to treat the infection.
People who have shigellosis, the CDC advises, should stay home if they work in health care, food service or child care. The agency also advises that during illness and for two weeks afterward, people should avoid preparing food for others, wash their hands frequently, refrain from swimming and refrain from sexual contact, or at least observe rigorous hygiene before and after sexual activity.
World Health Organization appointment Drug-resistant pathogens, the emergence of which is largely driven by the misuse and overuse of antibiotics in people and livestock, as one of the top 10 global public health threats facing humanity.
“The clinical pipeline, the drugs that are being tested in humans, is fragile and there isn’t enough of it there,” said Kevin Outterson, executive director of CARB-X, a Boston-based nonprofit group that seeks to spur innovation in early antibiotic research. and development.
There are encouraging signs with antibiotic development, at least in the early phases, Outterson said.
“If you want a drug that works against this disease or any other bacteria in 2033, we need to work on it today,” he said.
The new Shigella raises concerns in the wake of the global outbreak of mpox (formerly monkeypox), which has spread overwhelmingly through male-to-male sex. Cases of the virus, first identified in Britain in mid-May, peaked in the US and internationally in early August and have largely declined.
Similar to shigella cases, mpox infections, which can be severe, usually resolve without treatment and are rarely fatal. However, an article published February 21 in The Lancet found a mortality rate from mpox as high as 15% among people substantially immunocompromised by HIV.