Association between shigella infection and diarrhea varies based on location and age of children

Brianna Lindsay, Debasish Saha, Doh Sanogo, Sumon Kumar Das, Richard Omore, Tamer H. Farag, Dilruba Nasrin, Shan Li, Sandra Panchalingam, Myron M. Levine, Karen Kotloff, James P. Nataro, Laurence Magder, Laura Hungerford, A. S G Faruque, Joseph Oundo, M. Anowar Hossain, Mitchell Adeyemi, Oscar Colin Stine

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case-control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28-0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24-35 months of age (OR = 8.2, 95% CI = 4.3-15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3-23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.

Original languageEnglish (US)
Pages (from-to)918-924
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number5
StatePublished - Nov 4 2015
Externally publishedYes

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology


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