Shigellosis due to Shigella sonnei is rare among people growing up and living in developing countries; however, infections due to S sonnei becomes more common than those due to S flexneri as societies develop economically. The relation between risk of S sonnei infection and economic development may be explained by the exposure of developing-country populations to Plesiomonas shigelloides. P shigelloides is often found in surface water, and one serotype (serotype 17) possesses a cell-wall lipopolysaccharide identical to that of S sonnei. Thus, exposure to P shigelloides by drinking contaminated water may immunise populations to S sonnei. As economic development occurs, water quality improves and populations become susceptible to S sonnei. Although drinking pure water has many advantages, immunisation against S sonnei may be one benefit of traditional water sources.
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