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Abstract
Treatment Recommendation and Evaluation of Pathogenic Contribution of Shigella species to diarrheal episodes among HIV-seropositive patients in Lagos, Nigeria.
Iwalokun B.1, Ogunledun A.2, Uwah A.3, Coker C.4
Introduction: The pathogenic contribution of Shigella to diarrhea -mediated deterioration HIV infection remains unknown in many endemic loci in developing countries. This silent confounding factor may compromise the therapeutic efficacy of antidiarrheal regimens, promote diarrhea recurrence and cause early mortality in HIV-seropositive patients.
Objectives: To determine the incidence of shigellosis, antibiotic susceptibility and contribution to bacteremia in HIV-seropositive patients.
Methods: A total of 71 consecutive HIV-seropositive patients aged 21 – 48 yr with watery and bloody diarrhea at Tertiary Care Centres in Lagos, Nigeria were prospectively enrolled. The stool and blood samples collected were cultured on standard media for the isolation of aetiologic pathogens including shigellae. The recovered Shigella isolates were serotyped and their antibiotic sensitivities determined by microbroth dilution technique. Chi-square, regression and plasmid analyses were also done.
Results: 9 (12.7%) Shigella sp. comprising S. flexneri 2a (n = 3), S. flexneri 6 (n = 2), S. dysenteriae 1 (n = 1) and S. dysenteriae - non type 1 (n = 3) were found in the stool cultures examined. Diarrhea cases involving these serotypes have polymicrobial aetiology with significant (P < 0.05) association with E. coli compared to other bacteria pathogens. S flexneri 2a accounted for 2 (12.5%) of the 15 bacteremia cases detected. All the Shigella isolates were multidrug resistant including moderate resistance to ceftriaxone by the 2 bacteremic strains. The sensitivity of the isolates to ampicillin-sulbactam combination improved after plasmid (2 – 14kb) curing. None of the isolates was resistant to ciprofloxacin.The occurrence of shigellosis was strongly associated (P < 0.05) with CD4 lymphocyte depletion of < 400 cells/mm3 and viral load elevation (> 3000 RNA copies /ml).
Conclusions: Shigella contributes to diarrhea in HIV-seropositive patients in Nigeria with increased risk in those with low CD4 lymphocyte count but with a high possibility of preventing recurrent diarrhea using fluoroquinolones combined with effective ARV regimens.
The 3rd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
TuPe7.5C02
Suggested Citation
"IwalokunB., et al.
Treatment Recommendation and Evaluation of Pathogenic Contribution of Shigella species to diarrheal episodes among HIV-seropositive patients in Lagos, Nigeria..
Poster Exhibition:
The 3rd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
TuPe7.5C02"
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