Ciprofloxacin-resistant
shigellosis outbreaks among men who have sex with men (MSM) have not been
reported in Asia. During March 3-May 6, 2015, the Notifiable Disease
Surveillance System (NDSS) detected nine non-imported Shigella sonnei
infections among HIV-infected Taiwanese MSM.
We conducted a molecular
epidemiologic investigation using a 1:5 matched case-control study and
laboratory characterizations for the isolates. Of the nine patients, four
reported engagement in oral-anal sex before illness onset. Shigellosis was associated
with a syphilis report within 12 months (adjust odds ratio [aOR]: 8.6; 95%
confidence interval [CI]: 1.05-70.3) and no HIV outpatient follow-up within
12 months (aOR: 22.3; 95% CI: 2.5-201). S. sonnei isolates from the nine
patients were all ciprofloxacin-resistant and the resistance was associated
with S83L and D87G mutations in gyrA and S80I mutation in parC. The nine
outbreak isolates were discriminated into two closely related pulsed-field gel
electrophoresis (PFGE) genotypes and seven 8-locus multilocus variable-number
tandem repeat analysis (MLVA8) types that suggest multiple sources of
infections for the outbreak and possible under-recognition of infection among
Taiwanese MSM.
The outbreak isolates were characterized to be variants of the
intercontinentally-transmitted SS18.1 clone which falls into the globally
prevalent phylogenetic sublineage IIIb. Inter-database pattern similarity
searching indicated that the two PFGE genotypes had emerged in the United
States and Japan.
The epidemiologic characteristics of this outbreak suggest
roles of risky sexual behaviors or networks in S. sonnei transmission. We urge
enhanced surveillance and risk-reduction interventions regionally against
interplay of HIV and shigellosis among MSM.
Purchase full article at: http://goo.gl/hkLjJP
- 1Taiwan Centers for Disease Control, Taipei, Taiwan.
- 2National Institute of Infectious Diseases, Tokyo, Japan.
- 3Tokyo Metropolitan Institute of Public Health, Tokyo, Japan.
- 4Taiwan Centers for Disease Control, Taipei, Taiwan. Electronic address: loyichun@cdc.gov.tw.
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