<b>Epidemiology of Multidrug-resistant </b><b><i>Shigella</i></b><b> in Nairobi, Kenya: The role of asymptomatic carriage and environment</b>
Creators: name: Kering, Kelvin
Publisher: name: figshare
Year: 2024
Subjects: classificationCode: 310701
subject: Bacteriology

description: Shigella was the second most prominent cause of diarrhoeal-associated mortality among all ages and resulted in 212 438 (95% UI: 136 979–326 913) mortalities globally in 2016. Whereas it was the leading cause of mortality among diarrhoeal patients older than 70 years, it resulted in 63,713 deaths among children under five years with the highest burden of mortality in sub-Saharan Africa. In Kenya, studies have reported a Shigellosis prevalence of 18.7– 20.1% among children under five years. The emergence of antimicrobial resistance (AMR) in Shigella is a huge public health challenge globally. In 2017, the World Health Organisation (WHO) declared fluoroquinolone-resistant Shigella spp among the priority pathogens for the development of new antibiotics. Of concern in Kenya is the emergence and increasing resistance of Shigella to ceftriaxone and fluoroquinolones. Considering that asymptomatic shedding of Shigella, can serve as a source of person-to-person transmission of Multidrug Resistance (MDR) Shigella spp, there is a need to determine the impact of carriage on shigellosis incidence. Given that poor waste disposal in informal settlements could result in the presence and persistence of Shigella spp in the environment, there is a need to determine the role of the environment in the transmission of multi-drug resistant Shigella. This study aims to determine the epidemiology, carriage and genomic profile of MDR Shigella in patients and asymptomatic carriers and the role of the environment as a probable source of MDR Shigella and Antibiotic Resistant Genes (ARGs). In this study, 1,554 patients presenting with diarrhoea at four outpatient health facilities in Mukuru will be recruited after obtaining informed consent. Stool/ rectal swab samples will be collected and subjected to culture for isolation of Shigella. Presumptive non-duplicate isolates will be identified through biochemical tests. Antimicrobial susceptibility tests will be conducted through the disc diffusion method. Index patients with confirmed Shigella-positive samples will be followed to their households to recruit one contact to check for asymptomatic shedding. Both the index patient and contact will then be followed up for a month during which stool samples will be collected at five time points (day 0, day 3, day 7, day 14 and day 28) and subjected to culture. Open drain samples will also be collected around the household to check for the presence of multi-drug resistant Shigella. Socio-demographic, clinical and geolocation data will also be collected. Whole Genome Sequencing (WGS) will be done to determine the genomic properties of the Shigella isolates. Data from the proposed study will consist of; the prevalence of Shigella in acute disease, the prevalence of multidrug-resistant Shigella, the duration of asymptomatic carriage, Shigella spp present in the environment, genomic sequence data of the isolates, sociodemographic and clinical data associated with Shigella. The data obtained will be critical in informing plausible Shigellosis control measures.