{"id":29560,"date":"2016-02-01T12:04:54","date_gmt":"2016-02-01T12:04:54","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=29560"},"modified":"2016-02-05T16:59:48","modified_gmt":"2016-02-05T16:59:48","slug":"public-health-england-reports-cases-of-microbial-resistant-shigella","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/29560","title":{"rendered":"Public Health England reports cases of microbial resistant Shigella"},"content":{"rendered":"<p><strong>PHE press statement<\/strong><\/p>\n<p><strong>Public Health England (PHE) recently identified five cases of <em>Shigella sonnei<\/em> phage type 6 which show high levels of antimicrobial resistance &#8211; typically only seen before in <em>Shigella<\/em> infections associated with travel and therefore imported.<\/strong><\/p>\n<p>The <em>Shigella sonnei<\/em> isolated in these cases are clustered by whole genome sequencing suggesting they belong to an outbreak.<\/p>\n<p>Four cases are adult men who have sex with men (MSM) from London with sample dates from 21 September to 27 October inclusive. The fifth case, from mid-November, is an adult man from outside London with a likely sexual exposure in London.<\/p>\n<p>The isolates from these cases have genes conferring resistance to amoxicillin, ceftriaxone (first line treatment for HIV positive individuals with invasive shigellosis), trimethoprim, sulphonamides, tetracycline, including the extended-spectrum beta-lactamase (ESBL) resistance gene CTX-M-27 and macrolide resistance genes ermB\/mph(A). These resistance genes are plasmid mediated and therefore readily transmissible. The isolates are phenotypically sensitive to quinolones, carbapenems, aminogylcosides and fosfomycin.<\/p>\n<p>Our primary concerns are as follows: a) that this strain might spread rapidly among HIV positive MSM in high-risk sexual networks, including outside of London b) potential spread of resistance to other <em>Shigella<\/em> and other organisms c) the possibility of treatment failure for severe shigellosis disease in the immunocompromised.<\/p>\n<p>PHE would therefore recommend that all GUM and HIV doctors:<\/p>\n<ul>\n<li>Provide written advice to all MSM attending their services (especially HIV positive patients) on how to prevent infection with <em>Shigella<\/em>. Materials are available on the PHE website here:<br \/>\n<a href=\"https:\/\/www.gov.uk\/government\/publications\/shigella-leaflet-and-poster\">https:\/\/www.gov.uk\/government\/publications\/shigella-leaflet-and-poster<\/a><\/li>\n<li>Obtain appropriate and timely stool samples for patients presenting with acute diarrhoea, abdominal pain and fever.<\/li>\n<li>Provide advice to patients with Shigella on how to prevent onward transmission.<\/li>\n<li>Discuss the need for antibiotic management of severe disease (fever, bloody diarrhoea or signs of sepsis) with their microbiologist.<\/li>\n<li>Notify cases to their local Health Protection Team.<\/li>\n<li>Record any <em>Shigella<\/em> diagnosis in England using the appropriate SHHAPT code (SG1, SG2 or SG3) in the patient&#8217;s medical record, so that it can be reported in GUMCAD. See SHHAPT code look-up here:<br \/>\n<a href=\"https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/420625\/GUMCADv2_SHHAPT_Code_Look-up.pdf\">https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/420625\/GUMCADv2_SHHAPT_Code_Look-up.pdf<\/a>\u00a0(PDF)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>PHE press statement Public Health England (PHE) recently identified five cases of Shigella sonnei phage type 6 which show high levels of antimicrobial resistance &#8211; typically only seen before in Shigella infections associated with travel and therefore imported. The Shigella &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-29560","post","type-post","status-publish","format-standard","hentry","category-other-news"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/29560","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=29560"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/29560\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=29560"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=29560"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=29560"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}