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CDC warns about the rise in almost untreatable shigella bacterial infections

The Centers for Disease Control and Prevention is warning about a rise in extensively drug-resistant cases of the bacterial infection Shigella, a major cause of inflammatory diarrhea.

The agency calls the new form of the stomach bug, which causes the diarrheal condition known as shigellosis, a “serious public health threat.” Evidence suggests the illness is spreading among gay and bisexual men in particular, apparently through sexual contact, both in the U.S. and abroad. 

Eighty-seven percent of the cases were in men presumed to have sex with men.

Dr. Stephanie Cohen, the section director for HIV and STI prevention at the San Francisco Public Health Department, told NBC News that Shigella is “a really important and serious pathogen.” 

“It can cause really severe diarrhea, sometimes bloody diarrhea, cramps and abdominal pain,” she said. 

The infection can cause prolonged and debilitating illness, with about 6,400 U.S. patients needing hospitalization each year.

Death from shigellosis is rare, although it is more likely among people who are immunocompromised, such as by untreated HIV or chemotherapy for cancer.

Shigella is considered extensively drug resistant when it is not susceptible to any of the recommended first-line or alternative antibiotics, including azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole and ampicillin.

Now, doctors face a considerable challenge caring for patients with this form of Shigella. Reviewing an extensive roster of potential alternative antibiotics on the call Tuesday, Watkins noted that the medications are largely saddled with one or more limitations, such as unavailability in the U.S., lack of clinical trial data, resistance to the pathogen or the fact that they penetrate the gut lining poorly.

The CDC has called on health care providers to be vigilant for potential Shigella infections and to report suspected cases to state and local health departments, while educating people most at risk about shigellosis.

In addition to gay and bisexual men, antibiotic-resistant Shigella infections have been on the rise among people experiencing homelessness, international travelers and people living with HIV.

Of 232 cases reported from 2016 onward about which the CDC has data, 197, or 85%, were in men. Just one was in a child. Of the 41 of those people who answered questions about recent sexual activity, 88% were men reporting recent sexual contact with men.

People who have shigellosis, the CDC advises, should stay home if they work in health care, food service or child care. The agency also advises that during the illness and for two weeks after, people should avoid preparing food for others, wash hands often, refrain from swimming and abstain from sexual contact, or at least observe rigorous hygiene before and after sexual activity.

“The clinical pipeline, the drugs that are in human testing, is fragile, and there’s not enough there,” said Kevin Outterson, the executive director of CARB-X, a Boston-based nonprofit group that seeks to spur innovation in early antibiotic research and development.

There are encouraging signs with antibiotic development, at least in early phases, Outterson said.

“If you want a drug that’s going to work against this disease or any other bacteria in 2033, we need to be working on that today,” he said.

Benjamin Ryan is independent journalist specializing in science and LGBTQ coverage. He contributes to NBC News, The New York Times, The Guardian and Thomson Reuters Foundation and has also written for The Washington Post, The Nation, The Atlantic and New York.

Category: Science

Source: NBC Science

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