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Author Spotlight: Advancements in Understanding and Combatting Shigella Infections
Published on: February 9, 2024
The Impact of Non-Dysentery Shigella Infection on the Growth and Health of Children over Time (INSIGHT)-A Prospective
Subhra Chakraborty1, Sampa Dash2, Nowrin Akbar Antara2
1Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Insights
Non-dysentery Shigella-associated diarrhea (NDSD) in children poses significant risks, contrary to current treatment guidelines. Early diagnosis and intervention are crucial for improving outcomes in young children with shigellosis.
Area of Science:
- Infectious Diseases
- Pediatrics
- Public Health
Background:
- Shigella infections commonly cause non-dysentery diarrhea (NDSD) in children, often leading to underdiagnosis and undertreatment.
- Current World Health Organization guidelines recommend antibiotics only for bloody diarrhea, potentially neglecting severe outcomes associated with NDSD.
- The INSIGHT study investigates the underappreciated impact of NDSD on child morbidity and mortality.
Purpose of the Study:
- To compare the health outcomes of children with NDSD to those with Shigella dysentery (DS) and non-Shigella watery diarrhea (WD).
- To evaluate the effectiveness of a Rapid LAMP-based Diagnostic Test (RLDT) for early shigellosis detection in rural Bangladesh.
- To inform potential revisions of shigellosis treatment guidelines to improve child health and development.
Main Methods:
- Prospective cohort study enrolling children with NDSD, DS, and WD in Bangladesh.
- Longitudinal follow-up for 1 year (NDSD, DS) or 90 days (WD) to assess morbidity, mortality, and nutritional status.
- Implementation and assessment of a novel Rapid LAMP-based Diagnostic Test (RLDT) for Shigella detection.
Main Results:
- Data collection and analysis are ongoing; specific results will be reported upon study completion.
- The study will quantify the impact of NDSD on child morbidity, mortality, gut health, nutrition, and cognitive development.
- The study will assess the feasibility and impact of RLDT implementation in clinical settings.
Conclusions:
- Findings will elucidate the clinical significance of NDSD in pediatric populations.
- The study aims to provide evidence for revising global treatment guidelines for shigellosis.
- Improved diagnostic and treatment strategies are expected to enhance outcomes for children affected by Shigella infections.
Abstract:
(1) Shigella spp. (Shigella) is known for causing dysentery with blood in stool, but most children infected with Shigella have non-dysentery Shigella-associated diarrhea (NDSD). The World Health Organization recommends the use of antibiotics when diarrhea is bloody, leaving most NDSD cases untreated. The absence of dysentery may not indicate a low risk of death and severe morbidity. Rapid diagnosis and treatment of shigellosis in vulnerable, young children may be lifesaving. INSIGHT aims to determine the potential benefit of identifying NDSD cases (n = 296) and their outcomes compared to cases of Shigella dysentery [DS (n = 148)] and non-Shigella watery diarrhea [WD (n = 148)]. (2) Children seeking care at hospitals in Bangladesh will be enrolled and followed for 1 year (NDSD and DS) or 90 days (WD). We will determine the impact of NDSD on morbidity, mortality, gut health, nutritional status, and cognitive development compared to DS and WD in children and whether the simple "Rapid LAMP-based Diagnostic Test (RLDT)" can accelerate the detection and treatment of shigellosis in the clinical settings of rural Bangladesh. (3) INSIGHT will determine the impact of NDSD in children and determine if the treatment guidelines of shigellosis need to be revisited to improve clinical outcomes and the development of these children.
