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Open Access Research article

A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation

Ha Vinh12, Nguyen Thi Khanh Nhu12, Tran Vu Thieu Nga12, Pham Thanh Duy12, James I Campbell23, Nguyen Van Minh Hoang12, Maciej F Boni234, Phan Vu Tra My12, Christopher Parry2, Tran Thi Thu Nga12, Pham Van Minh12, Cao Thu Thuy12, To Song Diep2, Le Thi Phuong5, Mai Thu Chinh2, Ha Thi Loan2, Nguyen Thi Hong Tham5, Mai Ngoc Lanh2, Bui Li Mong5, Vo Thi Cuc Anh5, Phan Van Be Bay5, Nguyen Van Vinh Chau2, Jeremy Farrar12 and Stephen Baker12*

Author Affiliations

1 The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam

2 Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam

3 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK

4 The MRC Centre for Genomics and Global Health, Oxford, UK

5 Dong Thap Provincial Hospital, Dong Thap, Vietnam

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BMC Infectious Diseases 2009, 9:204  doi:10.1186/1471-2334-9-204

Published: 15 December 2009

Abstract

Background

Shigellosis remains considerable public health problem in some developing countries. The nature of Shigellae suggests that they are highly adaptable when placed under selective pressure in a human population. This is demonstrated by variation and fluctuations in serotypes and antimicrobial resistance profile of organisms circulating in differing setting in endemic locations. Antimicrobial resistance in the genus Shigella is a constant threat, with reports of organisms in Asia being resistant to multiple antimicrobials and new generation therapies.

Methods

Here we compare microbiological, clinical and epidemiological data from patients with shigellosis over three different periods in southern Vietnam spanning14 years.

Results

Our data demonstrates a shift in dominant infecting species (S. flexneri to S. sonnei) and resistance profile of the organisms circulating in southern Vietnam. We find that there was no significant variation in the syndromes associated with either S. sonnei or S. flexneri, yet the clinical features of the disease are more severe in later observations.

Conclusions

Our findings show a change in clinical presentation of shigellosis in this setting, as the disease may be now more pronounced, this is concurrent with a change in antimicrobial resistance profile. These data highlight the socio-economic development of southern Vietnam and should guide future vaccine development and deployment strategies.

Trial Registration

Current Controlled Trials ISRCTN55945881