ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
The Clinical Presentation of Culture-positive and Culture-negative, Quantitative Polymerase Chain Reaction (qPCR)-Attributable Shigellosis in the Global Enteric Multicenter Study and Derivation of a Shigella Severity Score: Implications for Pediatric Shigella Vaccine Trials.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Burden of Shigella among children with diarrhea in the Americas: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2025Pooled it
- Fecal biomarkers to characterize intestinal inflammation among children with medically attended diarrhea across six low-resource settings: Findings from the Enterics for Global Health (EFGH) Shigella surveillance study.PLoS neglected tropical diseases · 2026Article
- Effects ofmedRxiv : the preprint server for health sciences · 2026Article
- The incidence and antimicrobial resistance of Shigella-attributable diarrhoea in young children in low-income and middle-income countries from the multicountry Enterics for Global Health (EFGH) Shigella Surveillance Study: a prospective, facility-based hybrid surveillance study.The Lancet. Global health · 2026Article
- Shigella flexneri and Shigella sonnei among children under five in Kenya's urban informal settlement.Gut pathogens · 2026Article
- Gut bacteria-derived sphingolipids alter innate immune responses to oral cholera vaccine antigens.Nature communications · 2025Article
- Shigellosis.Lancet (London, England) · 2025Review
- Fecal microbiome profiling of children withMicrobiology spectrum · 2025Article
- Article
- The Application of the Vesikari and Modified Vesikari Severity Scores in Complicated Pediatric Gastroenteritis of Viral Origin: An Observational Study.Journal of clinical medicine · 2025Article
- Exploring Natural Immune Responses toOpen forum infectious diseases · 2024Article
- Evaluation of Fecal Inflammatory Biomarkers to Identify Bacterial Diarrhea Episodes: Systematic Review and Protocol for the Enterics for Global HealthOpen forum infectious diseases · 2024Article
- Diarrhea Case Surveillance in the Enterics for Global HealthOpen forum infectious diseases · 2024Article
- Qualitative Assessment of a Smartphone-Based Mobile Health Tool to Guide Diarrhea Management in Bangladesh.The American journal of tropical medicine and hygiene · 2024Article
- No Isolate, No Problem: Using a Novel Insertion Sequence PCR to Link Rats to Human Shigellosis Cases in an Underserved Urban Community.Microbiology spectrum · 2023Article
- Design of a Bacteriophage Cocktail Active againstAntibiotics (Basel, Switzerland) · 2022Article
- PivotalVaccines · 2022Article
- What Drives the Value of aVaccines · 2022Article
- Evaluation of a simple, rapid and field-adapted diagnostic assay for enterotoxigenic E. coli and Shigella.PLoS neglected tropical diseases · 2022Article
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52 authors.
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Abstract
backgroundShigella is a leading cause of childhood diarrhea and target for vaccine development. Microbiologic and clinical case definitions are needed for pediatric field vaccine efficacy trials.
methodsWe compared characteristics of moderate to severe diarrhea (MSD) cases in the Global Enteric Multicenter Study (GEMS) between children with culture positive Shigella to those with culture-negative, quantitative polymerase chain reaction (qPCR)-attributable Shigella (defined by an ipaH gene cycle threshold <27.9). Among Shigella MSD cases, we determined risk factors for death and derived a clinical severity score.
resultsCompared to culture-positive Shigella MSD cases (n = 745), culture-negative/qPCR-attributable Shigella cases (n = 852) were more likely to be under 12 months, stunted, have a longer duration of diarrhea, and less likely to have high stool frequency or a fever. There was no difference in dehydration, hospitalization, or severe classification from a modified Vesikari score. Twenty-two (1.8%) Shigella MSD cases died within the 14-days after presentation to health facilities, and 59.1% of these deaths were in culture-negative cases. Age <12 months, diarrhea duration prior to presentation, vomiting, stunting, wasting, and hospitalization were associated with mortality. A model-derived score assigned points for dehydration, hospital admission, and longer diarrhea duration but was not significantly better at predicting 14-day mortality than a modified Vesikari score.
conclusionsA composite severity score consistent with severe disease or dysentery may be a pragmatic clinical endpoint for severe shigellosis in vaccine trials. Reliance on culture for microbiologic confirmation may miss a substantial number of Shigella cases but is currently required to measure serotype specific immunity.
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