Infekcja shigella, inaczej szigellosis – Rokowania, prognozy i postęp choroby

Infekcja shigella, inaczej szigellosis
Rokowania, prognozy i postęp choroby

Infekcja Shigella (szigellosis) jest istotnym problemem zdrowotnym, szczególnie u niemowląt i małych dzieci, charakteryzującym się samoograniczającym przebiegiem trwającym zwykle 5-7 dni. Rokowanie jest korzystne przy wczesnej diagnostyce i terapii, jednak czynniki takie jak opóźnienie leczenia, immunosupresja, wiek skrajny, bakteriemia (z 20% śmiertelnością) oraz przedłużający się przebieg choroby powyżej 7 dni znacząco pogarszają prognozę. Powikłania, w tym zespół hemolityczno-mocznicowy z 50% śmiertelnością, stanowią poważne zagrożenie. Epidemiologicznie, ryzyko ciężkiego przebiegu wzrasta z wiekiem (RR 1,75 na każde 6 miesięcy), przy nieodpowiednich warunkach sanitarnych (RR 1,15), niskim wykształceniu matki (RR 1,14), wczesnym wprowadzeniu pokarmów uzupełniających (RR 1,10) oraz niedożywieniu (RR 0,91 na jednostkę z-score masy ciała do wieku). Do 2. roku życia 82% dzieci ulega zakażeniu, a 29,6% doświadcza biegunki wywołanej Shigellą.

Wstęp do prognozy infekcji Shigella (szigellosis)
Naturalny przebieg choroby

Czynniki złej prognozy
Powikłania infekcji

Czynniki ryzyka i wskaźniki prognostyczne
Predyktory hospitalizacji

Czynniki wpływające na hospitalizację

Znaczenie diagnostyki w prognozowaniu
Zmienność geograficzna prognozy
Podsumowanie czynników prognostycznych

Czynniki związane z pacjentem
Czynniki związane z patogenem
Czynniki związane z leczeniem
Czynniki środowiskowe
Kolejne rozdziały

Wstęp do prognozy infekcji Shigella (szigellosis)

Infekcja Shigella, znana również jako szigellosis, jest chorobą bakteryjną powodującą znaczącą chorobowość i śmiertelność zarówno w krajach rozwijających się, jak i rozwiniętych, zwłaszcza wśród niemowląt i małych dzieci¹. Przewidywanie przebiegu choroby i możliwych komplikacji jest kluczowym elementem w procesie podejmowania decyzji klinicznych dotyczących leczenia pacjentów z szigellosis. Najnowsze metody diagnostyczne niezależne od hodowli ujawniły większe obciążenie Shigella wśród dzieci w środowiskach o niskich zasobach niż wcześniej rozpoznawano², co podkreśla znaczenie dokładnej prognozy dla skutecznego zarządzania przypadkami.

Naturalny przebieg choroby

Szigellosis jest zazwyczaj chorobą samoograniczającą się i ustępuje w ciągu 5 do 7 dni³. Jeśli infekcja Shigella zostanie zdiagnozowana i leczona na czas, rokowanie jest dobre, a pacjenci zwykle wracają do zdrowia bez następstw⁴. Jednakże występowanie pewnych niekorzystnych czynników prognostycznych może zwiększyć zachorowalność i śmiertelność.

Czynniki złej prognozy

Do czynników pogarszających rokowanie zaliczamy⁵:

Opóźnienia w podawaniu odpowiedniej terapii
Stan immunokompromitowany pacjenta
Przedłużony czas trwania choroby powyżej 7 dni
Skrajne wartości wieku (bardzo małe dzieci i osoby starsze)
Bakteriemia

⁶

Bakteriemia, która występuje rzadko i głównie u niedożywionych dzieci, niesie ze sobą 20% wskaźnik śmiertelności⁷. Dodatkowo, pacjenci starsi wykazują wyższe wskaźniki hospitalizacji w porównaniu do ich odsetka w populacji, mimo że zachorowalność na Shigellę jest znacznie wyższa wśród niemowląt i małych dzieci⁸.

Powikłania infekcji

Powikłania szigellosis obejmują zespół hemolityczno-mocznicowy, definiowany jako triada: trombocytopenia, niedokrwistość hemolityczna i ostre uszkodzenie nerek⁹. Wskaźnik śmiertelności w przypadku tego powikłania sięga nawet 50%¹⁰, co czyni go najbardziej niebezpiecznym następstwem infekcji Shigella.

Czynniki ryzyka i wskaźniki prognostyczne

Badania epidemiologiczne zidentyfikowały kilka kluczowych czynników ryzyka wpływających na przebieg i ciężkość infekcji Shigella¹¹:

Wiek – starszy wiek zwiększa ryzyko (współczynnik ryzyka [RR]: 1,75, 95% CI: 1,70, 1,81 na każde 6-miesięczne zwiększenie wieku)
Nieodpowiednie warunki sanitarne (RR: 1,15, 95% CI: 1,03, 1,29)
Niskie wykształcenie matki (<10 lat, RR: 1,14, 95% CI: 1,03, 1,26)
Wprowadzenie pokarmów uzupełniających przed 3 miesiącem życia (RR: 1,10, 95% CI: 1,01, 1,20)
Niedożywienie (RR: 0,91, 95% CI: 0,88, 0,95 na jednostkę wzrostu wskaźnika z-score masy ciała do wieku)

¹²

Obserwuje się, że częstość występowania infekcji Shigella znacznie wzrasta w drugim roku życia dziecka¹³. Do drugiego roku życia 82,0% dzieci zostaje zakażonych Shigellą, a 29,6% doświadcza co najmniej jednego epizodu biegunki przypisywanej Shigelli¹⁴.

Predyktory hospitalizacji

Hospitalizacja z powodu szigellosis ma miejsce w przypadkach ciężkich objawów, przedłużającej się choroby lub u pacjentów ze zwiększonym ryzykiem zgonu¹⁵. Głównym powodem hospitalizacji jest obawa przed odwodnieniem i potrzeba podawania płynów¹⁶.

Czynniki wpływające na hospitalizację

Badania wykorzystujące algorytmy uczenia maszynowego wykazały, że można przewidzieć potrzebę hospitalizacji pacjentów z szigellosis na podstawie kilku czynników¹⁷:

Pochodzenie etniczne – wyższa świadomość i większa dostępność opieki zdrowotnej wśród niektórych populacji może zmniejszać prawdopodobieństwo hospitalizacji
Gatunek Shigelli – pacjenci zakażeni S. flexneri mają znacznie wyższy wskaźnik hospitalizacji niż pacjenci z innymi gatunkami
Wiek – osoby starsze mają wyższe wskaźniki hospitalizacji mimo niższej zachorowalności w porównaniu z dziećmi
Sezonowość – występują zmienne wzorce infekcji w zależności od miesiąca

¹⁸

Narzędzia obliczeniowe oparte na uczeniu maszynowym mogą pomóc lekarzom w podejmowaniu świadomych decyzji dotyczących hospitalizacji pacjenta w czasie rzeczywistym, na podstawie szerokiego zbioru danych, w przeciwieństwie do obecnej praktyki podejmowania decyzji opartej na intuicji i ograniczonych informacjach¹⁹.

Znaczenie diagnostyki w prognozowaniu

Metody diagnostyki niezależnej od hodowli bakteryjnej pozwoliły na zidentyfikowanie większej liczby przypadków klinicznie istotnych infekcji Shigella niż tradycyjne metody hodowlane²⁰. Epizody biegunki wywołanej przez Shigellę są bardziej prawdopodobnie ciężkie i mniej prawdopodobnie pozytywne w hodowli u młodszych dzieci²¹.

Tradycyjna diagnostyka oparta na hodowli nie wykrywa większości istotnych klinicznie przypadków ciężkiej biegunki i czerwonki²², co może prowadzić do opóźnień w diagnozie i leczeniu, a w konsekwencji do gorszego rokowania.

Zmienność geograficzna prognozy

Obciążenie infekcją Shigella znacznie różni się w zależności od lokalizacji geograficznej, ale jednolicie wzrasta w drugim roku życia i jest związane ze stanem zapalnym jelit²³. Częstość występowania Shigelli w stolcach bez biegunki waha się od 4,9% do 17,8% w różnych lokalizacjach, a częstość występowania biegunki przypisywanej Shigelli wynosi 31,8 przypadków (95% CI: 29,6, 34,2) na 100 dziecko-lat²⁴²⁵.

Wysokie obciążenie chorobą Shigella udokumentowane w badaniach podkreśla potencjalną użyteczność szczepionek przeciwko Shigelli w poprawie rokowania w populacjach wysokiego ryzyka²⁶.

Podsumowanie czynników prognostycznych

Rokowanie w infekcji Shigella zależy od wielu czynników, które można podzielić na kilka kategorii:

Czynniki związane z pacjentem

Wiek (skrajne wartości: bardzo małe dzieci i osoby starsze)
Stan odżywienia (niedożywienie zwiększa ryzyko)
Stan immunologiczny (immunosupresja pogarsza rokowanie)
Pochodzenie etniczne i dostęp do opieki zdrowotnej

²⁷²⁸²⁹

Czynniki związane z patogenem

Gatunek Shigella (S. flexneri wiąże się z wyższym wskaźnikiem hospitalizacji)
Obecność bakteriemii (rzadka, ale z wysoką śmiertelnością)

³⁰³¹

Czynniki związane z leczeniem

Czas do rozpoczęcia odpowiedniej terapii
Dostępność nawodnienia i opieki medycznej

³²³³

Czynniki środowiskowe

Warunki sanitarne
Dostęp do czystej wody
Praktyki żywieniowe w przypadku niemowląt

³⁴

Zrozumienie tych czynników prognostycznych pozwala na lepsze przewidywanie przebiegu infekcji Shigella i wdrożenie odpowiednich strategii profilaktycznych oraz terapeutycznych, co może znacząco poprawić wyniki leczenia i zmniejszyć śmiertelność związaną z tą chorobą.

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Materiały źródłowe

#1 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
Shigellosis causes significant morbidity and mortality in developing and developed countries, mostly among infants and young children. […] Hospitalisation due to Shigellosis is in cases of severe symptoms, a prolonged illness or in case of patients with increased risk of death. […] The higher awareness and the higher accessibility for health care among the Jewish population may also explain our findings regarding the significant contribution of the ethnicity feature as a predictor for hospitalisation, according to which, Jews are less likely to be hospitalised (comparing with other populations). […] Shigella morbidity is much higher among infants and young children in comparison with their rates in the population. However, we find higher rates of hospitalisation among elderly people.
#2 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.
#3 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#4 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#5 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#6 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#7 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#8 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
Shigellosis causes significant morbidity and mortality in developing and developed countries, mostly among infants and young children. […] Hospitalisation due to Shigellosis is in cases of severe symptoms, a prolonged illness or in case of patients with increased risk of death. […] The higher awareness and the higher accessibility for health care among the Jewish population may also explain our findings regarding the significant contribution of the ethnicity feature as a predictor for hospitalisation, according to which, Jews are less likely to be hospitalised (comparing with other populations). […] Shigella morbidity is much higher among infants and young children in comparison with their rates in the population. However, we find higher rates of hospitalisation among elderly people.
#9 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#10 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#11 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.
#12 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.
#13 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#14 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#15 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
Shigellosis causes significant morbidity and mortality in developing and developed countries, mostly among infants and young children. […] Hospitalisation due to Shigellosis is in cases of severe symptoms, a prolonged illness or in case of patients with increased risk of death. […] The higher awareness and the higher accessibility for health care among the Jewish population may also explain our findings regarding the significant contribution of the ethnicity feature as a predictor for hospitalisation, according to which, Jews are less likely to be hospitalised (comparing with other populations). […] Shigella morbidity is much higher among infants and young children in comparison with their rates in the population. However, we find higher rates of hospitalisation among elderly people.
#16 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
A major reason for hospitalisation due to Shigellosis is the concern of dehydration and the need for fluids. […] The findings were corroborated by several different machine learning algorithms that reached similar performances, strengthening the reliability and robustness of the predictions. […] These computational tools may help the physician in making informed decisions regarding the patient’s hospitalisation in real time, based on a broad dataset, in contrast to current practice of decision making based on intuition and limited information. […] However, according to our findings, the hospitalisation rate of S. flexneri patients is much higher than the hospitalisation rates of patients of other species, implying that predicting the species will assist the physicians in making better decisions. […] The models presented in this work enable focusing on vulnerable populations that are more prone to hospitalisation or to specific Shigella species infections, in specific months.
#17 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
A major reason for hospitalisation due to Shigellosis is the concern of dehydration and the need for fluids. […] The findings were corroborated by several different machine learning algorithms that reached similar performances, strengthening the reliability and robustness of the predictions. […] These computational tools may help the physician in making informed decisions regarding the patient’s hospitalisation in real time, based on a broad dataset, in contrast to current practice of decision making based on intuition and limited information. […] However, according to our findings, the hospitalisation rate of S. flexneri patients is much higher than the hospitalisation rates of patients of other species, implying that predicting the species will assist the physicians in making better decisions. […] The models presented in this work enable focusing on vulnerable populations that are more prone to hospitalisation or to specific Shigella species infections, in specific months.
#18 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
A major reason for hospitalisation due to Shigellosis is the concern of dehydration and the need for fluids. […] The findings were corroborated by several different machine learning algorithms that reached similar performances, strengthening the reliability and robustness of the predictions. […] These computational tools may help the physician in making informed decisions regarding the patient’s hospitalisation in real time, based on a broad dataset, in contrast to current practice of decision making based on intuition and limited information. […] However, according to our findings, the hospitalisation rate of S. flexneri patients is much higher than the hospitalisation rates of patients of other species, implying that predicting the species will assist the physicians in making better decisions. […] The models presented in this work enable focusing on vulnerable populations that are more prone to hospitalisation or to specific Shigella species infections, in specific months.
#19 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
A major reason for hospitalisation due to Shigellosis is the concern of dehydration and the need for fluids. […] The findings were corroborated by several different machine learning algorithms that reached similar performances, strengthening the reliability and robustness of the predictions. […] These computational tools may help the physician in making informed decisions regarding the patient’s hospitalisation in real time, based on a broad dataset, in contrast to current practice of decision making based on intuition and limited information. […] However, according to our findings, the hospitalisation rate of S. flexneri patients is much higher than the hospitalisation rates of patients of other species, implying that predicting the species will assist the physicians in making better decisions. […] The models presented in this work enable focusing on vulnerable populations that are more prone to hospitalisation or to specific Shigella species infections, in specific months.
#20 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#21 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.
#22 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#23 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#24 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.
#25 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#26 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Incidence of Shigella-attributable diarrhea was higher in older age groups (incidence rate ratio: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age). […] By two years of age, 82.0% (n = 1407) of children had been infected with Shigella, and 29.6% (n = 507) had at least one episode of Shigella-attributable diarrhea. […] The high burden of Shigella disease documented in MAL-ED highlights the potential utility of Shigella vaccines.
#27 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#28 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
Shigellosis causes significant morbidity and mortality in developing and developed countries, mostly among infants and young children. […] Hospitalisation due to Shigellosis is in cases of severe symptoms, a prolonged illness or in case of patients with increased risk of death. […] The higher awareness and the higher accessibility for health care among the Jewish population may also explain our findings regarding the significant contribution of the ethnicity feature as a predictor for hospitalisation, according to which, Jews are less likely to be hospitalised (comparing with other populations). […] Shigella morbidity is much higher among infants and young children in comparison with their rates in the population. However, we find higher rates of hospitalisation among elderly people.
#29 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.
#30 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#31 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
A major reason for hospitalisation due to Shigellosis is the concern of dehydration and the need for fluids. […] The findings were corroborated by several different machine learning algorithms that reached similar performances, strengthening the reliability and robustness of the predictions. […] These computational tools may help the physician in making informed decisions regarding the patient’s hospitalisation in real time, based on a broad dataset, in contrast to current practice of decision making based on intuition and limited information. […] However, according to our findings, the hospitalisation rate of S. flexneri patients is much higher than the hospitalisation rates of patients of other species, implying that predicting the species will assist the physicians in making better decisions. […] The models presented in this work enable focusing on vulnerable populations that are more prone to hospitalisation or to specific Shigella species infections, in specific months.
#32 Shigellosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482337/
Shigellosis is usually a self-limited disease and resolves within 5 to 7 days. […] If shigellosis is diagnosed and treated on time, the prognosis is good, and patients usually recover without sequelae. […] Certain poor prognostic factors may increase morbidity and mortality. These include delays in administering appropriate therapy if the patient is immunocompromised, prolonged disease duration of more than 7 days, extremes of age, and bacteremia. […] Bacteremia, which carries a 20% mortality rate, is rare and occurs mainly in malnourished children. […] Complications of shigellosis include hemolytic uremic syndrome, defined as a triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. The mortality rate is up to 50%.
#33 Prediction of Shigellosis outcomes in Israel using machine learning classifiers
https://pmc.ncbi.nlm.nih.gov/articles/PMC9133678/
A major reason for hospitalisation due to Shigellosis is the concern of dehydration and the need for fluids. […] The findings were corroborated by several different machine learning algorithms that reached similar performances, strengthening the reliability and robustness of the predictions. […] These computational tools may help the physician in making informed decisions regarding the patient’s hospitalisation in real time, based on a broad dataset, in contrast to current practice of decision making based on intuition and limited information. […] However, according to our findings, the hospitalisation rate of S. flexneri patients is much higher than the hospitalisation rates of patients of other species, implying that predicting the species will assist the physicians in making better decisions. […] The models presented in this work enable focusing on vulnerable populations that are more prone to hospitalisation or to specific Shigella species infections, in specific months.
#34 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. […] Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. […] Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella.