• Gerald T. Keusch
  • Michael L. Bennish


Shigellosis, an acute infectious enteritis of humans and on occasion subhuman primates, is often referred to as bacillary dysentery. The reason is that dysentery, a syndrome manifested by frequent passage of small-volume, bloody mucoid stools, abdominal cramps, and tenesmus, is widely considered to be the principal clinical presentation of the infection.(87) However, watery diarrhea without blood or mucus is common in all forms of shigellosis and may be the only intestinal sign of infection. (2,55) In addition, there are a myriad of manifestations described in shigellosis, some common and some rare, that without doubt qualify the organism as a protean pathogen. (10,114) The objective of this chapter is to present the salient features of shigellosis in sufficient detail to understand the spectrum of the disease and its distinctive epidemiology.


Diarrheal Disease Shiga Toxin Shigella Flexneri Shigella Dysenteriae Somatic Antigen 


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  1. 1.
    Ackerknecht, E. H. , History and Geography of the Most Important Diseases, Hafner, New York, 1965.Google Scholar
  2. 2.
    Anand, B. S. , Malhortra, V. , Bhattacharya, S. K., Datta, P. , Datta, D., Sen, D. , Bhattacharya, M. K., Mukherjee, P. P., and Pal, S. C., Rectal histology in acute bacillary dysentery, Gastroenterology 90:654–660 (1986).PubMedGoogle Scholar
  3. 3.
    Anonymous, The prospects for immunizing against Shigella spp. , in: New Vaccine Development-Establishing Priorities, Volume II, Diseases of Importance in Developing Countries (S. L. Katz, ed.), pp. 329–337, National Academy Press, 1986.Google Scholar
  4. 4.
    Anonymous, Ciprofloxacin, The Medical Letter 30:11–13 (1988).Google Scholar
  5. 5.
    Askenazi, S., Dinarl, G., Zevulunov, A., and Nitzan, M., Convulsion in shigellosis: Evaluation of possible risk factors, Am. J. Dis. Child. 141:208–210 (1987).Google Scholar
  6. 6.
    Avital, A., Maayan, C., and Goitein, K. J., Incidence of convulsion and encephalopathy in childhood Shigella infection, Clin. Pediatr. 21:645–648 (1982).CrossRefGoogle Scholar
  7. 7.
    Azad, M. A. K. , Islam, M. , and Butler, T. , Colonic perforation in Shigella dysenteriae type 1 infection, Pediatr. Infect. Dis. J. 5:103–104 (1986).CrossRefGoogle Scholar
  8. 8.
    Baine, W. B., Herron, C. A., Bridson, K., Barker, W. H. , Jr. , Lindell, S. , Mallison, G. F. , Wells, J. G., Martin, W. T., Kosuri, M. R. , Carr, F. , and Voelker, E. , Sr. , Waterborne shigellosis at a public school, Am. J. Epidemiol. 101:323–332 (1975).PubMedGoogle Scholar
  9. 9.
    Baron, L. S., Kopecko, D. J., Formal, S. B., Seid, R., Guerry, P. , and Powell, C., Introduction of Shigella, flexneri 2a type and group antigen genes into oral typhoid vaccine strain Salmonella typhi Ty21 a, Infect. Immun. 55:2797–2801 (1987).PubMedGoogle Scholar
  10. 10.
    Barrett-Connor, E., and Connor, J. D., Extraintestinal manifestations of shigellosis, Am. J. Gastroenterol. 53:234245 (1970).PubMedGoogle Scholar
  11. 11.
    Bartlett, A. V., III, Prado, D., Cleary, T. G., and Pickering, L. K. , Production of Shiga toxin and other cytotoxins by serogroups of Shigella, J. Infect. Dis. 154:996–1002 (1986).CrossRefGoogle Scholar
  12. 12.
    Barton, L. L. , and Pickering, L. K. , Shigellosis in the first week of life, Pediatrics 51:437–438 (1973).Google Scholar
  13. 13.
    Baskin, D. H., Lax, J. D., and Barenberg, D., Shigella bacteremia in patients with the acquired immune deficiency syndrome, Am. J. Gastroenterol. 82:338–341 (1987).PubMedGoogle Scholar
  14. 14.
    Bennish, M. L. , Clemens, J. , and Harris, J. , Risk factors for death among patients with shigellosis, Interscience Conference on Antimicrobial Agents and Chemotherapy, October. 1984, American Society for Microbiology, Washington, D.C., 1984.Google Scholar
  15. 15.
    Bensted, H. J. , Dysentery bacilli-shigella: A brief historical review, Can. J. Microbiol. 2:163–174 (1956).PubMedCrossRefGoogle Scholar
  16. 16.
    Biedner, B. , Rosenblatt, I. , Dogan, R. , and Yassai, Y., Corneal ulcer caused by Shigella flexneri in an infant, Am. J. Ophthal Mol. 104:90 (1987).Google Scholar
  17. 17.
    Black, R. E. , Graun, G. F. , and Blake, P. A. , Epidemiology of common-source outbreaks of shigellosis in the United States 1961–1975, Am. J. Epidemiol. 108:47–52 (1978).PubMedGoogle Scholar
  18. 18.
    Black, R. E., Brown, K. H., Becker, S., Alim, A. R. M. A. , and Huq, I. , Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh, Am. J. Epidemiol. 115:315–324 (1982).PubMedGoogle Scholar
  19. 19.
    Black, R. E., Brown, K. H., and Becker, S., Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh, Pediatrics 73:79–85 (1984).Google Scholar
  20. 20.
    Black, R. E. , Levine, M. M. , Clements, M. L. , Losonsky, G., Herrington, D., Berman, S., and Formal, S. B. , Prevention of shigellosis by a Salmonella typhiShigella sonnei bivalent vaccine, J. Infect. Dis. 155:1260–1265 (1987).PubMedCrossRefGoogle Scholar
  21. 21.
    Blaser, M. J., Pollard, R. A., and Feldman, R. A., Shigella infections in the United States, 1974–1980, J. Infect. Dis. 147:771–775 (1983).PubMedCrossRefGoogle Scholar
  22. 22.
    Blum, D., The role of water supplies and sanitation in prevention of acute diarrhoeal diseases, in: Diarrhoeal Disease and Malnutrition: A Clinical Update (M. Gracey, ed.), pp. 207–210, Churchill Livingstone, Edinburgh, 1985.Google Scholar
  23. 23.
    Boyce, J. M. , Hughes, J. M. , Alim, A. M. R. A. , Khan, M., Aziz, K. M. A., Wells, J. G., and Curlin, G. T., Patterns of Shigella infection in families in Bangladesh, Am. J. Trop. Med. Hyg. 31:1015–1020 (1982).PubMedGoogle Scholar
  24. 24.
    Boyd, J. S. K., The antigenic structure of the mannitolfermenting group of dysentery bacilli, J. Hyg. 38:477–499 (1938).CrossRefPubMedGoogle Scholar
  25. 25.
    Briend, A., Dykewicz, C., Graven, K., Mazumder, R. N., Wojtnyiak, B., and Bennish, M., Usefulness of nutritional indices and classifications in predicting death of malnourished children, Br. Med. J. 293:373–375 (1986).CrossRefGoogle Scholar
  26. 26.
    Butler, T. , Islam, M. R. , and Bardhan, P. K. , The leukemoid reaction in shigellosis, Am. J. Dis. Child. 138:162–165 (1984).PubMedGoogle Scholar
  27. 27.
    Butler, T. , Speelman, P. , Kabir, I. , and Banwell, J., Colonic dysfunction during shigellosis, J. Infect. Dis. 154:817–824 (1986).PubMedCrossRefGoogle Scholar
  28. 28.
    Buysse, J. , Stover, C. K. , Oaks, E. V. , Venkatesan, M., and Kopecko, D. J., Molecular cloning of invasion plasmid antigen (ipa) genes from Shigella flexneri: Analysis of ipa gene products and genetic mapping, J. Bacteriol. 169:2561–2569 (1987).PubMedGoogle Scholar
  29. 29.
    Caceres, A. , and Mata, L. J. , Serologic response of patients with Shiga dysentery, J. Infect. Dis. 129:439–443 (1974).PubMedCrossRefGoogle Scholar
  30. 30.
    Calderwood, S. B. , Auclair, F. , Donohue-Rolfe, A., Keusch, G. T. , and Mekalanos, J. J. , Nucleotide sequence of the iron-regulated Shiga-like toxin genes of Escherichia coli, Proc. Natl. Acad. Sci. Usa 84:4364–4368 (1987).CrossRefGoogle Scholar
  31. 31.
    Caldwell, G. R., De Carle, D. J., Reiss-Levy, E., and Hunt, D. R. , Shigella dysenteriae type 1 enterocolitis, Aust. N.Z. J. Med. 16:405–407 (1986).PubMedCrossRefGoogle Scholar
  32. 32.
    Calin, A., and Fries, J. F. , An “;;experimental “epidemic of Reiter’s syndrome revisited: Follow-up evaluation on genetic and environmental factors, Ann. Intern. Med. 84:564–566 (1976).PubMedGoogle Scholar
  33. 33.
    Castro, F. , Rosal, J. E. , and Sanchez, E. , Hallazgos anatomopatologicos en 173 casos de disenteria bacilar, Simposio sobre disenteria Shiga en Centroamerica, Organization Panamericana de la Salud, Publicacion Cientifica No. 283, pp. 17–26, 1974.Google Scholar
  34. 34.
    Centers for Disease Control, Multiply resistant shigellosis in a day-care center-Texas, Morbid. Mortal. Weekly Rep. 35:753–55 (1986).Google Scholar
  35. 35.
    Centers for Disease Control, Nationwide dissemination of multiply resistant Shigella sonnei following a commonsource outbreak, Morbid. Mortal. Weekly Rep. 36:633–634 (1987).Google Scholar
  36. 36.
    Centers for Disease Control, Multistate outbreak of Shigella sonnei gastroenteritis-United States, Morbid Mortal. Weekly Rep. 36:440–449 (1987).Google Scholar
  37. 37.
    Chantemesse, A., and Widal, F. , Sur les microbes de la dysenteria epidemique, Bull. Acad. Med. (Paris 19:522–529 (1888).Google Scholar
  38. 38.
    Chatkaeomorakot, A., Echeverria, P. , Taylor, D. N., Seriwatana, J. , and Leksomboon, U. , Trimethoprim-resistant Shigella and enterotoxigenic Escherchia coli strains in children in Thailand, Pediatr. Infect. Dis. J. 6:735–739 (1987).PubMedCrossRefGoogle Scholar
  39. 39.
    Clemens, J. D., Stanton, B. , Stoll, B. , Shahid, N. S., Banu, H., and Chowdhury, A. K. A. M. A., Breast feeding as a determinant of severity in shigellosis, Am. J. Epidemiol. 123:710–718 (1986).PubMedGoogle Scholar
  40. 40.
    Clerc, P. L. , Ryter, A. , Mounier, J., and Sansonetti, P. J. , Plasmid-mediated early killing of eucaryotic cells by Shigella flexneri as studied by infection of J774 macrophages, Infect. Immun. 55:521–527 (1987).PubMedGoogle Scholar
  41. 41.
    Clerc, P. L. , and Sansonetti, P. J., Entry of Shigella flexneri into Hela cells: Evidence for directed phagocytosis involving actin polymerization and myosin accumulation, Infect. Immun. 55:2681–2688 (1987).PubMedGoogle Scholar
  42. 42.
    Colin, A. , and Fries, J. F. , An “experimental “epidemic of Reiter’s syndrome revisited: Follow-up evaluation of genetic and environmental factors, Ann. Intern. Med. 84:564–566 (1976).Google Scholar
  43. 43.
    Conradi, H. , Uber losliche durch aseptische autolyse erhalten giftstoffe von ruhr and Typhusbazillen, Dtsch. Med. Wochenschr. 29:26–28 (1903).CrossRefGoogle Scholar
  44. 44.
    Councilman,W. T., and Lafleur, H. A., Amoebic dysentery, Johns Hopkins Hosp. Rep. 2:393–548 (1891).Google Scholar
  45. 45.
    Dale, D. C., and Mata, L. J., Studies of diarrheal disease in Central America. XI. Intestinal bacterial flora in malnourished children with shigellosis, Am. J. Trop. Med. 17:397–403 (1968).Google Scholar
  46. 46.
    Dewailly, E. , Poirier, C. , and Meyer, F. M., Health hazards associated with wind surfing on polluted water, Am. J. Public Health 76:690–691 (1986).PubMedCrossRefGoogle Scholar
  47. 47.
    Donadio, J. , and Gangarosa, E. , Foodborne shigellosis, J. Infect. Dis. 119:666–668 (1969).PubMedCrossRefGoogle Scholar
  48. 48.
    Donohue-Rolfe, A., and Keusch, G. T. , Shigella dysenteriae 1 cytotoxin: Periplasmic protein releasable by polymyxin B and osmotic shock, Infect. Immun. 39:270–274 (1983).PubMedGoogle Scholar
  49. 49.
    Donohue-Rolfe, A., Keusch, G. T., Edson, C., Thorley-Lawson, D., and Jacewicz, M. , Pathogenesis of Shigella diarrhea. IX. Simplified high yield purification of Shigella toxin and characterization of subunit composition and function by the use of subunit specific monoclonal and polyclonal antibodies, J. Exp. Med. 160:1767–1781 (1984).PubMedCrossRefGoogle Scholar
  50. 50.
    Donohue-Rolfe, A., Kelley, M. A. , Bennish, M., and Keusch, G. T. , Enzyme-linked immunosorbent assay for Shigella toxin, J. Clin. Microbiol. 24:65–68 (1986).PubMedGoogle Scholar
  51. 51.
    Drachman, R. H., Payne, F. J., Jenkins, A. A., Mackel, D. C., Petersen, N. J., Boring, J. R. , Gareau, F. E., Fraser, R. S., and Myers, G. G., An outbreak of water borne shigella gastroenteritis, Am. J. Hyg. 72:321–324 (1960).PubMedGoogle Scholar
  52. 52.
    Dritz, S. K., Ainsworth, T. E., Garrard, W. F., Back, A., Palmer, R. D., Boucher, L. A. , and River, E. , Patterns of sexually transmitted enteric diseases in a city, Lancet 2:3–4 (1977).PubMedCrossRefGoogle Scholar
  53. 53.
    Dupont, H. L., Enteropathogenic organisms: New etiologic organisms and concepts of disease, Med. Clin. North Am. 62:945–960 (1978).PubMedGoogle Scholar
  54. 54.
    Dupont, H. L. , Hornick, R. H. , Dawkins, A. T., Snyder, M. J. , and Formal, S. B., The response of man to virulent Shigella flexneri 2a, J. Infect. Dis. 119:296–299 (1969).CrossRefGoogle Scholar
  55. 55.
    Dupont, H. L., Gangarosa, E. J., Reller, L. B., Woodward, W. E. , Armstrong, R. W. , Hammond, J. , Glaser, K., and Morris, G. K., Shigellosis in custodial institutions, Am. J. Epidemiol. 92:172–179 (1970).PubMedGoogle Scholar
  56. 56.
    Dupont, H. L., Hornick, R. B., Snyder, M. J., Libonati, J. P. , Formal, S. B. , and Gangarosa, E. J., Immunity in shigellosis. I. Response of man to attenuated shigella strains, J. Infect. Dis. 125:5–11 (1972).PubMedCrossRefGoogle Scholar
  57. 57.
    Dupont, H. L. , Hornick, R. B. , Snyder, M. J. , Libonati, J. P. , Formal, S. B. , and Gangarosa, E. J. , Immunity in shigellosis. II. Protection induced by oral live vaccine or primary infection, J. Infect. Dis. 125:12–16 (1972).PubMedCrossRefGoogle Scholar
  58. 58.
    Dupont, H. L. , Sullivan, P. , Evans, D. G., Pickering, L. K., Evans, D. J., Vollet, J. J., Ericsson, C. D., Ackerman, P. B. , and Tjoa, W. S. , Prevention of traveler’s diarrhea (Emporiatric enteritis): Prophylactic administration of subsalicylate bismuth, J. Am. Med. Assoc. 243:237–241 (1980).CrossRefGoogle Scholar
  59. 59.
    Dupont, H. L., Ericsson, C. D., Johnson, P. C., Bitsura, J. A., Dupont, M. M., and De La Calada, F. S., Prevention of travelers’ diarrhea by the tablet formulation of bismuth subsalicylate, J. Am. Med. Assoc. 257:1347–1350 (1987).CrossRefGoogle Scholar
  60. 60.
    Ekwall, E., Haeggman, S., Kalin, M., Svenungsson, B. , and Lindberg, A. A. , Antibody response to Shigella sonnei infection determined by an enzyme-linked immunosorbent assay, Eur. J. Clin. Microbiol. 2:200–205 (1983).PubMedCrossRefGoogle Scholar
  61. 61.
    Endo, Y., Tsurugi, K., Yutsudo, T., Takeda, Y., Ogasawara, T. , and Igarashi, K. , Site of action of a Vero toxin (VT2) from Escherichia coli 157:H7 and of Shiga toxin on eukaryotic ribosomes. Rna N-glycosidase activity of the toxins, Eur. J. Biochem. 171:45–50 (1988).PubMedCrossRefGoogle Scholar
  62. 62.
    Evins, G. M., Gheesling, L. L., and Tauxe, R. V., Quality of commercially produced Shigella serogrouping and serotyping antisera, J. Clin. Microbiol. 26:438–442 (1988).PubMedGoogle Scholar
  63. 63.
    Eyre, J.W. H. ; Asylum dysentery in relation to S. dysenteriae, Br. Med. J. 1:1002–1004 (1904).PubMedCrossRefGoogle Scholar
  64. 64.
    Farrar, W. E., and Ridson, M., Antibiotic resistance in Shigella mediated by R factors, J. Infect. Dis. 123:477–484 (1971).PubMedCrossRefGoogle Scholar
  65. 65.
    Feldman, R. A. , Bhat, P. , and Kamath, K. R. , Infection and disease in a group of South Indian families. IV. Bacteriologic methods and a report of the frequency of enteric bacterial infection in preschool children, Am. J. Epidemiol. 92:367–375 (1970).Google Scholar
  66. 66.
    Floyd, T. M. , The incidence of Shigella organisms in a group of Egyptian village children, Am. J. Trop. Med. Hyg. 3:294–302 (1954).PubMedGoogle Scholar
  67. 67.
    Floyd, T. M. , Higgins, A. R. , and Kadar, M. A., Studies in shigellosis. V. The relationship of age to the incidence of shigella infections in Egyptian children, with special reference to shigellosis in the newborn and in infants in the first six months of life, Am. J. Trop. Med. 5:119–130 (1956).Google Scholar
  68. 68.
    Formal, S. B. , Abrams, G. D., Schneider, H. , and Sprinz, H. , Experimental Shigella infections. VI. Role of the small intestine in an experimental infection in guinea pigs, J. Bacteriol. 85:119–25 (1963).PubMedGoogle Scholar
  69. 69.
    Formal, S. B., Labrec, E. H., Kent, T. H., and Falkow, S., Abortive intestinal infection with an Escherichia coliShigella flexneri hybrid strain, J. Bacteriol. 89:1374–1382 (1965).PubMedGoogle Scholar
  70. 70.
    Formal, S. B., Kent, T. H., May, H. C., Palmer, A., Falkow, S., and Labrec, E. H., Protection of monkeys against experimental shigellosis with a living attenuated oral polyvalent dysentery vaccine, J. Bacteriol. 92:17–22 (1966).Google Scholar
  71. 71.
    Formal, S. B. , Kent, T. H. , Austin, S. , and Labrec, E. H., Fluorescent-antibody and histological study of vaccinated and control monkeys challenged with Shigella flexneri, J. Bacteriol. 91:2368–2376 (1966).Google Scholar
  72. 72.
    Formal, S. B. , Gemski, P. , Baron, L. S. , and Labrec, E. H. , A chromosomal locus which controls the ability of Shigella flexneri to evoke keratoconjunctivitis, Infect. Immun. 3:73–79 (1971).PubMedGoogle Scholar
  73. 73.
    Formal, S. B., Baron, L. S., Kopecko, D. J., Washington, O. , Powell, C. , Life, C. A. , Construction of a potential bivalent vaccine strain: Introduction of Shigella sonnei form I antigen genes into the galE-Salmonella typhi Tÿ21 a typhoid vaccine strain, Infect. Immun. 34:746–750 (1981).PubMedGoogle Scholar
  74. 74.
    Formal, S. B. , Hale, T. L. , and Sansonetti, P. J. , Invasive enteric pathogens, Rev. Infect. Dis. 5:S702-S707 (1983).CrossRefGoogle Scholar
  75. 75.
    Formal, S. B. , Hale, T. L. , Kapfer, C. , Cogan, J. P., Snoy, P. J., Chung, R., Wingfield, M. E., Elisberg, B. L. , and Baron, L. S. , Oral vaccination of monkeys with an invasive Escherichia coli K-12 hybrid expressing Shigella flexneri 2a somatic antigen, Infect. Immun. 46:465–469 (1984).PubMedGoogle Scholar
  76. 76.
    Frost, J. A., Willshaw, G. A., Barclay, E. A., Rowe, B. , Lemmens, P. , and Vandepitte, J., Plasmid characterization of drug-resistant Shigella dysenteriae 1 from an epidemic in central Africa, J. Hyg. 94:163–172 (1985).CrossRefPubMedGoogle Scholar
  77. 77.
    Fuchs, G., Mobassaleh, M., Donohue-Rolfe, A., Montgomery, R. K. , Grand, R. J., and Keusch, G. T., Pathogenesis of shigella diarrhea. XII. Rabbit intestinal cell microvillus membrane binding site for shigella toxin, Infect. Immun. 53:372–377 (1986).PubMedGoogle Scholar
  78. 78.
    Gangarosa, E. J., Perera, D. R., Mata, L. J., Mendizabal-Morris, C., Guzman, G. , and Reller, L. B. , Epidemic Shiga bacillus dysentery in Central America. II. Epidemiologic studies in 1969, J. Infect. Dis. 122:181–190 (1970).PubMedCrossRefGoogle Scholar
  79. 79.
    Gangarosa, E. J., Bennett, J. V., Wyatt, C., Pierce, P. E. , Olarte, J. , Hernandes, P. , Vasquez, V. , and Bessudo, D., An epidemic associated episome? J. Infect. Dis. 126:215–218 (1972).PubMedCrossRefGoogle Scholar
  80. 80.
    Gear, H. S. , Hygiene aspects of the El Alamein victory, 1942, Br. Med. J. 1:383–387 (1944).PubMedCrossRefGoogle Scholar
  81. 81.
    Gemski, P. , Jr. , and Formal, S. B. , Shigellosis: An invasive infection of the gastrointestinal tract, in: Microbiology1975 (D. Schlessinger, ed.), pp. 165–169, American Society for Microbiology, Washington, D.C. , 1975.Google Scholar
  82. 82.
    Gemski, P. , Sheahan, D. G. , Washington, O., and Formal, S. B. , Virulence of Shigella flexneri hybrids expressing Escherichia coli somatic antigens, Infect. Immun. 6:104–111 (1972).PubMedGoogle Scholar
  83. 83.
    Germanier, R. , and Furer, E. , Isolation and characterization of galE mutant Ty21A of Salmonella typhi: A candidate strain for a live, oral typhoid vaccine, J. Infect. Dis. 131:553–558 (1975).PubMedCrossRefGoogle Scholar
  84. 84.
    Gordon, J. E., Acute diarrhea! disease, Am. J. Med. Sci. 248:345–365 (1964).PubMedCrossRefGoogle Scholar
  85. 85.
    Gordon, J. E., Guzman, M., Ascoli, W., and Scrimshaw, N. S. , Acute diarrheal disease in less developed countries. 2. Patterns of epidemiological behavior in rural Guatemalan villages, Bull. Who 31:9–20 (1964).PubMedGoogle Scholar
  86. 86.
    Gordon, J. E., Ascoli, W., Pierce, V., Guzman, M., and Mata, L. J. , Studies of diarrheal disease in Central America. Vi. An epidemic of diarrhea in a Guatemalan highland village, with a component due to Shigella dysenteriae type 1, Am. J. Trop. Med. Hyg. 14:404–411 (1965).PubMedGoogle Scholar
  87. 87.
    Grady, G. F. , and Keusch, G. T. , Pathogenesis of bacterial diarrheas, N. Engl. J. Med. 285:831–841, 891–900 (1971).PubMedCrossRefGoogle Scholar
  88. 88.
    Green, M. S., Cohen, D., Block, C., Rouach, Z., and Dycian, R. , A prospective epidemiologic study of shigellosis in the Israel Defense Forces: Implications for the use of Shigella vaccines, Isr. J. Med. Sci. 23:811–815 (1987).PubMedGoogle Scholar
  89. 89.
    Griffiths, E., Stevenson, P., Hale, T. L., and Formal, S. B., Synthesis of aerobactin and a 76,000-dalton iron-regulated outer membrane protein by Escherichia coli K-12 Shigella flexneri hybrids and by enteroinvasive strains of Escherichia coli, Infect. Immun. 49:67–71 (1985).Google Scholar
  90. 90.
    Gross, R. J. , Thomas, L. V. , and Rowe, B. , Shigella dysenteriae, S. flexneri and S. boydii infections in England and Wales: The importance of foreign travel, Br. Med. J. 2:744 (1979).PubMedGoogle Scholar
  91. 91.
    Gross, R. J. , Rowe, B. , Cheasty, T. , and Thomas, L. V., Increase in drug resistance among Shigella dysenteriae, S. flexneri, and S. boydii, Br. Med. J. 283:575–576 (1981).CrossRefGoogle Scholar
  92. 92.
    Guerrant, R. L. , Shields, D. S. , Thorson, S. M., Schorling, J. B., and Groschel, D. H. M., Evaluation and diagnosis of acute infectious diarrhea, Am. J. Med. 78(Suppl. 6B):91–98 (1985).PubMedCrossRefGoogle Scholar
  93. 93.
    Hale, L. H., and Formal, S. B. , Protein synthesis in Hela or Henle 407 cells infected with Shigella dysenteriae 1, Shigella flexneri 2a, or Salmonella typhimurium W118, Infect. Immun. 32:137–144 (1981).PubMedGoogle Scholar
  94. 94.
    Hale, L. H. , and Formal, S. B. , Genetics of virulence in Shigella, Microbial. Pathogenesis 1:511–518 (1986). 95. Hale, L. H. , and Formal, S. B. , Pathogenesis of Shigella infections, Pathol. Immunopathol. Res. 6:117–127 (1987).PubMedCrossRefGoogle Scholar
  95. 96.
    Hale, L. H. , Oaks, E. V. , and Formal, S. B. , Identification and antigenic characterization of virulence-associated, plasmid-coded proteins of Shigella spp. and enteroinvasive Escherichia coli, Infect. Immun. 50:620–629 (1985).Google Scholar
  96. 97.
    Haltalin, K. C. , Neonatal shigellosis: Report of 16 cases and a review of the literature, Am. J. Dis. Child. 114:603611 (1967).PubMedGoogle Scholar
  97. 98.
    Haltalin, K. C., Nelson, J. D., Ring, R., Sladjoe, M., and Hinton, L. V., Double-blind treatment study of shigellosis comparing ampicillin, sulfadiazine, and placebo, J. Pediatr. 70:970–981 (1967).PubMedCrossRefGoogle Scholar
  98. 99.
    Haltalin, K. C., Nelson, J. D. , Hinton, L. V., Kusmiesz, H. T. , and Sladoje, M. , Comparison of orally absorbable and nonabsorbable antibiotics in shigellosis. A double blind study with ampicillin and neomycin, J. Pediatr. 72:708–720 (1968).PubMedCrossRefGoogle Scholar
  99. 100.
    Harari, I., Donohue-Rolfe, A., Keusch, G., and Arnon, R. , Synthetic peptides of Shiga toxin B-subunit induce antibodies which neutralize the biological activities of the toxin, Infect. Immun. 56:1618–1624 (1988).PubMedGoogle Scholar
  100. 101.
    Hardy, A. V., and Watt, J., Studies of the acute diarrheal diseases. Xiv. Clinical observations, Public Health Rep. 60:521–532 (1945).CrossRefGoogle Scholar
  101. 102.
    Hardy, A. V., and Watt, J., Studies of the acute diarrheal diseases. XVIII. Epidemiology, Public Health Rep. 63:363–378 (1948).PubMedCrossRefGoogle Scholar
  102. 103.
    Harris, J. C. , Dupont, H. L. , and Hornick, R. B. , Fecal leukocytes in diarrheal illness, Ann. Intern. Med. 76:697–703 (1972).PubMedGoogle Scholar
  103. 104.
    Higgins, A. R. , Floyd, T. M. , and Kader, M. A. , Studies in shigellosis. Ii. Observations on incidence and etiology of diarrheal disease in Egyptian village children, Am. J. Trop. Med. Hyg. 4:271–278 (1955).PubMedGoogle Scholar
  104. 105.
    Hollister, A. C., Beck, M. D., Gittelsohn, A. M., and Hemphill, E. C., Influence of water availability on shigella prevalence in children of farm labor families, Am. J. Public Health 45:354–362 (1955).CrossRefGoogle Scholar
  105. 106.
    Jacewicz, M. , and Keusch, G. T. , Pathogenesis of shigella diarrhea. Viii. Evidence for a translocation step in the cytotoxic action of Shiga toxin, J. Infect. Dis. 148:844–854 (1983).PubMedCrossRefGoogle Scholar
  106. 107.
    Jacewicz, M., Clausen, H., Nudelman, E. , Donohuerolfe, A., and Keusch, G. T., Pathogenesis of shigella diarrhea. Xi. Isolation of a shigella toxin binding glycolipid from rabbit jejunum and Hela cells and its identification as globotriaosylceramide, J. Exp. Med. 163:1391–1404 (1986).PubMedCrossRefGoogle Scholar
  107. 108.
    Johnson, P. C., Ericsson, C. D., Morgan, D. R., Dupont, H. L. , and Cabada, F. J. , Lack of emergence of resistant fecal flora during successful prophylaxis of traveler’s diarrhea with norfloxacin, Antimicrob. Agents Chemother. 30:671–674 (1986).PubMedCrossRefGoogle Scholar
  108. 109.
    Kabir, I., Butler, T., and Khanam, A., Comparative efficacies of single intravenous dose of ceftriaxone and ampicillin for shigellosis in a placebo-controlled trial, Antimicrob. Agents Chemother. 29:645–648 (1986).PubMedCrossRefGoogle Scholar
  109. 110.
    Kandel, G., Donohue-Rolfe, A., Donowitz, M., and Keusch, G. T. , Pathogenesis of Shigella diarrhea. Xv. Selective targeting of shiga-toxin to villus cells explains the effect of the toxin on intestinal electrolyte transport. J. Clin. Invest. 84:1509–1517 (1989).PubMedCrossRefGoogle Scholar
  110. 111.
    Karmali, M. A., Petric, M., Lim, C., Fleming, P. C., Arbus, G. S. , and Lior, H. , The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli, J. Infect. Dis. 151:775–782 (1985).CrossRefGoogle Scholar
  111. 112.
    Kaslow, R. A., Ryder, R. W., and Calin, A., Search for Reiter’s syndrome after an outbreak of Shigella sonnei dysentery, J. Rheumatol. 6:562–566 (1979).PubMedGoogle Scholar
  112. 113.
    Keenan, K. P. , Sharpnack, D. D., Collins, H. , Formal, S. B., and O’Brien, A. D., Morphologic evaluation of the effects of Shiga toxin and E. coli Shiga-like toxin on the rabbit intestine, Am. J. Pathol. 125:69–80 (1986).PubMedGoogle Scholar
  113. 114.
    Kenne, L. , and Lindberg, B. , Bacterial polysaccharides, in: The Polysaccharides (G. O. Aspinall, ed.), pp. 287–363, Academic Press, New York, 1983.Google Scholar
  114. 115.
    Keusch, G. T., Shigella infections, Clin. Gastroenterol.. 8:645–662 (1979).PubMedGoogle Scholar
  115. 116.
    Keusch, G. T. , Shigellosis, in: Bacterial Infections of Humans (A. S. Evans and H. A. Feldman, eds.), pp. 487–509, Plenum Medical, New York, 1982.CrossRefGoogle Scholar
  116. 117.
    Keusch, G. T., Antimicrobial therapy for enteric infections and typhoid fever: State-of-the art, Rev. Infect. Dis. 10(Suppl.):5199–5205 (1988).Google Scholar
  117. 118.
    Keusch, G. T. , and Jacewicz, M. , Serum enterotoxin-neutralizing antibody in human shigellosis, Nature New Biol. 241:31–32 (1973).PubMedGoogle Scholar
  118. 119.
    Keusch, G. T. , and Jacewicz, M. , Pathogenesis of shigella diarrhea. Vi. Toxin and antitoxin in S. flexneri and S. sonnei infections in humans, J. Infect. Dis. 135:552–556 (1977).PubMedCrossRefGoogle Scholar
  119. 120.
    Keusch, G. T., and Scrimshaw, N. S., Selective primary health care. Strategies for control of disease in the developing world. Xiv. The control of infection to reduce the prevalence of infantile and childhood malnutrition, Rev. Infect. Dis. 8:273–287 (1986).PubMedCrossRefGoogle Scholar
  120. 121.
    Keusch, G. T., Grady, G. F., Mata, L. J., and Mciver, J. M. , The pathogenesis of Shigella diarrhea. 1. Enterotoxin production by Shigella dysenteriae I, J. Clin. Invest. 51:1212–1218 (1972).PubMedCrossRefGoogle Scholar
  121. 122.
    Keusch, G. T. , Grady, G. F. , Takeuchi, A. , and Sprinz, H. , The pathogenesis of Shigella diarrhea. Ii. Enterotoxin induced acute enteritis in rabbit ileum, J. Infect. Dis. 126:92–95 (1972).PubMedCrossRefGoogle Scholar
  122. 123.
    Keusch, G. T. , Jacewicz, M., Levine, M. M. , Hornick, R. B. , and Kochwa, S. , Pathogenesis of shigella diarrhea: Serum anticytotoxin antibody response produced by toxigenic and nontoxigenic Shigella dysenteriae 1, J. Clin. Invest. 57:194–202 (1976).PubMedCrossRefGoogle Scholar
  123. 124.
    Keusch, G. T. , Donohue-Rolfe, A. , and Jacewicz, M., Shigella toxin(s): A review, Pharmacol. Thera. 15:403–438 (1982).CrossRefGoogle Scholar
  124. 125.
    Keusch, G. T. , Donohue-Rolfe, A. , and Jacewicz, M., Shigella toxin and the pathogenesis of shigellosis, Ciba Found. Symp. 112:193–214.Google Scholar
  125. 126.
    Khan, W. W., Interruption of shigellosis by handwashing, Trans. R. Soc. Trop. Med. Hyg. 66:164–168 (1982).CrossRefGoogle Scholar
  126. 127.
    Knowlessar, M., and Forbes, G. B. , The febrile convulsion in shigellosis, N. Engl. J. Med. 258:520–526 (1958).CrossRefGoogle Scholar
  127. 128.
    Korzeniowski, D. M. , Barada, F. A. , Rouse, J. D., and Guerrant, R. L. , Value of examination for fecal leukocytes in the early diagnosis of shigellosis, Am. J. Trop. Med. Hyg. 28:1031–1035 (1979).PubMedGoogle Scholar
  128. 129.
    Koster, F. , Levin, J. , Walker, L. , Tunk, K. S. K., Gilman, R. H., Rahaman, M. M., Majid, M. A., Islam, S. , and Williams, R. C., Hemolytic-uremic syndrome after shigellosis: Relation to endotoxin and circulating immune complexes, N. Engl. J. Med. 298:927–933 (1978).PubMedCrossRefGoogle Scholar
  129. 130.
    Kostrewski, J. , and Stypulkowska-Misiurewicz, H., Changes in the epidemiology of dysentery in Poland and the situation in Europe, Arch. Immunol. Ther. Exp. 16:429–451 (1968).Google Scholar
  130. 131.
    Kourany, M., Vasquez, M. A., and Mata, L. J., Prevalence of pathogenic enteric bacteria in children of 31 Panamanian communities, Am. J. Trop. Med. Hyg. 20:608–615 (1971).PubMedGoogle Scholar
  131. 132.
    Kruse, W. , Weitere Untersuchungen uber die Ruhr und Ruhrbrazillen, Dtsch. Med. Wochenschr. 27:370–372 (1901).CrossRefGoogle Scholar
  132. 133.
    Labrec, E. H. , Schneider, H. , Magnani, T. J. , and Formal, S. B. , Epithelial cell penetration is an essential step in the pathogenesis of bacillary dysentery, J. Bacteriol. 88:1503–1518 (1964).PubMedGoogle Scholar
  133. 134.
    Lahat, E. , Aladjem, M., Heipert, J. , and Mundel, G., Shigellosis: Incidence of convulsions and resistance to antibiotics, Helv. Paediatr. Acta 39:123–128 (1984).PubMedGoogle Scholar
  134. 135.
    Leighton, P. M. , An outbreak of shigellosis in the province of New Brunswick, Can. J. Public Health 68:249–252 (1977).PubMedGoogle Scholar
  135. 136.
    Levine, M. M. , Shigella and Salmonella diarrhoeal disease, Trop. Doctor 9:4–9 (1979).Google Scholar
  136. 137.
    Levine, M. M. , Antimicrobial therapy for infectious diarrhea, Rev. Infect. Dis. 8(Suppl. 2):5207–5216 (1986).CrossRefGoogle Scholar
  137. 138.
    Levine, M. M. , Dupont, H. L., Gangarosa, E. J. , Hornick, R. B., Snyder, M. J., Libonati, J. P., Glaser, K., and Formal, S. B. , Shigellosis in custodial institutions. Ii. Clinical, immunologic and bacteriologic response of institutionalized children to oral attenuated shigella vaccines, Am. J. Epidemiol. 96:40–49 (1972).PubMedGoogle Scholar
  138. 139.
    Levine, M. M., Dupont, H. L., Formal, S. B., Hornick, R. B. , Takeuchi, A., Gangarosa, E. J. , Snyder, M. J., and Libonati, J. P. , Pathogenesis of Shigella dysenteriae (Shiga) dysentery, J. Infect. Dis. 127:261–270 (1973).PubMedCrossRefGoogle Scholar
  139. 140.
    Levine, M. M., Gangarosa, E. J. , Werner, M. , and Morris, G. K. Shigellosis in custodial institutions. 3. Prospective clinical and bacteriologic surveillance of children vaccinated with oral attenuated shigella vaccines, J. Pediatr. 84:803–806 (1974).PubMedCrossRefGoogle Scholar
  140. 141.
    Levine, M. M., Gangarosa, E. J., Barrow, W. B., Morris, G. K. ,Wells, J. G., and Weiss, C. G. , Shigellosis in custodial institutions. Iv. In vivo stability and transmissibility of oral attenuated streptomycin-dependent shigella vaccines, J. Infect. Dis. 131:704–707 (1975).CrossRefGoogle Scholar
  141. 142.
    Levine, M. M., Gangarosa, E. J., Barrow, W. B., and Weiss, C. F., Shigellosis in custodial institutions. V. Effect of intervention with streptomycin-dependent Shigella sonnei vaccine in an institution with endemic disease, Am. J. Epidemiol. 104:88–92 (1976).PubMedGoogle Scholar
  142. 143.
    Levine, M. M., Woodward, W. E., Formal, S. B., Gemski, P. , Jr. , Dupont, H. L. , Hornick, R. B. , and Snyder, M. J , Studies with a new generation of oral attenuated shigella vaccine: Escherichia coli bearing surface antigens of Shigella flexneri, J. Infect. Dis. 136:577–582 (1977).PubMedCrossRefGoogle Scholar
  143. 144.
    Lindberg, A. A., and Holme, T. , Evaluation of some extraction methods for the preparation of bacterial lipopolysaccharides for structural analysis, Acta Pathol. Microbiol. Scand. Sect. B 80:751–759 (1972).Google Scholar
  144. 145.
    Lindberg, A. A., Haeggman, S. ,Karlsson, K. , Cam, P. D., and Trach, D. D., The humoral antibody response to Shigella dysenteriae type 1 infection, as determined by Elisa, Bull. Who 62:597–606 (1984).PubMedGoogle Scholar
  145. 146.
    Lindberg, A. A., Brown, J. E., Stromberg, N., Westling-Ryd, M. , Schultz, J. E. , and Karlsson, K.-A., Identification of the carbohydrate receptor for Shiga toxin produced by Shigella dysenteriae type 1, J. Biol. Chem. 262:1779–1785 (1987).PubMedGoogle Scholar
  146. 147.
    Lindsay, D. R. , Stewart, W. H., and Watt, J. , Effect of fly control on diarrheal disease in an area of moderate morbidity, Public Health Rep. 68:361–367 (1953).PubMedCrossRefGoogle Scholar
  147. 148.
    Losch, F. , Massenhafte entwickelung von aeroben in dickdarm, Arch. Pathol. Anat. Physiol. 65:196–211 (1875).Google Scholar
  148. 149.
    Macomber, H. H., Acute bacillary dysentery: Clinicopathologic study of 263 consecutive cases, Arch. Intern. Med. 69:624–635 (1942).CrossRefGoogle Scholar
  149. 150.
    Makino, S. , Sasakawa, C., Kamata, K. , Kurata, T., and Yoskikawa, M., A genetic determinant required for continuous reinfection of adjacent cells on a large plasmid in S. flexneri 2a, Cell 46:551–555 (1986).PubMedCrossRefGoogle Scholar
  150. 151.
    Makintubee, S., Mallonee, J., and Istre, G. R., Shigellosis outbreak associated with swimming, Am. J. Public Health 77:166–168 (1987).PubMedCrossRefGoogle Scholar
  151. 152.
    Malengreau, M. , Molima-Koba Gillieaux, M. , Defeyter, M. , Kyele-Duibone, Mukolo-Ndjolo, Outbreak of Shigella dysentery in eastern Zaire, 1980–1982, Ann. Soc. Belge Med. Trop. 63:59–67 (1983).Google Scholar
  152. 153.
    Martin, D. L. , Gustafson, T. L. , Pelosi, J. W. , Suarez, L. , and Pierce, G. V. , Contaminated produce-A common source for two outbreaks of Shigella gastroenteritis, Am. J. Public Health 76:299–305 (1986).Google Scholar
  153. 154.
    Mata, L. J., The Children of Santa Maria Cauque: A Prospective Field Study of Health and Growth, Mit Press, Cambridge, Mass., 1978.Google Scholar
  154. 155.
    Mata, L. J., and Castro, F. , Epidemiology, diagnosis and impact of Shiga dysentery in Central America, Ind. Trop. Health 8:30–37 (1974).Google Scholar
  155. 156.
    Mata, L. J., Catalan, M. A., and Gordon, J. E., Studies of diarrheal disease in Central America. Ix. Shigella carriers among young children of a heavily seeded Guatemalan convalescent home, Am. J. Trop. Med. Hyg. 15:632–638 (1966).PubMedGoogle Scholar
  156. 157.
    Mata, L. J. , Urrutia, J. J. , Garcia, B. , Fernandez, R., and Behar, M., Shigella infection in breast-fed Guatemalan Indian neonates, Am. J. Dis. Child. 117:142–146 (1969).PubMedGoogle Scholar
  157. 158.
    Mata, L. J., Gangarosa, E. J., Caceres, A., Perera, D. R. , and Mejicanos, M. L. , Epidemic Shiga bacillus dysentery in Central America. I. Etiologic investigations in Guatemala, 1969, J. Infect. Dis. 122:170–180 (1970).PubMedCrossRefGoogle Scholar
  158. 159.
    Mathan, M. M., and Mathan, V. I., Ultrastructural pathology of the rectal mucosa in Shigella dysentery, Am. J. Pathol. 123:25–38 (1986).PubMedGoogle Scholar
  159. 160.
    Maurelli, A. T., and Sansonetti, P. J., Identification of a chromosomal gene controlling temperature-regulated expression of Shigella virulence, Proc. Natl. Acad. Sci. Usa 85:2820–2824 (1988).PubMedCrossRefGoogle Scholar
  160. 161.
    Maurelli, A. T., Baudry, B., D’Hauteville, H., Hale, T. L. , and Sansonetti, P. J., Cloning of plasmid Dna sequences involved in invasion of Hela cells by Shigella flexneri, Infect. Immun. 49:164–171 (1985).Google Scholar
  161. 162.
    Mccabe, C. J., and Haines, T. W., Diarrheal disease control by improved human excreta disposal, Public Health Rep. 72:921–928 (1957).PubMedCrossRefGoogle Scholar
  162. 163.
    Mccartney, J. E., and Olitsky, P. K., Separation of the toxins of Bacillus dysenteriae Shiga, J. Exp. Med. 37:767–779 (1923).PubMedCrossRefGoogle Scholar
  163. 164.
    Mciver, J. , Grady, G. F. , and Formal, S. B. , Immunization with Shigella dysenteriae type 1: Evaluation of antitoxic immunity in prevention of experimental disease in rhesus monkeys (Macaca mulatta), J. Infect. Dis. 136:416–421 (1977).PubMedCrossRefGoogle Scholar
  164. 165.
    Mel, D. M., Arsic, B. L. , Nikolic, B. D. , and Radovanovic, M. L., Studies on vaccination against bacillary dysentery. 4. Oral immunization with live monotypic and combined vaccines, Bull. Who 39:375–380 (1968).PubMedGoogle Scholar
  165. 166.
    Merson, M. H., Goldmann, D. A., Boyer, K. M., Petersen, N. J. , Patton, C., Everett, L. G. , Downs, H., Steckler, A., and Barker, W. H. , An outbreak of Shigella sonnei gastroenteritis on Colorado River raft trips, Am. J. Epidemiol. 100:186–196 (1974).PubMedGoogle Scholar
  166. 167.
    Merson, M. H., Tenney, J. H., Meyers, J. D., Wood, B. T., Wells, J. G., Rimzo, W., Cline, B., Dewitt, W. E., Skaliy, P. , and Mallison, G. F. , Shigellosis at sea: An outbreak aboard a passenger cruise ship, Am. J. Epidemiol. 101:165–175 (1975).PubMedGoogle Scholar
  167. 168.
    Mildvan, D., Gelb, A. M., and William, D., Venereal transmission of enteric pathogens in male homosexuals: Two case reports, J. Am. Med. Assoc. 238:1387–1389 (1977).CrossRefGoogle Scholar
  168. 169.
    Mobassaleh, M., Donohue-Rolfe, A. , Jacewicz, M., Grand, R. J., and Keusch, G. T., Pathogenesis of shigella diarrhea. Xiii. Evidence for a developmentally regulated glycolipid receptor for shigella toxin involved in the fluid secretory response of rabbit small intestine, J. Infect. Dis. 157:1023–1031 (1988).PubMedCrossRefGoogle Scholar
  169. 170.
    Morduchowicz, G. , Huminer, D., Siegman-Igra, Y., Drucker, M., Block, C. S., and Pitlik, S. D., Shigella bacteremia in adults. A report of five cases and review of the literature, Arch. Intern. Med. 147:2034–2037 (1987).PubMedCrossRefGoogle Scholar
  170. 171.
    Morris, G. K., Koehler, J. A., Gangarosa, E. J., and Sharrar, R. G., Comparison of media for direct isolation and transport of shigellae from fecal specimens, Appl. Microbiol. 19:434–437 (1970).PubMedGoogle Scholar
  171. 172.
    Moyer, M. P. , Dixon, P. S. , Rothman, S. W. , and Brown, J. E. , Cytotoxicity of Shiga toxin for primary cultures of human colonic and ileal epithelial cells, Infect. Immun. 55:1533–1535 (1987).PubMedGoogle Scholar
  172. 173.
    Mulder, J. B., Shigellosis in nonhuman primates: A review, Lab. Anim. Sci. 21:734–738 (1971).PubMedGoogle Scholar
  173. 174.
    Munshi, M. H., Sack, D. A. ,Haider , K. , Ahmed, Z. U., Rahaman, M. M. , and Morshed, M. G., Plasmid mediated resistance to nalidixic acid in Shigella dysenteriae type 1, Lancet 2:419–421 (1987).PubMedCrossRefGoogle Scholar
  174. 175.
    Nassif, X., Mazert, M.-C., Mounier, J., and Sansonetti, P., Evaluation with an iuc::Tn10 mutant of the role of aerobactin production in the virulence of Shigella flexneri, Infect. Immun. 55:1963–1969 (1987).Google Scholar
  175. 176.
    Nelson, J. D., and Haltalin, K. C., Accuracy of diagnosis of bacterial diarrheal disease by clinical features, J. Pediatr. 78:519–522 (1971).PubMedCrossRefGoogle Scholar
  176. 177.
    Neu, H. C., Bacterial resistance to fluoroquinolones, Rev. Infect. Dis. 10(Suppl. 1):S57-S63 (1988).CrossRefGoogle Scholar
  177. 178.
    Noer, H. R., An “experimental “epidemic of Reiter syndrome, J. Am. Med. Assoc. 198:693–698 (1966).CrossRefGoogle Scholar
  178. 179.
    Oaks, E. V. , Hale, T. L. , and Formal, S. B. , Serum immune response to Shigella protein antigens in rhesus monkeys and humans infected with Shigella spp. , Infect. Immun. 53:57–63 (1986).PubMedGoogle Scholar
  179. 180.
    O’Brien, A. D., and Holmes, R. K., Shiga and Shiga-like toxins, Microbiol. Rev. 51:206–220 (1987).PubMedGoogle Scholar
  180. 181.
    O’Brien, A. D., Thompson, M. R., Gemski, P., Doctor, B. P. , and Formal, S. B. , Biological properties of Shigella flexneri 2a toxin and its serological relationship to Shigella dysenteriae 1 toxin, Infect. Immun. 15:796–798 (1977).PubMedGoogle Scholar
  181. 182.
    Olitsky, P. K. , and Kligler, I. H. , Toxins and anti-toxins of Bacillus dysenteriae Shiga, J. Exp. Med. 31:19–33 (1920).PubMedCrossRefGoogle Scholar
  182. 183.
    Osada, Y. , and Ogawa, H. , A possible role of glycolipids in epithelial cell penetration by virulent Shigella flexneri 2a, Microbial Immunol. 21:405–410 (1977).Google Scholar
  183. 184.
    Palchaudhuri, S. , Kumar, R. , Sen, D. , Pal, R. , Ghosh, S. , Sarkar, B. , Bhattacharya, S. K. , and Pal, S. C. , Molecular epidemiology of plasmid patterns in Shigella dysenteriae type 1 obtained from an outbreak in west Bengal (India), Fems Microbiol. Lett. 30:187–191 (1985).CrossRefGoogle Scholar
  184. 185.
    Patton, C. M., Gangarosa, E. J., Weissman, J. B., Merson, M. H. , and Morris, G. K. , Diagnostic value of indirect hemagglutination in the seroepidemiology of shigella infections, J. Clin. Microbiol. 3:143–148 (1976).PubMedGoogle Scholar
  185. 186.
    Pickering, L. K. , Dupont, H. L. , Olarte, J. , Conklin, R., and Ericsson, C. Fecal leukocytes in enteric infections, Am. J. Clin. Pathol. 68:562–565 (1977).PubMedGoogle Scholar
  186. 187.
    Pickering, L. K. , Evans, D. G. , Dupont, H. L. , Vollet, J. J., and Evans, D. J., Diarrhea caused by Shigella, rotavirus, and Giardia in day-care centers: Prospective study, J. Pediatr. 99:51–56 (1981).PubMedCrossRefGoogle Scholar
  187. 188.
    Pickering, L. K. , Bartlett, A. V. , and Woodward, W. E. , Acute infectious diarrhea among children in day care: Epidemiology and control, Rev. Infect. Dis. 8:539–547 (1986).PubMedCrossRefGoogle Scholar
  188. 189.
    Prado, D., Cleary, T. G., Pickering, L. K., Ericsson, C. D., Bartlett, A. V., III, Dupont, H. L., and Johnson, P. C., The relation between production of cytotoxin and clinical features in shigellosis, J. Infect. Dis. 154:149–155 (1986).PubMedCrossRefGoogle Scholar
  189. 190.
    Rahaman, M. M., and Wahed, M. A., Direct nutrient loss and diarrhea, in: Diarrhea and Malnutrition: Interactions, Mechanisms, and Interventions (L. C. Chen and N. S. Scrimshaw, eds.), pp. 268–286, Plenum Press, New York, 1983.Google Scholar
  190. 191.
    Rahaman, M. M. , Huq, I. , and Dey, C. R. , Superiority of MacConkey’s agar over Salmonella-Shigella agar for isolation of Shigella dysenteriae type 1, J. Infect. Dis. 131:700–703 (1975).PubMedCrossRefGoogle Scholar
  191. 192.
    Rahaman, M. M., Khan, M. M., Aziz, K. M. S., Islam, M. S., and Golam Kibriya, A. K. M., An outbreak of dysentery caused by Shigella dysenteriae type 1 on a coral island in the Bay of Bengal, J. Infect. Dis. 132:15–19 (1975).PubMedCrossRefGoogle Scholar
  192. 193.
    Rahaman, M. M., Alam, A. R. M. J., Islam, M. R., Greenough, W. B. , and Lindenbaum, J. , Shiga bacillus dysentery associated with marked leukocytosis and erythrocyte fragmentation, Johns Hopkins Med. J. 135:65–70 (1975).Google Scholar
  193. 194.
    Rosenberg, M. L. , Weissman, J. B. , Gangarosa, E. J., Reller, L. B. , and Beasley, R. P. , Shigellosis in the United States: Ten year review of nationwide surveillance, Am. J. Epidemiol. 104:543–551 (1976).PubMedGoogle Scholar
  194. 195.
    Rout, W. R. , Formal, S. B. , Giannella, R. A., and Dammin, G. J., Pathophysiology of shigella diarrhea in the rhesus monkey: Intestinal transport, morphological and bacteriological studies, Gastroenterology 68:270–278 (1975).PubMedGoogle Scholar
  195. 196.
    Sack, R. B., Santosham, M., Froelich, J. L., Medina, C., Orskov, F., and Orskov, I., Doxycycline prophylaxis of travelers’ diarrhea in Honduras, an area where resistance is common among enterotoxigenic Escherichia coli, Am. J. Trop. Med. Hyg. 33:460–466 (1984).Google Scholar
  196. 197.
    Sakai, T., Sasakawa, C., Makino, S., and Yoshikawa, M., Dna sequence and product analysis of the virF locus responsible for Congo red binding and cell invasion in Shigella flexneri 2a, Infect. Immun. 54:395–402 (1986).PubMedGoogle Scholar
  197. 198.
    Salam, M. A., and Bennish, M. L., Randomized, double blind trial of nalidixic acid vs. ampicillin in the treatment of childhood shigellosis, Ix International Congress of Infectious and Parasitic Diseases, Munich, July 1986.Google Scholar
  198. 199.
    Sandyk, R. , and Brennan, M. J. W. , Fulminating encephalopathy associated with Shigella flexneri infection, Arch. Dis. Child. 58:70–72 (1983).PubMedCrossRefGoogle Scholar
  199. 200.
    Sansonetti, P. J., Kopecko, D. J., and Formal, S. B., Shigella sonnei plasmids: Evidence that a large plasmid is necessary for virulence, Infect. Immun. 34:75–83 (1981).PubMedGoogle Scholar
  200. 201.
    Sansonetti, P. J., Kopecko, D. J., and Formal, S. B., Involvement of a plasmid in the invasive ability of Shigella flexneri, Infect. Immun. 35:852–860 (1982).Google Scholar
  201. 202.
    Sansonetti, P. J., D’Hauteville, H., Ecobichon, C., and Pourcel, C., Molecular expression of virulence plasmids in Shigella and enteroinvasive Escherichia coli, Ann. Microbiol. (Paris) 134A:295–318 (1983).Google Scholar
  202. 203.
    Sansonetti, P. J. , Hale, T. L. , Dammin, G. I. , Kapper, C. , Collins, H. H. , and Formal, S. B. , Alterations in the pathogenicity of Escherichia coli K 12 after transfer of plasmids and chromosomal genes from Shigella flexneri, Infect. Immun. 39:1392–1402 (1983).Google Scholar
  203. 204.
    Sansonetti, P. H., Ryter, A., Clerc, P. , Maurelli, A. T. , and Mounier, J. , Multiplication of Shigella flexneri within HeLa cells: Lysis of the phagocytic vacuole and plasmid-mediated contact hemolysis, Infect. Immun. 51:461–469 (1986).PubMedGoogle Scholar
  204. 205.
    Sasakawa, C., Makino, S. , Kamata, K. , and Yoshikawa, M., Isolation, characterization, and mapping of Tn5 insertions into the 140 megadalton invasion plasmid defective in mouse Sereny test in Shigella flexneri 2a, Infect. Immun. 54:32–36 (1986).PubMedGoogle Scholar
  205. 206.
    Schlossberg, D., and Mcgowan, J. E. , Shigella infection and antibiotic resistance, Ann. Intern. Med. 83:120–121 (1975).PubMedGoogle Scholar
  206. 207.
    Seidah, N. G., Donohue-Rolfe, A. , Lazure, C., Auclair, F. , Keusch, G. T. , and Chretien, M. , Complete amino acid sequence of Shigella toxin B-chain. A novel polypeptide containing 69 amino acids and one disulfide bridge, J. Biol. Chem. 261:13928–13931 (1986).PubMedGoogle Scholar
  207. 208.
    Sereny, B. , Experimental Shigella conjunctivitis, Acta Mi-crobiol. Acad. Sci. Hung. 2:293–296 (1955).Google Scholar
  208. 209.
    Shahid, N. S., Rahaman, M. M., Haider, K., Banu, H., and Rahman, N., Changing pattern of resistant Shiga bacillus (Shigella dysenteriae type 1) and Shigellaflexneri in Bangladesh, J. Infect. Dis. 152:1114–1119 (1985).PubMedCrossRefGoogle Scholar
  209. 210.
    Shiga, K. , Ueber den Dysenterie-bacillus (Bacillus dysenteriae), Zentralbl. Bakteriol. Orign. 24:913–918 (1898).Google Scholar
  210. 211.
    Shiga, K. , The trend of prevention, therapy and epidemiology of dysentery since the discovery of its causative organism, N. Engl. Med. 26:1205–1211 (1936).CrossRefGoogle Scholar
  211. 212.
    Speelman, P. , Kabir, I. , and Islam, M., Distribution and spread of colonic lesions in shigellosis: A colonoscopic study, J. Infect. Dis. 150:899–903 (1984).PubMedCrossRefGoogle Scholar
  212. 213.
    Speelman, P. , Mcglaughlin, R. , Kabir, I., and Butler, T. , Differential clinical features and stool findings in shigellosis and amoebic dysentery, Trans. R. Soc. Trop. Med. Hyg. 81:549–551 (1987).PubMedCrossRefGoogle Scholar
  213. 214.
    Spika, J. S., Dabis, F., Hargrett-Bean, N., Salcedo, J., Veillard, S. , and Blake, P. A., Shigellosis at a Caribbean resort. Hamburger and North American origin as risk factors, Am. J. Epidemiol. 126:1173–1180 (1987).PubMedGoogle Scholar
  214. 215.
    Steward, W. H., Mccabe, L., Jr., Hemphill, E. C., Decapito, T., Diarrheal disease control studies. Iv. The relationship of certain environmental factors to the prevalence of Shigella infection, Am. J. Trop. Med. Hyg. 4:718–724 (1955).Google Scholar
  215. 216.
    Stoll, B. J., Glass, R. I., Huq, M. I., Khan, M. U., Banu, H., and Holt, J. , Epidemiologic and clinical features of patients infected with Shigella who attended a diarrheal disease hospital in Bangladesh, J. Infect. Dis. 146:177–183 (1982).PubMedCrossRefGoogle Scholar
  216. 217.
    Stoll, B. J., Glass, R. I., Banu, H., Huq, M. I., Khan, M. U., and Ahmed, M., Value of stool examination in patients with diarrhoea, Br. Med. J. 285:2037–2040 (1983).CrossRefGoogle Scholar
  217. 218.
    Struelens, M. J., Patte, D., Kabir, I., Salam, A., Nath, S. N. , and Butler, T. , Shigella septicemia: Prevalence, presentation, risk factors, and outcome, J. Infect. Dis. 152:784–790 (1985).PubMedCrossRefGoogle Scholar
  218. 219.
    Takeuchi, A. , Sprinz, H. , Labrec, E. H., and Formal, S. B. , Experimental bacillary dysentery: An electron microscopic study of the response of the intestinal mucosa to bacterial invasion, Am. J. Pathol. 47:1011–1044 (1965).PubMedGoogle Scholar
  219. 220.
    Tauxe, R. V., Johnson, K. E., Boase, J. C., Helgerson, S. D., and Blake, P. A., Control of day-care shigellosis: A trial of convalescent day care in isolation, Am. J. Public Health 76:627–630 (1986).PubMedCrossRefGoogle Scholar
  220. 221.
    Thomas, M. E. M., and Tillet, H. E., Dysentery in general practice: A study of cases and their contacts in Enfield and an epidemiological comparison with salmonellosis, J. Hyg. 71:373–389 (1973).CrossRefPubMedGoogle Scholar
  221. 222.
    Tiemens, E. M. , Shipley, P. L. , Correia, R. A. , Shields, D. S. , and Guerrant, R. L. , Sulfamethoxazole-trimethoprim-resistant Shigella flexneri in northeastern Brazil, Antimicrob. Agents Chemother. 25:653–654 (1985).CrossRefGoogle Scholar
  222. 223.
    Tobias, J. D., Starke, J. R., and Tosi, M. F., Shigella keratitis: A report of two cases and a review of the literature, Pediatr. Infect. Dis. J. 6:79–81 (1987).PubMedCrossRefGoogle Scholar
  223. 224.
    Todd, C., On a dysentery toxin and anti-toxin, J. Hyg. 4:480–494 (1904).CrossRefPubMedGoogle Scholar
  224. 225.
    Tramont, E. C., Chung, R., Berman, S., Keren, D., Kapfer, C., and Formal, S. B. , Safety and antigenicity of typhoid-Shigella sonnei vaccine (strain 5076–1C), J. Infect. Dis. 149:133–136 (1984).PubMedCrossRefGoogle Scholar
  225. 226.
    Van Bohemen, C. G., Lionarons, R. J., Van Bodegom, P., Dinant, H. J., Landheer, J. E., Nabbe, A. J., Grumet, F. C., and Zanen, H. C., Susceptibility and HLAB27 in post-dysenteric arthropathies, Immunology 56:377–379 (1985).PubMedGoogle Scholar
  226. 227.
    Van Bohemen, C. G., Nabbe, A. J. J. M., Grumet, F. C., Landheer, J. E., Dinant, H. J., and Zanen, H. C., Lack of correlation between Hla-B27-like antigenic epitopes on Shigellaflexneri and the occurrence of reactive arthritis, Clin. Exp. Immunol. 65:679–682 (1986).PubMedGoogle Scholar
  227. 228.
    Van Heyningen, W. E., and Gladstone, G. P., The neurotoxin of Shigella shiga. 1. Production, purification and properties of the toxin, Br. J. Exp. Pathol. 34:202–216 (1953).Google Scholar
  228. 229.
    Watanabe, H., and Nakamura, A., Identification of Shigella sonnei form I plasmid genes necessary for cell invasion and their conservation among Shigella species and enteroinvasive Escherichia coli, Infect. Immun. 53:352–358 (1986).Google Scholar
  229. 230.
    Watanabe, T. , Infective heredity of multiple drug resistance in bacteria, Bacteriol. Rev. 27:87–115 (1963).PubMedGoogle Scholar
  230. 231.
    Watt, J., Hollister, A. C., Jr., Beck, M. D., and Hemphill, E. C., Diarrhea’ diseases in Fresno County, California, Am. J. Public Health 43:728–741 (1953).CrossRefGoogle Scholar
  231. 232.
    Weissmann, J. B. , Schmerler, A. , Weiler, P. , Filice, G. , Godbey, N., and Hansen, I., The role of preschool children and day-care centers in the spread of shigellosis in urban communities, J. Pediatr. 84:797–802 (1974).CrossRefGoogle Scholar
  232. 233.
    Wells, J. G., and Morris, G. K., Evaluation of transport methods for isolating Shigella, J. Clin. Microbiol. 13:789–790 (1981).Google Scholar
  233. 234.
    White, F. M. M. , and Pedersen, A. T. , Epidemic shigellosis on a worktrain in Labrador, Can. Med. Assoc. J. 115:647–649 (1976).PubMedGoogle Scholar
  234. 235.
    Willis, T. , Practice of Physick, T. Dring, C. Harper, & J. Leigh, London, 1684.Google Scholar

12. Suggested Reading

  1. Anonymous, The prospects for immunizing against Shigella spp., in: New Vaccine Development—Establishing Priorities, Volume Ii, Diseases of Importance in Developing Countries (S. L. Katz, ed.), pp. 329–337, National Academy Press, 1986.Google Scholar
  2. Black, R. E., Graun, G. F., and Blake, P. A., Epidemiology of common-source outbreaks of shigellosis in the United States 1961–1975, Am. J. Epidemiol. 108:47–52 (1978).PubMedGoogle Scholar
  3. Blaser, M. J., Pollard, R. A., and Feldman, R. A., Shigella infections in the United States, 1974–1980, J. Infect. Dis. 147:771–775 (1983).PubMedCrossRefGoogle Scholar
  4. Keusch, G. T., Shigella infections, Clin. Gastroenterol. 8:645–662 (1979).PubMedGoogle Scholar
  5. Pickering, L. K. , Bartlett, A. V. , and Woodward, W. E, Acute infectious diarrhea among children in day care: Epidemiology and control, Rev. Infect. Dis. 8:539–547 (1986).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Gerald T. Keusch
    • 1
  • Michael L. Bennish
    • 2
    • 3
  1. 1.Department of Medicine Division of Geographic Medicine and Infectious DiseasesNew England Medical Center HospitalsBostonUSA
  2. 2.International Centre for Diarrhhoeal Disease Research—BangladeshOhakaBangladesh
  3. 3.Departments of Pediatrics and Medicine Division of Geographic Medicine and Infectious DiseasesNew England Medical Center HospitalsBostonUSA

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