{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T20:42:20Z","timestamp":1786912940499,"version":"build-2736575974"},"reference-count":21,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,11,4]]},"abstract":"<jats:p>Molecular identification of the invasion plasmid antigen-H (<jats:italic>ipaH<\/jats:italic>) gene has been established as a useful detection mechanism for <jats:italic>Shigella<\/jats:italic> spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case\u2013control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify <jats:italic>Shigella<\/jats:italic> spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for <jats:italic>Shigella<\/jats:italic> quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28\u20130.81). The association between <jats:italic>Shigella<\/jats:italic> quantity and MSD increased with age, with a peak in children of 24\u201335 months of age (OR = 8.2, 95% CI = 4.3\u201315.7) and the relationship between <jats:italic>Shigella<\/jats:italic> quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3\u201323.8). This study found that qPCR identified more cases of <jats:italic>Shigella<\/jats:italic> and age, site, and breast-feeding status were significant risk factors for MSD.<\/jats:p>","DOI":"10.4269\/ajtmh.14-0319","type":"journal-article","created":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T02:18:47Z","timestamp":1441073927000},"page":"918-924","source":"Crossref","is-referenced-by-count":27,"title":["Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children"],"prefix":"10.4269","volume":"93","author":[{"given":"Brianna","family":"Lindsay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debasish","family":"Saha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doh","family":"Sanogo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumon Kumar","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Omore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer H.","family":"Farag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilruba","family":"Nasrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Panchalingam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myron M.","family":"Levine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Kotloff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Nataro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Magder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hungerford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. S. G.","family":"Faruque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Oundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Anowar","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Adeyemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar Colin","family":"Stine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Lancet","first-page":"209","article-title":"Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study","volume":"382","author":"Kotloff","year":"2013"},{"key":"ref2","series-title":"Clin Infect Dis","first-page":"1223","article-title":"Quantitative real-time polymerase chain reaction for enteropathogenic Escherichia coli: a tool for investigation of asymptomatic versus symptomatic infections","volume":"53","author":"Barletta","year":"2011"},{"key":"ref3","series-title":"J Med Microbiol","first-page":"667","article-title":"Sensitivity and performance characteristics of a direct PCR with stool samples in comparison to conventional techniques for diagnosis of Shigella and enteroinvasive Escherichia coli infection in children with acute diarrhea in Calcutta, India","volume":"50","author":"Dutta","year":"2001"},{"key":"ref4","series-title":"J Clin Microbiol","first-page":"2822","article-title":"Multiplex real-time PCR for detection of Campylobacter, Salmonella, and Shigella","volume":"51","author":"Barletta","year":"2013"},{"key":"ref5","series-title":"Diagn Microbiol Infect Dis","first-page":"121","article-title":"Development of a multiplex polymerase chain reaction assay for diarrheagenic Escherichia coli and Shigella spp. and its evaluation on colonies, culture broths, and stool","volume":"73","author":"Taniuchi","year":"2012"},{"key":"ref6","series-title":"PLoS Med","first-page":"e353","article-title":"A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology","volume":"3","author":"Von Seidlein","year":"2006"},{"key":"ref7","series-title":"Thammasat Int J Sci Technol","first-page":"52","article-title":"Using real-time PCR to detect shigellosis: ipaH detection in Kaeng-Khoi District, Saraburi Province, Thailand","volume":"12","author":"Samosornsuk","year":"2007"},{"key":"ref8","series-title":"J Clin Microbiol","first-page":"2031","article-title":"Detection of Shigella by a PCR assay targeting the ipaH gene suggests increased prevalence of shigellosis in Nha Trang, Vietnam","volume":"42","author":"Vu","year":"2004"},{"key":"ref9","series-title":"J Clin Microbiol","first-page":"1740","article-title":"Quantitative PCR for detection of Shigella improves ascertainment of Shigella burden in children with moderate-to-severe diarrhea in low-income countries","volume":"51","author":"Lindsay","year":"2013"},{"key":"ref10","series-title":"J Clin Microbiol","first-page":"3263","article-title":"Survey of culture, goldengate assay, universal biosensor assay, and 16S rRNA gene sequencing as alternative methods of bacterial pathogen detection","volume":"51","author":"Lindsay","year":"2013"},{"key":"ref11","series-title":"Gut Pathog","first-page":"4","article-title":"Emerging trends in the etiology of enteric pathogens as evidenced from an active surveillance of hospitalized diarrheal patients in Kolkata, India","volume":"2","author":"Nair","year":"2010"},{"key":"ref12","series-title":"Emerg Infect Dis","first-page":"606","article-title":"Diarrheagenic pathogens in polymicrobial infections","volume":"17","author":"Lindsay","year":"2011"},{"key":"ref13","series-title":"Emerg Infect Dis","first-page":"242","article-title":"Microbiota that affect risk for shigellosis in children in low-income countries","volume":"21","author":"Lindsay","year":"2015"},{"issue":"(Suppl 4)","key":"ref14","series-title":"Clin Infect Dis","first-page":"S232","article-title":"The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case\/control study","volume":"55","author":"Kotloff","year":"2012"},{"issue":"(Suppl 4)","key":"ref15","series-title":"Clin Infect Dis","first-page":"S294","article-title":"Diagnostic microbiologic methods in the GEMS-1 case\/control study","volume":"55","author":"Panchalingam","year":"2012"},{"key":"ref16","series-title":"J Infect Dis","first-page":"1794","article-title":"Etiology of diarrhea in Bangladeshi infants in the first year of life analyzed using molecular methods","volume":"208","author":"Taniuchi","year":"2013"},{"key":"ref17","series-title":"Am J Epidemiol","first-page":"710","article-title":"Breast feeding as a determinant of severity in shigellosis. Evidence for protection throughout the first three years of life in Bangladeshi children","volume":"123","author":"Clemens","year":"1986"},{"key":"ref18","series-title":"Pediatrics","first-page":"406","article-title":"Community-based evaluation of the effect of breast-feeding on the risk of microbiologically confirmed or clinically presumptive shigellosis in Bangladeshi children","volume":"90","author":"Ahmed","year":"1992"},{"key":"ref19","series-title":"Am J Trop Med Hyg","first-page":"258","article-title":"Epidemiology of shigellosis among children exposed to cases of Shigella dysentery: a multivariate assessment","volume":"56","author":"Ahmed","year":"1997"},{"key":"ref20","series-title":"HIV Prevalence-Ages 15\u201349 (%)","author":"UNAIDS","year":"2014"},{"issue":"(Suppl 1)","key":"ref21","series-title":"Nature","first-page":"29","article-title":"Reducing stunting among children: the potential contribution of diagnostics","volume":"444","author":"Ricci","year":"2006"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/93\/5\/article-p918.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/93\/5\/article-p918.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/93\/5\/article-p918.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T18:59:07Z","timestamp":1723057147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/93\/5\/article-p918.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,4]]},"references-count":21,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.14-0319","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,4]]}}}