EPIDEMIC SHIGELLA-DYSENTERIAE TYPE-1 IN BURUNDI - PANRESISTANCE AND IMPLICATIONS FOR PREVENTION

An epidemic of Shigella dysenteriae type 1 infections has affected Afr ica since 1979. Reported dysentery cases increase sharply in Burundi d uring September through December. Of stool samples from 189 patients r eporting bloody diarrhea in November 1990, a pathogen was identified i n 123 (65%). The pathogen was S. dysenteriae type 1 in 82 (67%). All S . dysenteriae type 1 isolates were resistant to ampicillin, chloramphe nicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Thirty-two specimens (26%) yielded othe r Shigella species. Patients with S. dysenteriae type 1 were more like ly than those with other Shigella infections to have abdominal pain, ' 'lots of blood'' in the stool, blood in the stool specimen examined by the interviewer, recent contact with a person with dysentery, or rece nt antimicrobial treatment. Thus, the seasonal increase in dysentery w as due largely to multidrug-resistant S. dysenteriae type 1, clinical and epidemiologic features may predict such infection, and efforts to control this epidemic must focus on preventing transmission.