Shigella spp. with reduced azithromycin susceptibility, Quebec, Canada, 2012-2013.
Bottom Line: During 2012-2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected.Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.
During 2012-2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.
Related in: MedlinePlus
Mentions: From January 2012 through April 2013, infection with 4 Shigella spp. pulse types with decreased azithromycin susceptibility was locally acquired by 9 patients (mean age 45 years, range 29–55 years) (Tables 1, 2). Among these patients, 1 HIV-positive man was infected successively with 2 Shigella species with reduced azithromycin susceptibility, 11 months apart, resulting in a total of 10 infections (Figure). All 9 men reported having had sex with men, and 7 were HIV positive. CD4 cell counts were 320 ×106 cells/L for 1 HIV-positive patient and 420–540 × 106 cells/L for the other 6. HIV viral load was <40 copies/mL for 3 of the 6 patients for whom data were available and 58–90,074 copies/mL for the other 3. During the previous 6 years, 7 men for whom these data were available had experienced 1–7 (median 4) other sexually transmitted diseases. Of the 9 men, 4 reported use of sex venues and none had worked in daycare centers or as a food handler. All 9 patients received follow-up care at medical clinics outside the hospital, but 4 patients received care at the emergency room for 24–48 hours. For treatment, 4 patients received ciprofloxacin and 2 received azithromycin; antimicrobial drug treatment is unknown for the other 3 patients. For these 9 men, information was unknown with regard to receipt of azithromycin before illness onset, clinical outcome data, and antimicrobial drug treatment failure. Among the Shigella pulse types with reduced susceptibility to azithromycin, 2 originated from outbreaks among MSM (Figure), which are being investigated by Quebec public health departments and LSPQ.