BACKGROUND: The Office of Acute Communicable Diseases of the Baltimore City Health Department detected a cluster of Shigellosis cases, specifically Shigella flexneri, amongst African American men who were HIV positive. A total of seven confirmed cases with first onset of symptoms on April 1, 2015 and last onset of symptoms on December 1, 2015 were identified. A genetic analysis done by the Maryland Labs Administration showed PFGE patterns JZXN11.0136, JZXN11.0089, and JZXN11.0006. A full genetic sequencing on three specimens with PFGE pattern JZXN11.0136 was done. These laboratory results along with epidemiologic information provide evidence that the Shigella bacteria is being spread through sexual contact. Using the epidemiologic information, African American men who are HIV positive are transmitting the bacteria through unprotected oral-anal sex. Due to sexual transmission of Shigella in this susceptible population, this office took steps to educate providers on appropriate testing for the enteric pathogen and provide prevention strategies amongst the African American community.
METHODS: a follow up interview was conducted of confirmed Shigellosis cases meeting the case definition; to obtain additional information including identity of sexual partners. The Maryland Labs Administration performed full genetic sequencing on those specimens identified in this cluster of Shigella flexneri. Summary statistics of all seven cases will be used in identification of uniqueness. Sensitivity of this Shigella species to treatment was also considered and presented to treating providers to inform them on appropriate treatment options.
RESULTS: a prevention campaign was initiated in Baltimore City amongst self-identified “Men who have sex with men” as well as those who exhibit these behaviors but do not identify as MSM. Post cards were distributed in venues frequented by this population, i.e. clubs, bars, on internet hookup sites. In addition, a letter to providers was sent by the Maryland DHMH informing them of the increase in cases. This Office solicited feedback from these providers as well as community advocates to better inform prevention messages for continued efforts at prevention throughout the year.
CONCLUSIONS: due to the potential long-term effects of the Shigella bacterial infection, including post-infectious arthritis, blood stream infection or sepsis, seizures, and hemolytic-uremic syndrome, or HUS, providers need to appropriately diagnose patients and treat appropriately. The population of HIV-infected individuals would also benefit from early detection and appropriate treatment. By educating the community of high-risk men and women in Baltimore City about this emerging infectious, sexually transmitted disease, additional cases and potential outbreaks can be prevented.