Admission Clinical Characteristics of 792 Inpatients <15 Years by Species of <i>Shigella.</i>

<p>Values are n (%) unless noted.</p>*<p>P<0.020: <i>S. dysenteriae</i> type 1 versus <i>S. flexneri</i>, <i>S. boydii</i>, or <i>S. sonnei</i>; <i>S. dysenteriae</i> types 2–10 versus <i>S. flexneri</i>, <i>S. boydii</i> or <i>S. sonnei</i>; <i>S. flexneri</i> versus <i>S. sonnei</i>. P<0.008: <i>S. dysenteriae</i> type 1 versus non-<i>S. dysenteriae</i> type 1.</p>†<p>Duration of illness data were missing for 2/157 patients in the <i>S. dysenteriae</i> type 1 group, 5/504 patients in the <i>S. flexneri</i> group, and 1/77 patient in the <i>S. boydii</i> group.</p>‡<p>P<0.009: <i>S. dysenteriae</i> types 2–10 versus <i>S. dysenteriae</i> type 1, <i>S. flexneri</i>, <i>S. boydii</i> or <i>S. sonnei.</i></p>§<p>P<0.007: <i>S. dysenteriae</i> type 1 versus <i>S. flexneri or S. boydii</i>; <i>S. flexneri</i> versus <i>S. boydii.</i></p>||<p>Weight-for-age was calculated as a percentage of the United States National Center for Health Statistics median weight-for-age^17.</p>¶<p>Weight-for-age data were missing for 5/157 patients in the <i>S. dysenteriae</i> type 1 group, 1/24 patient in the <i>S. dysenteriae</i> type 2–10 group, and 11/504 patients in the <i>S. flexneri</i> group.</p>**<p>P<0.002: <i>S. dysenteriae</i> type 1 versus <i>S. flexneri or S. boydii</i>; <i>S. dysenteriae</i> types 2–10 versus <i>S. flexneri</i> or <i>S. boydii.</i></p

Outcome of 792 patients <15 Years by Species of <i>Shigella</i>.

<p>Values are n (% of patients by species).</p

Extra-intestinal Manifestations of Shigellosis in 792 Inpatients <15 Years by Species of <i>Shigella.</i>

<p>Values are worst (most abnormal) during hospital stay. Values are n (%).</p>*<p>P<0.040: <i>S. dysenteriae type 1</i> versus <i>S. boydii</i>, <i>S. flexneri</i> versus <i>S. boydii.</i></p>†<p>P<0.05: <i>S. dysenteriae</i> type 1 versus <i>S. boydii; S. dysenteriae</i> types 2–10 versus <i>S. flexneri</i>, <i>S. boydii</i> or <i>S. sonnei.</i></p>‡<p>Blood leukocytes data were missing for 10/157 patients in the <i>S. dysenteriae</i> type 1 group, 26/504 patients in the <i>S. flexneri</i> group, 6/77 patients in the <i>S. boydii</i> group, and 1/30 patient in the <i>S. sonnei</i> group.</p>§<p>.P<0.001: <i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> types 2–10, <i>S. flexneri, S. boydii.</i></p>||<p>Hematocrit data were missing for 4/157 patients in the <i>S. dysenteriae</i> type 1 group, 23/504 patients in the <i>S. flexneri</i> group, and 5/77 patients in the <i>S. boydii</i> group.</p>¶ ¶ ¶<p>P<0.019: <i>S. dysenteriae</i> type 1 versus <i>S. flexneri</i> or <i>S. boydii</i>; <i>S dysenteriae</i> type 2–10 versus <i>S. flexneri</i> or <i>S. boydii.</i></p>**<p>Serum Creatinine data were missing for 53/157 patients in the <i>S. dysenteriae</i> type 1 group, 9/24 patients in the <i>S. dysenteriae</i> types 2–10 group, 304/504 patients in the <i>S. flexneri</i> group, 51/77 patients in the <i>S. boydii</i> group, and 20/30 patients in the <i>S. sonnei.</i></p>††<p>P = 0.001: <i>S. dysenteriae</i> type 1 versus <i>S. flexneri.</i></p>‡‡<p>Diagnosis of hemolytic-uremic syndrome required three criteria to be met: 1) an absolute packed cell volume <20%; or 2) a decrease in absolute packed cell volume of >10% in 24 hours; or 3) ≥0.5% schistocytes on a peripheral blood; and 4) serum creratinine, >180 mmol/L.</p>§§<p>P<0.050: <i>S. dysenterie</i> type 1 vesus <i>S. flexneri</i>; <i>S. flexneri</i> versus <i>S. sonnei.</i></p>|| ||<p>Serum sodium data were missing for 9/157 patients in the <i>S. dysenteriae</i> type1 group, 34/504 patients in the <i>S. flexneri</i> group, 9/77 patients in the <i>S. boydii</i> group, and 2/30 patients in the <i>S. sonnei.</i></p>¶¶<p>P<0.001: <i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> type 2–10, <i>S. flexneri</i>, <i>S. boydii</i> or <i>S. sonnei.</i></p>***<p>Blood glucose data were missing for 121/157 patients in the <i>S. dysenteriae</i> type 1 group, 19/24 patients in the <i>S. dysenteriae</i> types 2–10 group, 402/504 patients in the <i>S. flexneri</i> group, 63/77 patients in the <i>S. boydii</i> group, and 25/30 patients in the <i>S. sonnei</i> group.</p>†††<p>Serum protein data were missing for 105/157 patients in the <i>S. dysenteriae</i> type 1 group, 15/24 patients in the <i>S. dysenteriae</i> types 2–10 group, 378/504 patients in the <i>S. flexneri</i> group, 52/77 patients in the <i>S. boydii</i> group; and 23/30 patients in the <i>S. sonnei</i> group.</p>‡‡‡<p>P<0.035: <i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> types 2–10, or <i>S. boydii.</i></p>§§§<p>Blood culture data were missing for 42/157 patients in the <i>S. dysenteriae</i> type 1 group, 5/24 patients in the <i>S. dysenteriae</i> types 2–10 group, 172/504 patients in the <i>S. flexneri</i> group, 32/77 patients in the <i>S. boydii</i> group; and 10/30 patients in the <i>S. sonnei</i> group.</p

Summary of Previous Studies Examining Risk Factors for Death in Patients with Shigellosis.

<p>All studies used multivariate logistic regression analysis to determine factors predictive of death with the exception of Mitra (reference 34), which used bivariate analysis.</p

Intestinal Manifestation of Shigellosis in 792 Inpatients <15 Years by Species of <i>Shigella</i>.

<p>Values are n (%), unless noted.</p>*<p>Stool character data were missing for 1/157 patient in the <i>S. dysenteriae</i> group, 1/504 in the <i>S. flexneri</i> group, and 1/77 in the <i>S. boydii</i> group.</p>†<p>P<0.001:<i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> type 2–10, <i>S. flexneri</i>, <i>S. boydii</i> or <i>S. sonnei.</i></p>‡<p>Stool frequency data were missing for 3/157 patients in the <i>S. dysenteriae</i> type 1 group, 9/504 patients in the <i>S. flexneri</i> group, 5/77 patients in the <i>S. boydii</i> group, and 1/30 patient in the <i>S. sonnei</i> group.</p>§<p>P<0.001: <i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> type 2–10, <i>S. flexneri</i>, <i>S. boydii</i>, or <i>S. sonnei.</i></p>||<p>Rectal prolapse data were missing for 6/157 patients in the <i>S. dysenteriae</i> type 1 group, 13/504 patients in the <i>S. flexneri</i> group, 3/77 patients in the <i>S. boydii group</i>, and 1/30 patient in the <i>S. sonnei</i> group.</p>¶<p>P<0.040: <i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> type 2–10, <i>S. flexneri</i>, <i>S. boydii</i>, or <i>S. sonnei</i>; <i>S. flexneri</i> versus <i>S. boydii.</i></p>**<p>P = 0.006, <i>S. flexneri</i> versus <i>S. boydii.</i></p>††<p>P<0.015: <i>S. dysentereriae</i> type 1 versus <i>S. flexneri, S. boydii</i>, or <i>S. sonnei.</i></p>‡‡<p>Stool leukocyte count data were missing for 11/157 patients in the <i>S. dysenteriae</i> type 1 group, 1/24 patient in the <i>S. dysenteriae</i> type 2–10 group, 48/504 patients in the <i>S. flexneri</i> group, 10/77 patients in the <i>S. boydii</i> group, and 6/30 patients in the <i>S. sonnei</i> group.</p>§§<p>P<0.020: <i>S. dysenteriae</i> type 1 versus <i>S. flexneri</i>, <i>S. boydii</i>, or <i>S. sonne</i>; <i>S. dysenteriae</i> type 2–10 versus <i>S. boydii</i>; <i>S. flexneri</i> versus <i>S. boydii</i>, or <i>S. sonnei</i>; <i>S. boydii</i> versus <i>S.sonnei.</i></p>§§<p>Stool erythrocyte count data were missing for 11/157 patients in the <i>S. dysenteriae</i> type 1 group, 1/24 patient in the <i>S. dysenteriae</i> type 2–10 group, 46/504 patients in the <i>S. flexneri</i> group, 10/77 patients in the <i>S. boydii</i> group, and 6/30 patients in the <i>S. sonnei</i> group.</p>|| ||<p>P<0.050: <i>S. dysenteriae</i> type 1 versus <i>S. dysenteriae</i> type 2–10, <i>S. flexneri</i>, <i>S. boydii</i>, or <i>S. sonnei</i>; <i>S. dysenteriae</i> type 2–10 versus <i>S. sonnei</i>; <i>S. flexneri</i> versus <i>S. boydii</i>, or <i>S. sonnei</i>; <i>S. boydii</i> versus <i>S.sonnei.</i></p

Features Predictive of Death in 792 Patients <15 Years with Shigellosis in a Multiple Logistic Regression Analysis.

*<p>Median weight-for-age is based on United States National Center for Health Statistics standard^17.</p><p>Analysis was limited to 451 (86%) of the 525 patients discharged improved, and 65 (78%) of the 83 patients who died for whom information on each of the variables entered into the final iteration of the multiple logistic regression analysis was available.</p><p>Variables significant (P<0.05) in the bivariate analysis but excluded from the multiple logistic regression analysis because information was available for a limited number of the 516 patients were blood glucose, available for 127 (25%) patients, and serum protein, available in 163 (32%) patients.</p

Isolation of <i>Shigella</i> Species by Age Group of Patients Admitted to the Dhaka Hospital of the ICDDR, B.

<p>Values are n (% of patients in age group).</p>*<p>P<0.040; S. dysenteriae type 1 versus S. flexneri, S. boydii or S.sonnei; S. dysenteriae types 2–10 versus S. sonnei; S. flexneri versus S. sonnei.</p>†<p>P<0.006: S. dysenteriae type 1 versus S. flexneri, S. boydii or S. sonnei.</p

Flow diagram of the progress through the phase of the trial from enrollment until data analysis for the 3 groups.

<p>Flow diagram of the progress through the phase of the trial from enrollment until data analysis for the 3 groups.</p

A Comparison of Three Quantitative Methods to Estimate G6PD Activity in the Chittagong Hill Tracts, Bangladesh

<div><p>Background</p><p>Glucose-6-phosphate-dehydrogenase-deficiency (G6PDd) is a major risk factor for primaquine-induced haemolysis. There is a need for improved point-of-care and laboratory-based G6PD diagnostics to unsure safe use of primaquine.</p><p>Methods</p><p>G6PD activities of participants in a cross-sectional survey in Bangladesh were assessed using two novel quantitative assays, the modified WST-8 test and the CareStart^™ G6PD Biosensor (Access Bio), The results were compared with a gold standard UV spectrophotometry assay (Randox). The handheld CareStart^™ Hb instrument (Access Bio) is designed to be a companion instrument to the CareStart^™ G6PD biosensor, and its performance was compared to the well-validated HemoCue^™ method. All quantitative G6PD results were normalized with the HemoCue^™ result.</p><p>Results</p><p>A total of 1002 individuals were enrolled. The adjusted male median (AMM) derived by spectrophotometry was 7.03 U/g Hb (interquartile range (IQR): 5.38–8.69), by WST-8 was 7.03 U/g Hb (IQR: 5.22–8.16) and by Biosensor was 8.61 U/g Hb (IQR: 6.71–10.08). The AMM between spectrophotometry and WST-8 did not differ (p = 1.0) but differed significantly between spectrophotometry and Biosensor (p<0.01). Both, WST-8 and Biosensor were correlated with spectrophotometry (r_s = 0.5 and r_s = 0.4, both p<0.001). The mean difference in G6PD activity was -0.12 U/g Hb (95% limit of agreement (95% LoA): -5.45 to 5.20) between spectrophotometry and WST-8 and -1.74U/g Hb (95% LoA: -7.63 to 4.23) between spectrophotometry and Biosensor. The WST-8 identified 55.1% (49/89) and the Biosensor 19.1% (17/89) of individuals with G6PD activity <30% by spectrophotometry. Areas under the ROC curve did not differ significantly for the WST-8 and Biosensor irrespective of the cut-off activity applied (all p>0.05). Sensitivity and specificity for detecting G6PD activity <30% was 0.55 (95% confidence interval (95%CI): 0.44–0.66) and 0.98 (95%CI: 0.97–0.99) respectively for the WST-8 and 0.19 (95%CI: 0.12–0.29) and 0.99 (95%CI: 0.98–0.99) respectively for the Biosensor. Hb concentrations measured by HemoCue^™ and CareStart^™ Hb were strongly correlated (r_s = 0.8, p<0.001, mean difference = 0.09 g Hb/dL, 95% LoA: -2.15 to 2.34).</p><p>Conclusion</p><p>WST-8 and the CareStart^™ G6PD Biosensor represent advances in G6PD diagnostics in resource poor settings, but will require further development before clinical deployment. The CareStart^™ Hb instrument produced a precise measure of haemoglobin concentration.</p></div

Demographic and baseline characteristics of study subjects.

<p><b>NOTE:</b> SD, standard deviation; °C, degree Celsius; GM/µL, geometric mean/micro Liter.</p