PATIENTS AND METHODS
ICDDR, B operates a diarrhoea treatment centre at Matlab, arural area of Bangladesh, which lies 45km south east of Dhaka. Since 1963 a demographic surveillance system (DSS) which consists of regular cross sectional census and longitudinal registration of vital events has been maintained in the area. Details of the study area, its people and field research procedures have been reported elsewhere11. From February 1978, rectal swab, stool specimens were obtained from all admitted DSS (about 35% of total admissions) registered patients and cultured for Shigellae, Yibrio cholerae and Salmonellae using standard procedures12. The clinical and microbiological records of all DSS patients admitted between February, 1978 and December1987 were reviewed to obtain the age distribution, seasonality, antibiotic sensitivity patterns and mortality information of Shigella patients. During 1977-7913 and 1983-8414 Shigella strains were tested for sensitivity to tetracycline, ampicillin, chloramphenicol, kenamycin, gentamycin, streptomycin and cotriffioxazole by tIle Bauer-Kirby technique15. In 1987, these were tested only against ampicillin, cotrimoxazole and nalidixic acid. The Shigella isolation techniques remained same for the whole period of study.
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2. Rahaman, M.M., Khan, M.M., Aziz, K.M.S., Islam M.S. and Kibriya, A.K.M. An outbreak of dysentery caused by Shigella dysenterise type ion a coral island in the Bay of Bengal. ). Infect. Dia., 1975; 132: 15.
3. Rosenberg. M.L, Weiaaman, ).B., Gangarosa, E.J., Reller, LB. and Bessley, RP. Shigellosis in the United States: Ten year review of nationwide surveillance, 1964-1973. Am.). epidemiol., 1976; 104: 543.
4. Gangarosa, LI., Perera, D.R., Mats, Li., Mandiazabal-Moris, C, Guzman, 0. and Reller, LB. Epidemic Shigabacillua dysentery in Central America. IL Epidemiologic studies in 1969. 3. Infect. Dia., 1970; 122: 181.
5. Khsn, M.U., Roy, N.C., Islam, MR., Huq, M.I. and Stoll, B. Fourteen years of Shigellosis in Dhaka: An epidemiological analysis. Int. 3. Epidemiol., 1985; 14: 607.
6. Black, RE., Merson, M.H., Rahmsn, A.S.M.M., Yunus, M., AIim, A. R.M.A., Huq, I., Yolken, RH. and Curtin, G.T. A two-year study of bacterial, viral, and parasitic agents associated with diarrhoea in rural Bangladesh.). Infect Dia., 1980; 142: 660.
7. Olarte, J., Filloy, Land Ganlindo, & Reaistanceof Shigella dyaenteriae type ito ampicillin and other antimicrobial agents; strains isolated during a dysentery outbreak in a hospital in Mexico city.). Infect Dis., 1976; 133: 572.
8. Haq, M.I., Ghsmdi, MA_A., Haider, K. and AIim, ALMA. Antimicrobial ‘susceptibility pattern of the clinical isolates of Shigella spin the eastern province of Saudi Arabia. Asian Med. 3., 1987; 30: 228.
9. Shahid, N.S., Rahaman, M.M., Haider, K., Banu, H. and Rahman, N. Ctsanging pattern ofresistantShiga bacillus (Shigella dysenteriae type 1) and Shigella flexn’eriin Bangladesh. 3. Infect Dis., 1985; 152: 1114.
10. Zaman, K., Yunus, M.,Baqui, A_H., Hosasin, K.M.B. and Khan, M.D. Cotrimoxazole resistant Shigella dysenteriae type 1 outbreak in a family in rural Banladesh (letter). Lancet, 1983; 2: 796.
11. lnternational Centre for Diarrhoeal Disease Research, Bangladesh: Demographic Sur. veillance System-Matlab, Vol 1, methods and procedures, 1978,28p. (ICDDR,B Scientitk Report No.9, 1978).
12. Edwards, P.R and Ewing. W.H. Identification of enterobacteriacese. 3rd ed. Minneapolis, Burgess, 1972,p 362.
13. Yunus, M., Mizanur Rahman, A_SM., Farooque, A.S.G. and Glass, R.I. Clinical trial of arnpicillin v. trimethoprim-sulphametoxazole in the treatment of Shigella dysentery.). Trop. Med. Hyg., 1982; 85: 195.
14. Baqui, A_H., Zaman, K., Yunua, M., Mitra, AK., Hosssin, K.M.B. and Banu, H. Epidemiologlcal and clinical characteristics of Shigellosia in rural Bangladesh.). Diar. Dia.Res., 1988; 6: 21.
15. Bauer, A.W., Kirby, W.M.M., Sherris, IC. and Truck, M. Antibioticsusceptibility testing by a standardized single disk method. Am.J., Clin. Pathol., 1966; 45: 493.
16. Wilson, it, Feldman, R.A., Davis,). and LaVenture, M. Family illness associated with Shigells infection: the interrelationship of age of the index patients and the age of household members in acquisition of illness, J. Infect. Dia., 1981; 143: 130.
17. Pal, S.C Epidemic bacillary dysentery in West Bengal, India, 1984. Lancet, 1984; 1: 1462.
18. Bennish, M., Eusof, A, Kay, B. and Wierzbs, T. Multiresistant Shigella infections in Bangladesh. Lancet, 1985; 2: 441.
19. Hossain, K.M.B., Glass, R.I., Huq, I., Yunus, M. and Hosaain, M.M. Surveillance of Shigellosia in Matlab: a ruveyear review. In Rahaman, M.M., Greenough, W.B. III., Novak, N.R. and Rahman, S eds. Shigellosia: a continuing global problem; proceedings of an International conference, Cox’s Bazar, 1981. Dhaka: International Centre for Diarrhoeal Disease Research, Bangladesh, 1983, 100.
20. Stool, B.J., Glass, RI., Huq, Ml., Khan, MU., Banu, H. and Holt,). Epidemiologic and clinical features of patients infected with Shigella who attended a diarrhoeal disease hospital in Bangladesh.). Infect. Dis., 1982; 146: 177.
22. Clemens, 3D., Stanton, B., Stool, B., Shahid, N.S., Banu, H., and Chowdhury, A.K.M.A. Breast feeding as a determinant of severity in Shigellosis: evidence for protection throughout the first three years of life in Bangladeshi children. Am.). Epidemiol., 1986; 123: 710.
22. Munahi, M.H., Sack, D.A., Haider, K., Ahmed, LU., Rahaman, M.M. and Morshed, M.G. Plasmid-mediated resistance to nalidixic acid in Shigella dysenterise type 1. Lancer. 1987; 2:419.
23. Hoasain, M.M., Glass, RL and Khsn, M.R. Antibiotic use in a rural community in Banglsdeah. Int.). Epidemiol., 1982; 11: 402.
24. Khan, M.U. Interruption of ahigellosis by hand washing. Trans. R. Soc. Trop. Med. Hyg., 1982; 76: 164.