Buscar en
Enfermedades Infecciosas y Microbiología Clínica (English Edition)
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Imported infection by CTX-M-15 extended-spectrum beta-lactamase-producing Shigel...
Journal Information
Vol. 37. Issue 2.
Pages 141 (February 2019)
Vol. 37. Issue 2.
Pages 141 (February 2019)
Scientific letter
Full text access
Imported infection by CTX-M-15 extended-spectrum beta-lactamase-producing Shigella sonnei
Caso importado de infección por Shigella sonnei portadora de betalactamasa de espectro extendido CTX-M-15
Patricia González Donapetry, Paula Pescador Martín, Rosa Gómez-Gil Mira, Guillermo Ruiz Carrascoso
Corresponding author

Corresponding author.
Servicio de Microbiología, Hospital Universitario La Paz, Madrid, Spain
This item has received
Article information
Full Text
Download PDF
Full Text

Shigellosis is an acute intestinal infection of worldwide distribution caused by different species of the genus Shigella, with Shigella sonnei being the most prevalent in our area. The existence of strains of S. sonnei that produce extended-spectrum beta-lactamases (ESBL) has been widely reported in Asian countries such as China,1 Japan,2 South Korea,3 Iran4 or Vietnam.5 However, infection due to these bacteria in Spain6 is anecdotal. With the increase of tourism to exotic places, in recent years there has been an increase in the number of imported cases of rare infections in Spain or the expansion of strains with resistance to antibiotics, as is the case described below:

A 33-year-old man, born in Spain, went to the emergency department in the summer of 2017 with symptoms that began that morning, characterised by epigastric pain, nausea, vomiting and watery diarrhoea with mucus, accompanied by a fever of up to 38°C and hyporexia. There was no associated respiratory or urinary symptoms. The patient had returned to Spain six days before from a 23-day trip through Vietnam and Cambodia, with a two-hour layover at Dubai airport. He was accompanied by his wife, who had presented diarrhoeal symptoms during the trip, without fever, lasting seven days. The patient had not received any type of vaccination prior to the trip nor had prophylaxis for malaria been carried out, so a thick blood smear and malaria antigen detection were performed, both resulting in negative tests. In his lab results, he had leukocytosis (23,800cells/mm3) with marked neutrophilia (21,900cells/mm3) and an increase in C-reactive protein (73mg/dl). Samples of faeces and urine were sent to the microbiology department for conventional culture and the patient was discharged with antibiotic treatment (ciprofloxacin) and hydroelectrolytic replenishment.

In the stool culture, non-lactose fermenting bacteria were isolated in the Salmonella-Shigella medium which were identified as S. sonnei by the triple sugar-iron agar (TSI) test, agglutination with specific antisera and biochemical tests. The antibiogram was performed by the broth microdilution method using a Microscan® panel, which showed resistance to ampicillin, cephalothin, cefuroxime, cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin, amikacin, co-trimoxazole and nalidixic acid, but susceptibility to norfloxacin, ciprofloxacin and levofloxacin. It had an extended-spectrum beta-lactamase phenotype with inhibition by clavulanic acid. The type of beta-lactamase was determined by real-time PCR (Progenie Molecular®) and subsequent Sanger sequencing resulting in beta-lactamase of the CTX-M-15 type.

The case presented is the first imported case described in Spain of S. sonnei producing CTX-M-15. ESBL-producing S. sonnei infections in Spain are scarcely collected in the literature, with the exception of one native case6 reported in 2011. Up to seven types of beta-lactamases of the CTX-M type have been described in the genus Shigella: CTX-M-2, CTX-M-3, CTX-M-14, CTX-M-15, CTX-M-55,2 CTX-M-577 and CTX-M-64, with beta-lactamase CTX-M-15 being the one reported most frequently in Asian countries such as Vietnam, Korea, China, Japan, Iran, Turkey and Lebanon.8 The case presented highlights the importance of tourism to exotic places in the expansion of ESBL-producing strains in rare genera in Spain.

F. Qu, Z. Ying, C. Zhang, Z. Chen, S. Chen, E. Cui, et al.
Plasmid-encoding extended-spectrum β-lactamase CTX-M-55 in a clinical Shigella sonnei strain China.
Future Microbiol, 9 (2014), pp. 1143-1150
J. Seto, M. Inage.
Detection of CTX-M-15 extended-spectrum beta-lactamase gene-producing Shigella sonnei from diffuse outbreak in Japan.
Kansenshogaku Zasshi, 86 (2012), pp. 608-609
J.S. Kim, J. Kim, Jeon S.E., S.J. Kim, N.O. Kim, S. Hong, et al.
Complete nucleotide sequence of the IncI1 plasmid pSH4469 encoding CTX-M-15 extended-spectrum β-lactamase in a clinical isolate of Shigella sonnei from an outbreak in the Republic of Korea.
Int J Antimicrob Agents, 44 (2014), pp. 533-537
R. Ranjbar, F.M. Ghazi, S. Farshad, G.M. Giammanco, A. Aleo, P. Owlia, et al.
The occurrence of extended-spectrum β-lactamase producing Shigella spp. in Tehran, Iran.
Iran J Microbiol, 5 (2013), pp. 108-112
J.S. Kim, J.J. Kim, S.J. Kim, S.E. Jeon, K.Y. Seo, J.K. Choi, et al.
Outbreak of ciprofloxacin-resistant Shigella sonnei associated with travel to Vietnam, Republic of Korea.
Emerg Infect Dis, 21 (2015), pp. 1247-1250
C. Seral, B. Rojo-Bezares, A. Garrido, M.J. Gude, Y. Sáenz, F.J. Castillo.
Characterisation of a CTX-M-15-producing Shigella sonnei in a Spanish patient who has not travelled abroad.
Enferm Infecc Microbiol Clin, 30 (2012), pp. 469-471
C.L. Zhang, Q.Z. Liu, J. Wang, X. Chu, L.M. Shen, Y.Y. Guo.
Epidemic and virulence characteristic of Shigella spp. with extended-spectrum cephalosporin resistance in Xiaoshan District, Hangzhou, China.
BMC Infect Dis, 14 (2014), pp. 260
A.H. Sabra, G.F. Araj, M.M. Kattar, R.Y. Abi-Rached, M.T. Khairallah, J.D. Klena, et al.
Molecular characterization of ESBL-producing Shigella sonnei isolates from patients with bacilliary dysentery in Lebanon.
J Infect Dev Ctries, 3 (2009), pp. 300-305

Please cite this article as: González Donapetry P, Pescador Martín P, Gómez-Gil Mira R, Ruiz Carrascoso G. Caso importado de infección por Shigella sonnei portadora de betalactamasa de espectro extendido CTX-M-15. Enferm Infecc Microbiol Clin. 2019;37:141.

Copyright © 2018. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos