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Abstract
Shigellosis is an acute diarrheal disease caused by bacteria of the genus Shigella. Following the occurrence of a large outbreak of shigellosis as well as sporadic cases since 1998, shigellosis has been a major health problem in Korea. There have been major changes in epidemiology during the last five decades concerning shigellosis in terms of total incidence of shigellosis, prevalence of certain serogroups, selection of specific clones, and introduction of new Shigella clones. S. dysenteriae was the most prevalent species until the early twentieth century, S. flexneri was the most prevalent until the late 1980s, and S. sonnei has been the most prevalent since 1990. Diverse serotypes of S. dysenteriae (4 serotypes), S. flexneri (8 serotypes), and S. boydii (4 serotypes) were found during the Korean War and many of these Korean endemic Shigella strains circulated in the community until the late 1970s. However, the endemic strains of S. dysenteriae, S. boydii, and S. sonnei disappeared in the late 1980s. A new clone of S. sonnei that was introduced between the late 1980s and the early 1990s was responsible for a large proportion of shigellosis in recent years. S. flexneri serotype 4a was the most frequently found during the Korean War and then the incidence of S. flexneri 2a gradually increased with time. S. flexneri isolates detected from 1991 to 1997 were all serotype 2a. However, the diverse clones of S. flexneri reemerged in Korea since 1999. It has not been determined whether the S. flexneri strains from the 2000s were the descendants of the Korean endemic strains or imported new strains, but the PFGE patterns were different between S. flexneri strains from the 1980s and 2000s. The widespread of new S. sonnei strains and the persistence of S. flexneri strains are responsible for the endemicity of shigellosis in Korea.
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Figure 2.
The representative of PFGE patterns of S. flexneri isolates in Korea. S. flexneri isolates during the periods of 1983 to 2003 were selected based on antimicrobial susceptibility, transferability of antimicrobial resistance, and biochemical profiles.
Figure 3.
The representative of PFGE patterns of S. sonnei isolates in Korea. S. sonnei isolates during the periods of 1977 to 2000 were selected based on antimicrobial susceptibility, transferability of antimicrobial resistance, and resistant mechanisms of antimicrobial agents.
Table 1.
Prevalence of Shigella species isolated in Korea during the periods of 1952 to 1953
Table 2.
Prevalence of Shigella species isolated in Daegu and Kyungpook province during the periods of 1961 to 1968
Table 3.
Prevalence of Shigella species in Korea during the last five decades
Table 4.
Prevalence of serotype of S. flexneri isolates in Korea during the last five decades
| Serotype | Incidence of S. flexneria | ||||
|---|---|---|---|---|---|
| 1952∼1954 | 1961∼1969 | 1970∼1979 | 1991∼1997 | 1998∼2004 | |
| 1a | 11.7% | 9.0% | 1.1% | – | – |
| 1b | – | 0.9% | 0.7% | – | – |
| 2a | 26.8% | 50.2% | 93.2% | 100% | 84.8% |
| 2b | – | 6.3% | – | – | 3.0% |
| 3a,c | 14.0% | 8.5% | 0.2% | – | 6.0% |
| 4a | 34.2% | 16.1% | 0.2% | – | – |
| 4b | – | 5.8% | – | – | – |
| 5 | 12.3% | 3.1% | – | – | 3.0% |
| Others (X, Y) | 1.0% | 0% | 4.6% | – | 3.0% |
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