Characterization ofShigella sonneiIsolate Carrying Shiga Toxin 2–Producing Gene

To the Editor: Shigella sonnei causes a bacillary dysentery called shigellosis.Shiga toxins 1 (Stx1) and 2 (Stx2) are mainly produced by Shiga toxin-producing Escherichia coli (STEC), but Stx1 can also be produced by S. dysenteriae serotype 1 (1).Compared with STEC-producing Stx1, STEC-producing Stx2 has been reported to be more highly pathogenic and to be associated with hemolytic uremic syndrome (HUS) and hemorrhagic colitis (2); the association with HUS especially has been reported for subtypes Stx2a and Stx2c (3).Stx-converting bacteriophages play a key role in expression of the stx gene in E. coli and in the lateral gene transfer between the bacteria (4).Although these bacteriophages have not been isolated from S. dysenteriae serotype 1, evidence suggests that the bacteria's stx gene may be associated with a bacteriophage (5).The stx 1 gene, which is located in a bacteriophage, has previously been detected in S. sonnei (6).We describe an S. sonnei isolate with the stx 2a gene.In November 2013, 3 days after her return to Finland from a 2-week visit to relatives in southern Morocco, a 49-year-old woman was admitted to a hospital for bloody diarrhea, fever, and abdominal pain.Her symptoms began with watery diarrhea and fever 5 days before she returned home.The diarrhea ceased after a few days, but symptoms worsened, and diarrhea was visibly bloody after she returned to Finland.On admission, the patient had C-reactive protein and hemoglobin levels of 41 mg/L (reference value <3 mg/L) and 118 g/L (reference value 117-155 g/L), respectively; no thrombocytopenia was observed.No antimicrobial drugs were prescribed because STEC infection was clinically suspected.The patient responded well to intravenous fluid treatment and was discharged from the hospital 3 days after admission.At a follow-up visit 1 week later, she was asymptomatic and had a C-reactive protein level of 19 mg/L.Shigella spp. was isolated from a feces sample obtained from the patient on illness day 8, and an STEC signal Outbreak of Leishmania braziliensis Cutaneous Leishmaniasis, Saül, French Guiana