Shigellosis among Tourists -- Union of Soviet
Socialist Republics, 1983
CDC has received several reports of a severe diarrheal illness
affecting tour groups to the southern Union of Soviet Socialist
Republics (U.S.S.R.)in 1983:
Tour #1. A 60-year-old woman developed vomiting, chills, and
diarrhea in July 1983 in Tashkent, Uzbek Soviet Socialist Republic.
She had been in Bukhara, Uzbek, for the 2 days before her onset of
illness. The diarrhea persisted for 2 weeks, despite medication
prescribed by physicians in the U.S.S.R., and on her return to the
United States, she consulted her private physician. She was
treated
with trimethoprim/sulfamethoxazole, and after 3 days, the diarrhea
resolved. Stool culture yielded Shigella flexneri 1b.
Tour #2. A 52-year-old man became ill with diarrhea and chills
in
September 1983, while on a tour in Yerevan, Armenian Soviet
Socialist
Republic. His symptoms persisted after his return to the United
States, and a stool culture grew S. flexneri 1b.
Tour #3. A physician-member of a tour group to the Caucasus in
August 1983 reported that more than 60% of tour-group members
experienced an illness characterized by high fever, nausea, and
nonbloody diarrhea that lasted 2 days to 2 weeks. The illness
first
occurred after the group had been in Tbilisi, Georgian Soviet
Socialist Republic, for several days. The illness was treated
empirically with trimethoprim/sulfamethoxazole or doxycycline;
antidiarrheal medications were avoided.
Following these reports, CDC contacted tour leaders who had led
39
tours through the U.S.S.R. between April and October 1983. In 12
of
the 39 tours, more than one-third of tour members had a diarrheal
illness compatible with shigellosis.
All 12 affected tour groups were among the 18 groups that
traveled
through either Uzbek Soviet Socialist Republic or the Caucasus
Mountain Republics of Georgia, Armenia, or Azerbaidzhan during July
through October 1983. In contrast, none of 17 tour groups to the
U.S.S.R. that did not visit these areas in the southern U.S.S.R.
and
none of four tours to the Caucasus in May and June 1983 experienced
similar outbreaks of diarrheal disease. The Shigella isolates from
tours 1 and 2 were confirmed as S. flexneri type 1b, resistant to
ampicillin and chloramphenicol and sensitive to
trimethoprim/sulfamethoxazole. S. sonnei was isolated from a
member
of a tour to the Caucasus returning to the United States in late
August; this isolate was not characterized further. No other
pathogens were reported to have been isolated among the surveyed
groups.
Reported by CW Bird, MD, R Locey, MD, Oakland County Health Div,
Oakland County, KR Wilcox, Jr, MD, Michigan State Dept of Public
Health; DB Prescott, MD, Storrs, Connecticut; Enteric Diseases Br,
Div
of Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Persons who traveled to the Soviet Republics of
Uzbek, Georgia, Armenia, and Azerbaidzhan in summer and fall of
1983
appear to have been at high risk for acquiring a febrile diarrheal
illness, some of which was shigellosis. Shigella is usually
transmitted person-to-person or via contaminated food or water.
The
source of the illness in these tour groups is not known. It is not
known whether a similar risk was present before 1983 or will be
present in 1984. Antimicrobial-resistant Shigella should be
considered in the differential diagnosis of diarrheal illness
occurring in tourists to these areas.
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