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Shigellosis is the major global cause of dysentery.  Shigella sonnei , which has historically been more commonly isolated in developed countries, is undergoing an unprecedented expansion across industrializing regions in Asia, Latin America, and the Middle East. The precise reasons underpinning the epidemiological distribution of the various  Shigella  species and this global surge in  S .  sonnei  are unclear but may be due to three major environmental pressures. First, natural passive immunization with the bacterium  Plesiomonas shigelloides  is hypothesized to protect populations with poor water supplies against  S .  sonnei . Improving the quality of drinking water supplies would, therefore, result in a reduction in  P .  shigelloides  exposure and a subsequent reduction in environmental immunization against  S .  sonnei . Secondly, the ubiquitous amoeba species  Acanthamoeba castellanii  has been shown to phagocytize  S .  sonnei  efficiently and symbiotically, thus allowing the bacteria access to a protected niche in which to withstand chlorination and other harsh environmental conditions in temperate countries. Finally,  S .  sonnei  has emerged from Europe and begun to spread globally only relatively recently. A strong selective pressure from localized antimicrobial use additionally appears to have had a dramatic impact on the evolution of the  S .  sonnei  population. We hypothesize that  S .  sonnei , which exhibits an exceptional ability to acquire antimicrobial resistance genes from commensal and pathogenic bacteria, has a competitive advantage over  S .  flexneri , particularly in areas with poorly regulated antimicrobial use. Continuing improvement in the quality of global drinking water supplies alongside the rapid development of antimicrobial resistance predicts the burden and international distribution of  S .  sonnei  will only continue to grow. An effective vaccine against  S .  sonnei  is overdue and may become one of our only weapons against this increasingly dominant and problematic gastrointestinal pathogen.

The Rising Dominance of Shigella sonnei: An Intercontinental Shift in the Etiology of Bacillary Dysentery