Shigellosis

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Other names:Shigella gastroenteritis; Shigella enteritis; Enteritis - shigella; Gastroenteritis - shigella; Traveler's diarrhea - shigellosis

Shigellosis is a disease caused by a group of bacteria called Shigella.

Shigella-culture.png
Shigella stool.jpg

Cause

Shigellosis is a diarrheal disease caused by a group of bacteria called Shigella. There are four different species of Shigella:

  • Shigella sonnei (the most common species in the United States)
  • Shigella flexneri
  • Shigella boydii
  • Shigella dysenteriae

S. dysenteriae and S. boydii are rare in the United States, though they continue to be important causes of disease in the developing world. Shigella dysenteriae type 1 can be deadly .

Transmission

Shigella germs are in the stool (poop) of sick people while they have diarrhea and for up to a week or two after the diarrhea has gone away. Shigella germs are very contagious; it takes just a small number of Shigella germs to make someone sick. People can get shigellosis when they put something in their mouths or swallow something that has come into contact with the stool of someone else who is sick with shigellosis. People could get sick by:

Getting Shigella germs on their hands and then touching your food or mouth. You can get Shigella germs on your hands after:

  • Touching surfaces contaminated with germs from stool from a sick person, such as toys, bathroom fixtures, changing tables or diaper pails
  • Changing the diaper of a sick child or caring for a sick person
  • Eating food that was prepared by someone who is sick with shigellosis
  • Swallowing recreational water (for example, lake or river water) while swimming or drinking water that is contaminated with stool (poop) containing the germ
  • Having exposure to stool during sexual contact with someone who is sick or recently (several weeks) recovered from shigellosis.

Riskfactors

  • Young children are the most likely to get shigellosis, but people of all ages are affected .
  • Travelers to developing countries may be more likely to get shigellosis, and to become infected with strains of Shigella bacteria that are resistant to important antibiotics
  • Gay and bisexual men and other men who have sex with men (MSM)† are more likely to acquire shigellosis than the general adult population
  • People who have weakened immune systems due to illness (such as HIV) or medical treatment (such as chemotherapy for cancer) can get a more serious illness. A severe shigellosis may involve the infection spreading into the blood, which can be life-threatening
  • Large outbreaks of shigellosis often start in childcare settings and spread among small social groups such as in traditionally observant Jewish communities

Symptoms

Symptoms often develop about 1 to 7 days (average 3 days) after coming into contact with the bacteria. Symptoms include:

  • Acute (sudden) abdominal pain or cramping
  • Acute fever
  • Blood, mucus, or pus in the stool
  • Crampy rectal pain
  • Nausea and vomiting
  • Watery diarrhea

About 1 in 10 children (under age 15) with severe shigella enteritis develop nervous system problems. These may include febrile seizures (also called a "fever fit") when body temperature rises quickly and the child has seizures. A brain disease (encephalopathy) with headache, lethargy, confusion, and stiff neck can also develop.

Diagnosis

If you have symptoms of shigellosis, your health care provider will check for:

  • Dehydration (not enough fluids in your body) with a fast heart rate and low blood pressure
  • Abdominal tenderness
  • Elevated level of white blood cells in the blood
  • Stool culture to check for white blood cells

Treatment

  • Most people will recover from shigellosis without treatment in 5 to 7 days. People who have shigellosis should drink plenty of fluids to prevent dehydration.
  • In some people, bismuth subsalicylate (for example, Pepto-Bismol) can help to relieve symptoms .
  • People with shigellosis should not use anti-diarrheal medication, such as loperamide (for example, Imodium) or diphenoxylate with atropine (for example, Lomotil). These medications may make symptoms worse .
  • Healthcare providers may prescribe antibiotics for some people who have severe cases of shigellosis. Antibiotics such as ciprofloxacin (common treatment for adults), and azithromycin (common treatment for children) are useful for severe cases of shigellosis because they can help people get better faster . However, some antibiotics are not effective against certain types of Shigella bacteria. Healthcare providers can order laboratory tests to determine which antibiotics are likely to work.

Prevention

Prevention includes properly handling, storing, and preparing food, and good personal hygiene. Handwashing is the most effective way to prevent shigellosis. Avoid food and water that may be contaminated.

Epidemiology

Insufficient data exist, but it is estimated to have caused the death of 34,000 children under the age of five in 2013, and 40,000 deaths in people over five years of age. Shigella also causes about 580,000 cases annually among travelers and military personnel from industrialized countries.

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