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Shigellosis

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

 

Shigellosis is an infection of the lining of the intestines. It is caused by a group of bacteria called shigella.

Causes

 

There are several types ofshigella bacteria, including.

  • Shigella sonnei, also called "group D" shigella, is responsible for most cases of shigellosis in the United States.
  • Shigella flexneri, or "group B" shigella, causes almost all other cases.
  • Shigella dysenteriae, or "group A" shigella is rare in the United States, but can lead to deadly outbreaks in developing countries.

People infected with the bacteria release it into their stool. They can spread the bacteria to water or food, or directly to another person. Getting just a little bit of the shigella bacteria into your mouth is enough to cause infection.

Outbreaks of shigellosis are linked with poor sanitation, contaminated food and water, and crowded living conditions.

Shigellosis is common among travelers in developing countries and workers or residents in refugee camps.

In the United States, the condition is most commonly seen in daycare centers and places where groups of people live, such as nursing homes.

 

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

 

Exams and Tests

 

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

 

The goal of treatment is to replace fluids and electrolytes (salt and minerals) that are lost in diarrhea.

Medicines that stop diarrhea are generally not given because they can cause the infection to take longer to go away.

Self-care measures to avoid dehydration include drinking electrolyte solutions to replace the fluids lost by diarrhea. Several varieties of electrolyte solutions are available over-the-counter (without a prescription).

Antibiotics can help shorten the length of the illness and help prevent it from spreading to others in group living or daycare settings. They may also be prescribed for people with severe symptoms.

If you have diarrhea and cannot drink fluids by mouth because of severe nausea, you may need medical attention and intravenous (IV) fluids. This is especially common in small children who have shigellosis.

People who take diuretics ("water pills") may need to stop taking these medicines if they have acute shigella enteritis. Never stop taking any medicine without first talking to your provider.

 

Outlook (Prognosis)

 

The infection is often mild and goes away on its own. Most people, except malnourished children and those with weakened immune systems, recover fully.

 

Possible Complications

 

Complications may include:

  • Dehydration, severe
  • Hemolytic-uremic syndrome (HUS), a form of kidney failure with anemia and clotting problems
  • Reactive arthritis

About 1 in 10 children 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, or a brain disease (encephalopathy) with headache, lethargy, confusion, and stiff neck.

 

When to Contact a Medical Professional

 

Call your provider if diarrhea does not improve, if there is blood in the stool, or if there are signs of dehydration.

Go to the emergency room if these symptoms occur in a person with shigellosis:

  • Confusion
  • Headache with stiff neck
  • Lethargy
  • Seizures

These symptoms are most common in children.

 

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.

 

 

References

Bhutta ZA. Acute gastroenteritis in children. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 340.

DuPont HL. Approach to the patient with suspected enteric infection. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 283.

Haines CF, Sears CL. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 110.

Keusch GT. Shigellosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 309.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 140.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration


     

    Review Date: 3/13/2016

    Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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