Alternate Names: Shigellosis; Shigella gastroenteritis
Causes and Risks:
Shigella enteritis is an acute infection caused by 1 of 4 strains of the Shigella bacteria. Outbreaks of the disease have been associated with poor sanitation, inadequate water supplies, contaminated food, crowded living conditions, and fly-infested environments.
It is common among travelers in developing countries and workers or people living on reservations, refugee camps, and institutions. The incubation period is 1 to 7 days, with an average of 3 days.
Although uncommon in adults, neurologic symptoms can develop in children. In up to 40% of children with severe shigellosis, seizures (febrile seizures), headache, lethargy, confusion, and stiff neck resembling meningitis (nuchal rigidity) can occur. The risk factors are the same as the conditions associated with the disease.
There are about 18,000 cases of Shigellosis per year in the U.S.
Prevention: Proper handling, storage, and preparation of food in addition to good sanitation are principles of prevention. Hand-washing is the most effective preventative measure.
Symptoms:
Signs and Tests:
- Fast heart rate and low blood pressure if dehydration develops
- Abdominal tenderness
- Eelevated white blood cell count
- Stool culture shows Shigella
- Stools may have white blood cells
Treatment: Natural course of the disease is 2-3 days. The objective of treatment is to replace fluids and electrolytes (salt and minerals) lost by diarrhea.
Antidiarrheal medications are generally not given, as they may prolong the infectious process.
Self-care measures to avoid dehydration include drinking electrolyte solutions to replace the fluids lost by diarrhea. Several varieties of pleasant-tasting electrolyte solutions are available over-the-counter.
Antibiotics may be indicated for those who are severely symptomatic. Trimethoprim or sulfamethoxazole; ampicillin; ciprofloxacin; or chloramphenicol are frequently used.
People with diarrhea who are unable to take fluids by mouth because of nausea may need medical attention and intravenous fluids, especially small children.
People taking diuretics need to be cautious with diarrhea, and may need to stop taking the diuretic during the acute episode as directed by the health care provider.
Prognosis: Often the infection is mild and self-limited. Prognosis is excellent except among malnourished and immunocompromised children.
Complications:
- Severe dehydration
- Neurologic symptoms including seizures (in children)
- Hemolytic-uremic syndrome (HUS)
- Reiter's syndrome
Call your health care provider if diarrhea does not improve, blood is noted in the stools, or if dehydration seems to be developing.
Go to the emergency room if seizures occur, or if confusion, lethargy, headache with stiff neck, or similar symptoms develop in a person with shigellosis (these symptoms are most common in children).
