Shigella (Shigellosis): Symptoms, Causes, Prevention, Treatment
Author: Thomas C. Weiss : Contact: Disabled World (www.disabled-world.com)
Published: 2015-10-27 : (Rev. 2020-12-10)
Synopsis and Key Points:
Information regarding Shigella infection (shigellosis), an intestinal disease with the main sign being diarrhea, which is often bloody.
Signs and symptoms of shigella infection usually start a day or two after contact with shigella, yet might take up to a week to develop.
A shigella infection usually clears up without complications, although it might take weeks or even months before your bowel habits return to usual.
Shigellosis, (Bacillary dysentery or Marlow Syndrome), is defined as a foodborne illness caused by infection by bacteria of the genus Shigella. The causative organism is frequently found in water polluted with human feces, and is transmitted via the fecal-oral route. The usual mode of transmission is directly person-to-person hand-to-mouth, in the setting of poor hygiene among children. Signs and symptoms of Shigellosis can range from mild abdominal discomfort to full-blown dysentery characterized by cramps, diarrhea, with slimy-consistent stools, fever, blood, pus, or mucus in stools or tenesmus.
Example: This may happen in a child care setting when staff members do not wash their hands well enough after changing diapers, or helping toddlers with toilet training. Shigella bacteria can also be passed in contaminated food, or by drinking or swimming in contaminated water. Children between the ages of two and four are most likely to experience a shigella infection. A mild case commonly clears up on its own within a week. When treatment is required, a doctor will generally prescribe antibiotics.
Symptoms of Shigella Infection
Signs and symptoms of shigella infection usually start a day or two after contact with shigella, yet might take up to a week to develop. The signs and symptoms can include the following:
- Abdominal pain or cramps
- Diarrhea, often times containing mucus or blood
While some people experience no symptoms after they have been infected with shigella, their feces might continue to be contagious for up to a few weeks. It is important to contact a doctor or pursue urgent care if you or your child has bloody diarrhea, or diarrhea severe enough to cause weight loss and dehydration. Contact a doctor if you or your child had diarrhea and a fever of 101F or higher.
A shigella infection occurs when a person accidentally swallows shigella bacteria. Examples of causes of a shigella infection include the following.
- Direct Person-To-Person Contact: Person-To-Person contact is the most common way shigella is spread.
- Swallowing Contaminated Water: Water may become contaminated either from sewage, or from a person with shigella infection swimming in it.
- Touching Your Mouth: If you do not wash your hands well after changing the diaper of a child who has shigella infection, you might become infected as well.
- Eating Contaminated Food: Infected people who handle food may transmit the bacteria to others who consume the food. Food may also become contaminated if it grows in a field containing sewage.
One of the risk factors for a shigella infection is simply being a toddler. Shigella infection is most common in children who are between the ages of two and four. Another risk factor is living or traveling in areas lacking sanitation. People who live or travel to developing countries are more likely to contract shigella infection. Additional risk factors include:
- Being a Sexually Active Gay Male: Men who have sex with men are at increased risk because of direct or indirect oral-anal contact.
- Living in Group Housing: Living in group housing or participating in group activities are risk factors. Close contact with others spreads the bacteria from person to person. Shigella outbreaks are more common in community wading pools, child care centers, jails, nursing homes and military barracks.
A shigella infection usually clears up without complications, although it might take weeks or even months before your bowel habits return to usual. Complications of a shigella infection may include:
- Rectal Prolapse: In this condition, straining during bowel movements might cause the mucous membrane or lining of the rectum to move out through the anus.
- Dehydration: Persistent diarrhea may cause dehydration. Symptoms may include lightheadedness, dizziness, a lack of tears in children, dry diapers and sunken eyes. Severe dehydration can lead to shock and death.
- Hemolytic Uremic Syndrome: Hemolytic uremic syndrome is a rare complication of shigella, more commonly caused by bacteria called, 'E. Coli,' which may lead to a low red blood cell count, low platelet count and acute kidney failure.
- Seizures: Some children who run high fevers with a shigella infection experience seizures. It is not known whether the convulsions are a result of the fever, or the shigella infection itself. If your child experiences a seizure, contact a doctor at once.
- Reactive Arthritis: Reactive arthritis develops in response to infection. Signs and symptoms include joint pain and inflammation, usually in the person's feet, ankles and hips; itching, redness and discharge in one or both eyes, as well as painful urination.
- Toxic Megacolon: Toxic megacolon is a rare complication that happens when a person's colon becomes paralyzed, preventing them from having a bowel movement or passing gas. Signs and symptoms include abdominal swelling and pain, fever and weakness. If the person does not receive adequate treatment for toxic megacolon, their colon might rupture, causing peritonitis, a life-threatening infection requiring emergency surgery.
Treating Shigella Infection
Diarrhea and bloody diarrhea may result from a number of different diseases. Confirming shigellosis involves taking a sample of a person's stool to be tested in a laboratory for the presence of shigella bacteria, or their toxins. Shigella infection usually runs its course in five to seven days. Replacing lost fluids from diarrhea might be all the treatment a person needs, especially if their general health is good and their shigella infection is mild. Avoid drugs intended to treat diarrhea such as loperamide or atropine because they might worsen the condition.
For severe shigella infection, antibiotics may shorten the duration of the illness. Some shigella bacteria; however, have become drug resistant. It is better not to take antibiotics unless your shigella infection is severe. Antibiotics might also be necessary for infants, seniors, or people who have HIV infection, as well as in situations where there is a high risk of spreading the disease.
For adults who are generally healthy, drinking water might be enough to counteract the dehydrating effects of diarrhea. Children may benefit from an oral rehydration solution such as Pedialyte. Children and adults who are severely dehydrated need treatment in an emergency room, where they can receive fluids and salts intravenously instead of by mouth. Intravenous hydration provides the body with water and essential nutrients more rapidly than oral solutions do.
Even though the World Health Organization has been working on a shigella vaccine, nothing is available at this time. To prevent the spread of shigella, wash your hands often and thoroughly. Supervise small children when they wash their hands, and dispose of soiled diapers appropriately. Disinfect diaper-changing areas after use. Do not prepare food for others if you have diarrhea.
Keep children with diarrhea home from child care, school, or play groups. Avoid swallowing water from lakes, ponds or untreated pools. Avoid sexual activities with anyone who has diarrhea, or who recently recovered from diarrhea.
Shigella Facts and Statistics
- The main sign of shigella infection is diarrhea, which often is bloody.
- An estimated 18,000 cases of shigellosis occur annually in the United States.
- Children between the ages of 2 and 4 are most likely to get shigella infection.
- Fatality rates of shigellosis epidemics in developing countries can be 5 to 15%.
- Getting just a little bit of the Shigella bacteria into your mouth is enough to cause infection.
- Shigellosis is common among travelers in developing countries and workers or residents in refugee camps.
- Outbreaks of shigellosis are linked with poor sanitation, contaminated food and water, and crowded living conditions.
- Shigella causes approximately 580,000 cases annually among travelers and military personnel from industrialized countries.
- In the U.S., the condition is most commonly seen in day care centers and places where groups of people live, such as nursing homes.
- The infection is often mild and goes away on its own. Most patients, except malnourished children and those with weakened immune systems, recover fully.
- Conservative estimates suggest Shigella causes approximately 90 million cases of severe dysentery annually, with at least 100,000 of these resulting in death, mostly among children in the developing world.
- About 1 in 10 children with severe Shigella enteritis develop neurological problems, including 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.
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