Shigellosis
Shigella gastroenteritis; Shigella enteritis; Enteritis - shigella; Gastroenteritis - shigella; Traveler's diarrhea - shigellosisShigellosis is a bacterial infection of the lining of the intestines. It is caused by a group of bacteria called Shigella.
Causes
There are several types of Shigella 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. However, it 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 to 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
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
Read Article Now Book Mark Article - Acute fever
- Blood, mucus, or pus in the stool
Blood, mucus, or pus in the stool
Black or tarry stools with a foul smell are a sign of a problem in the upper digestive tract. It most often indicates that there is bleeding in the ...
Read Article Now Book Mark Article - Crampy rectal pain
- Nausea and vomiting
- Watery and bloody 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 the presence of the bacteria
Stool culture
A fecal culture is a lab test to find organisms in the stool (feces) that can cause gastrointestinal symptoms and disease.
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Treatment
The goal of treatment is to replace fluids and electrolytes (salt and minerals) that are lost in diarrhea and stop the infection with antibiotics.
Electrolytes
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
Read Article Now Book Mark ArticleMedicines 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 types of electrolyte solutions are available over-the-counter (without a prescription).
Dehydration
Dehydration occurs when your body does not have as much water and fluids as it needs. Dehydration can be mild, moderate, or severe, based on how much...
Read Article Now Book Mark ArticleAntibiotics can help shorten the length of the illness. These medicines also help prevent the illness 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 care and intravenous (IV) fluids. This is more common in small children who have shigellosis.
Intravenous
Intravenous means "within a vein. " Most often it refers to giving medicines or fluids through a needle or tube inserted into a vein. This allows th...
Read Article Now Book Mark ArticlePeople 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.
Acute
Acute means sudden. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.
Read Article Now Book Mark ArticleOutlook (Prognosis)
The infection can be mild and goes away on its own. Most people, except malnourished children and those with weakened immune systems, typically recover fully.
Possible Complications
Complications may include:
- Dehydration, severe
- Hemolytic-uremic syndrome (HUS), a form of kidney failure with anemia and clotting problems
Hemolytic-uremic syndrome
Shiga-like toxin producing E coli hemolytic-uremic syndrome (STEC-HUS) is a disorder that most often occurs when an infection in the digestive system...
Read Article Now Book Mark Article - Reactive arthritis
Reactive arthritis
Reactive arthritis is a type of arthritis that follows an infection. It may also cause inflammation of the eyes, skin and urinary and genital system...
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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.
Febrile seizures
A febrile seizure is a convulsion in a child triggered by a fever.
Read Article Now Book Mark ArticleLethargy
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark ArticleConfusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark ArticleWhen to Contact a Medical Professional
Contact 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
Fleckenstein JM. Approach to the patient with suspected enteric infection. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 262.
Kotloff KL. Acute gastroenteritis in children. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 387.
Lima AAM, Warren CA, Guerrant RL. Acute dysentery syndromes (diarrhea with fever). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 99.
MacLennan CA. Shigellosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 285.
Melia JMP, Sears CL. Infectious enteritis and proctocolitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 110.
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 - illustration
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
Digestive system organs
illustration
Bacteria - illustration
Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.
Bacteria
illustration
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 - illustration
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
Digestive system organs
illustration
Bacteria - illustration
Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.
Bacteria
illustration
Review Date: 3/16/2024
Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.