Gastrointestinal Infections Shigellosis Infections

Gastrointestinal Infections
Shigellosis infections
Overview of Conditions
• Shigellosis is an infectious intestinal disease caused by a group of
bacteria called Shigella.
•
It is spread through contaminated water and food or through contact
with contaminated faces. The bacteria release toxins that irritate the
intestines.
•
Most who are infected with Shigella develop diarrhea, fever, and
stomach cramps starting a day or two after they are exposed to the
bacteria.
•
Shigellosis usually resolves in 5 to 7 days. Some people who are
infected may have no symptoms at all, but may still pass the Shigella
bacteria to others.
•
Toddlers and preschoolers are more likely than older children and
adults to get shigellosis. This may be because young children put
their fingers in their mouths often and are more likely to ingest the
bacteria.
•
The spread of Shigella can be stopped by frequent and careful
handwashing with soap and taking other hygiene measures.
Clinical Presentation
• General features — Shigellosis is an infection of the colon,
particularly the rectosigmoid portion of the colon. Patients with
Shigella gastroenteritis typically present with:
●High Fever
●Abdominal pain
●Mucoid diarrhea
●Bloody diarrhea
●Watery diarrhea
●Vomiting
•
The incubation period ranges from one to seven days, with an
average of three days The disease typically begins with
constitutional symptoms such as fever, anorexia, and malaise.
Initially diarrhea is watery, but subsequently may contain blood
and mucus.
Diagnosis
Shigella should be suspected in the setting of frequent, small volume, bloody stools,
abdominal cramps, and tenesmus, particularly if accompanied by fever. Nausea and
vomiting are notably absent in most patients.
The presence of white blood cells and red blood cells on direct microscopic examination of
the stool is consistent with the diagnosis of Shigella; these findings should raise suspicion of
the diagnosis prior to the availability of microbiological testing results.
Organism identification
• Stool culture — Stool culture is the preferred method for the diagnosis of Shigella, as it
provides an isolate for subsequent susceptibility testing.Shigella is a fastidious
organism; it requires prompt handling and optimally should be inoculated onto agar at
the bedside. Culture from a stool sample may give a better yield than culture from a
rectal swab. The best yield is from a mucoid part of stool. If transport of the sample is
required, the best medium is buffered glycerol saline
• Molecular testing — Many clinical microbiology laboratories are now using automated

polymerase chain reaction (PCR) diagnostics on stool.
• Susceptibility testing — Antimicrobial susceptibility testing should be performed on

all Shigella isolates to inform antibiotic selection if treatment is indicated. Identifying
drug-resistant infections can also inform appropriate public health measures .
Management
Pharmacological:
Shigellosis
Antimicrobial therapy is generally indicated only for patients with moderate
or severe dysentery, or immunocompromised patients; it is not required
for patients with mild disease or where symptoms have settled prior to
identification. Treatment reduces disease transmission and may therefore
also be considered for public health reasons in certain groups eg food
handlers or the institutionalised. Treatment should be guided by sensitivity
results where available.
For moderate cases, use:

chloramphenicol 500 mg (child 2 months or older: 12.5 mg/kg up to
500 mg) orally 6-hourly, or 1g IV 6-hourly for 5 days
OR
trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older:
4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 5 days
OR
ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly
for 5 days
Management
Pharmacological:
For severe cases, use:
ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) IV, 12-hourly
OR
ceftriaxone 2 g (child: 1 month or older: 50 mg/kg up to 2 g) IV, daily
OR
cefotaxime 2g (child 50mg/kg up to 2g) IV, 8-hourly
Once improved, switch to oral therapy as above for a total of 5 days (IV +
oral).
Non-Pharmacological:
• Rehydration is the mainstay of therapy in all patients.
• Good hygiene practices and staying away from childcare, school or
work.
• In particular, advise men who have sex with men to abstain from sex
while symptomatic and for 7 days after symptoms have resolved.

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Gastrointestinal Infections

• Molecular testing — Many clinical microbiology laboratories are now using automated

• Susceptibility testing — Antimicrobial susceptibility testing should be performed on

For moderate cases, use:

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