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Definition:

Shigellosis is an acute bacterial infection of the lining of the intestines.



Alternative Names:

Shigella gastroenteritis; Shigella enteritis; Enteritis - shigella; Gastroenteritis - shigella



Causes, incidence, and risk factors:

Shigellosis is caused by a group of bacteria called Shigella.

There are several types of Shigella.

  • Shigella sonnei, also called "group D" Shigella, is responsible for most cases of shigellosis in the United States.
  • Shigella flexneri, or "group B" Shigella, cause almost all other cases.
  • Shigella dysenteriae type 1 is rare in the U.S. but can lead to deadly outbreaks in developing countries.

People infected with the bacteria release it into their stool. The bacteria can spread from an infected person to contaminate water or food, or directly to another person. Getting just a little bit of the Shigella bacteria into your mouth is enough to cause symptoms.

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

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

There are about 18,000 cases of shigellosis per year in the United States. The condition is most commonly seen in day care centers and similar places.



Symptoms:

Symptoms usually develop about 1 to 7 days (average 3 days) after you come in contact with the bacteria.

Symptoms include:



Signs and tests:
  • Dehydration with fast heart rate and low blood pressure
  • Abdominal tenderness
  • Elevated white blood cell count
  • Stool culture
  • White blood cells in stool


Treatment:

The symptoms usually last 2 to 7 days. The goal of treatment is to replace fluids and electrolytes (salt and minerals) lost in diarrhea.

Medications that stop diarrhea are generally not given because they may prolong the course of the disease.

Self-care measures to avoid dehydration include drinking electrolyte solutions to replace the fluids lost by diarrhea. Several varieties of electrolyte solutions are now available over the counter.

Antibiotics can help shorten the length of the illness and help prevent it from spreading to others in group living or day care situations. They may also may be prescribed for patients with severe symptoms. Frequently used antibiotics include sulfamethoxazole and trimethoprim (Bactrim), ampicillin, ciprofloxacin (Cipro), or azithromycin.

Persons with diarrhea who cannot drink fluids by mouth because of nausea may need medical attention and fluids through a vein ( intravenously ).This is especially common in small children.

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



Support Groups:



Expectations (prognosis):

Often the infection is mild and goes away on its own. Most patients, except malnourished children and those with weakened immune systems, have an excellent outlook.



Complications: Complications may include:

Up to 40% of children with severe shigella enteritis develop neurological problems including febrile seizures or brain disease (encephalopathy) with headache, lethargy , confusion , and stiff neck.



Calling your health care provider:

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 the following occur in a person with shigellosis:

  • Confusion
  • Headache with stiff neck
  • Lethargy
  • Seizures

Such symptoms are most common in children.



Prevention:

Prevention involves the proper handling, storage, and preparation of food, in addition to good cleanliness. Hand washing is the most effective preventive measure. Avoid contaminated food and water.



References:

Goldberg MB. Shigellosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 330.

Ochoa TJ, Cleary TG. Shigella. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 196.




Review Date: 9/1/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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