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Section 3. Summaries of Infectious Diseases
Shigella Infections
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Shigella species primarily infect
the large intestine, causing clinical manifestations that range
from watery or loose stools with minimal or no constitutional
symptoms to more severe symptoms, including fever, abdominal
cramps or tenderness, tenesmus, and mucoid stools with or without
blood. Clinical presentations vary with
Shigella species; patients
with
Shigella sonnei infection usually exhibit watery diarrhea;
people with
Shigella flexneri, Shigella boydii, and
Shigella dysenteriae infection typically have bloody diarrhea and severe
systemic symptoms. Rare complications include bacteremia, Reiter
syndrome (after
S flexneri infection), hemolytic-uremic syndrome
(after
S dysenteriae type 1 infection), toxic megacolon and
intestinal perforation, and toxic encephalopathy (ekiri syndrome).
ETIOLOGY: Shigella species are aerobic, gram-negative bacilli
in the family Enterobacteriaceae. Four species (with more than
40 serotypes) have been identified. Among
Shigella isolates
reported in the United States in 2003, approximately 88% were
S sonnei, 11% were
S flexneri, 1% were
S boydii, and 0.3% were
S dysenteriae.
Shigella dysenteriae is rare in the United States
but is endemic in rural Africa and the Indian subcontinent.
EPIDEMIOLOGY: Humans are the natural host for
Shigella, although
other primates may be infected. The primary mode of transmission
is fecal-oral. Children 5 years of age or younger in child care
settings, their caregivers, and other people living in crowded
conditions are at increased risk of infection. Travel to resource-limited
countries with inadequate sanitation may place the traveler
at risk of infection. Ingestion of as few as 10 to 200 organisms
is sufficient for infection to occur, depending on
Shigella . . . [Go to Full Text]
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