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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

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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 high fever, abdominal cramps or tenderness, tenesmus, and mucoid stools with or without blood. Clinical presentations tend to vary with Shigella species; patients with Shigella sonnei infection usually exhibit watery diarrhea; people with Shigella flexneri, Shigella boydii, and Shigella dysenteriae infection more often 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).


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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 industrialized nations, including the United States, approximately 75% are S sonnei, 20% are S flexneri, 3% are S boydii, and less than 1% are S dysenteriae. In developing countries, especially in Africa and southeast Asia, S flexneri predominates, and S dysenteriae often causes outbreaks.


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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 can 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 species. Predominant . . . [Go to Full Text]


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