Shigellosis is infection that is caused by the gram-negative bacteria Shigella and that results in watery diarrhea or dysentery (the frequent and often painful passage of small amounts of stool that contains blood, pus, and mucus).
Shigella bacteria are a common cause of dysentery throughout the world. Probably about a quarter of a million people in the United States develop shigellosis each year.
Because stomach acid does not easily destroy these bacteria, ingesting even a small number of them causes infection. In the large intestine, the bacteria cause inflammation and are then excreted in stool. As a result, infection spreads easily from person to person when hands are soiled. Infection is also spread through the following:
Infection easily spreads among people who live together. Outbreaks also occur in places that are overcrowded and have inadequate sanitation, such as
Children are more likely to become infected and to have severe symptoms, such as seizures.
There are four species of Shigella. All cause diarrhea. However, one—Shigella dysenteriae—is more likely to cause severe diarrhea, dysentery, and complications.
Mild infections cause low-grade fever (about 100.4 to 102° F [38 to 38.9° C]) and watery diarrhea 1 to 2 days after people ingest the bacteria. Abdominal cramps and a frequent urge to defecate are common with more severe infections. Severe infections may cause low-grade or moderate fever and watery diarrhea that progresses to dysentery. In dysentery, bowel movements are frequent and contain blood, pus, and mucus.
Children, particularly young children, are most likely to have severe complications:
Severe dehydration can lead to shock and death, mainly in chronically ill, malnourished, or debilitated children and in older people. In hemolytic-uremic syndrome, red blood cells are destroyed, causing anemia with fatigue, weakness, and light-headedness. Blood clots abnormally, causing the kidneys to stop functioning. Seizures or strokes can also occur.
Some adults develop eye inflammation, painful urination, and reactive arthritis (see see Reactive Arthritis) weeks to months after the diarrhea.
A doctor suspects shigellosis based on the typical symptoms of pain, fever, and watery or bloody diarrhea in people who are likely to have been exposed to the bacteria. To confirm the diagnosis, doctors may take a sample of stool and send it to a laboratory to grow (culture) the bacteria.
Prevention includes the following:
Currently, no vaccine is available.
Water and salts lost because of diarrhea are replaced, usually by mouth. Symptoms typically resolve within 4 to 8 days. Antibiotics are not routinely required for mild infections.
Severe infections may last 3 to 6 weeks and require hospitalization so that fluids containing salts can be given intravenously and complications, such as hemolytic-uremic syndrome, can be treated. Antibiotics, such as azithromycin, ciprofloxacin, or trimethoprim-sulfamethoxazole, are given, particularly when people are very young or very old, when the infection is severe, or when the infection is likely to spread to other people. Antibiotics reduce the severity of symptoms and the length of time the bacteria are excreted in stool.
Drugs to stop diarrhea (such as diphenoxylate or loperamide) may prolong the infection and should not be used.
Last full review/revision September 2008 by Matthew E. Levison, MD