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).

• The bacteria are excreted in stool and can be easily spread when hygiene or sanitation is inadequate.
• People may have watery diarrhea, sometimes leading to severe dehydration.
• Identifying the bacteria in a sample of stool can confirm the diagnosis.
• For people with shigellosis and people who care for them, meticulous hygiene is necessary to avoid spreading the infection.
• Fluids are given by mouth or, if the infection is severe, intravenously.
• Antibiotics are used.

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:

• Oral-anal sex
• Food contaminated by infected food handlers who do not wash their hands with soap after using a toilet
• Water contaminated with human waste
• Swimming and wading pools that are inadequately chlorinated

Infection easily spreads among people who live together. Outbreaks also occur in places that are overcrowded and have inadequate sanitation, such as

• Day-care centers for children
• Long-term care facilities
• Refugee camps
• Institutions for the intellectually disabled (mentally retarded)
• Cruise ships
• Military camps
• Developing countries

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.

Symptoms

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:

• High fever (up to 106o F [41° C]), sometimes with delirium
• Severe dehydration with weight loss
• Up to 20 bowel movements a day
• With severe diarrhea, protrusion of part of the rectum out of the body (rectal prolapse)
• Rarely, marked swelling of the intestine and tearing (perforation) of the large intestine
• Hemolytic-uremic syndrome if the infection is due to Shigella dysenteriae

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 Joint Disorders: Reactive Arthritis) weeks to months after the diarrhea.

Diagnosis

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

Prevention includes the following:

• Infected people should not prepare food for others.
• After using the toilet, infected people should wash their hands, and someone should clean and disinfect the toilet before it is used again.
• People caring for people with shigellosis should wash their hands with soap and water, particularly before they touch other people or handle food.
• Infected children with symptoms should not have contact with uninfected children.
• Diapers of infected children should be disposed of in a sealed garbage can, and the area used to change diapers should be wiped with disinfectant after each use.
• Stool that contaminates clothing and bedclothes of infected people should be flushed away in running water, and the soiled clothing and bedclothes should be washed in a washing machine using the hot water cycle. When finished, surfaces of the sink, toilet, and washing machine should be wiped down with a disinfectant, such as diluted chlorine bleach.

Currently, no vaccine is available.

Treatment

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 azithromycinSome Trade Names
ZITHROMAX
, ciprofloxacinSome Trade Names
CILOXAN CIPRO
, or trimethoprim-sulfamethoxazoleSome Trade Names
, 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 loperamideSome Trade Names
IMODIUM
) may prolong the infection and should not be used.

Last full review/revision September 2008 by Matthew E. Levison, MD