Shigella enteritis

Alternative names
Shigellosis; Shigella gastroenteritis

Definition
Shigella enteritis is an acute infection of the lining of the small intestine caused by 1 of 4 different strains of the shigella bacteria.

Causes, incidence, and risk factors

Outbreaks of shigella enteritis are associated with poor sanitation, inadequate water supplies, contaminated food, crowded living conditions, and fly-infested environments.

Shigella enteritis is common among travelers in developing countries and workers or residents of reservations, refugee camps, and similar institutions. The incubation period is 1 to 7 days, with an average of 3 days.

Although uncommon in adults, neurologic symptoms can develop in children. In up to 40% of children with severe shigella enteritis, febrile seizures, headache, Lethargy, confusion, and stiff neck resembling Meningitis (nuchal rigidity) can occur.

There are about 18,000 cases of shigella enteritis per year in the US.

Symptoms

     
  • Acute Abdominal pain or cramping  
  • Tenesmus (crampy rectal pain)  
  • Watery diarrhea  
  • nausea and Vomiting  
  • Acute fever  
  • Blood, mucus, or pus in stool

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 natural course of the disease is 2-3 days. The objective of treatment is to replace fluids and electrolytes (salt and minerals) lost in diarrhea.

Antidiarrheal medications 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 may be indicated for patients with severe symptoms. Sulfamethoxazole-trimethoprim (Bactrim), ampicillin, ciprofloxacin (Cipro), or chloramphenicol (Chloromycetin) are frequently used.

People with diarrhea who are unable to take fluids by mouth because of nausea may need medical attention and intravenous fluids, especially small children.

People taking diuretics should be cautious if they develop diarrhea, and may be directed by the provider to stop taking the diuretic during the acute episode.

Expectations (prognosis)
Often the infection is mild and self-limited. Prognosis is excellent except among malnourished and immunocompromised children.

Complications

     
  • Severe dehydration  
  • Neurologic symptoms including seizures (in children)  
  • Hemolytic-uremic syndrome (HUS), a form of kidney failure with anemia and clotting problems  
  • Reiter’s syndrome, which involves Eye pain and redness, Joint pain, and pain with urination

Calling your health care provider
Call your provider if diarrhea does not improve, if blood is noted in the stool, or if dehydration seems to be developing.

Go to the emergency room if seizures occur, or if confusion, Lethargy, headache with stiff neck, or similar symptoms develop in a person with shigella enteritis (most common in children).

Prevention
Proper handling, storage, and preparation of food, in addition to good sanitation, are principles of prevention for this disease. Hand washing is the most effective preventive measure.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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