Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most Shigella infections are the result of the bacterium passing from one person to another.
The spread of Shigella from an infected person to others can be stopped by frequent hand washing with soap.
The Shigella bacteria pass from one infected person to the next. Shigella are present in the diarrheal stools of infected persons while they are sick and for up to a week or two afterwards. Most Shigella infections are the result of the bacterium passing from stools or soiled fingers of one person to the mouth of another person.
Vegetables can become contaminated if they are harvested from a field with sewage in it. Flies can breed in infected feces and then contaminate food.
Water may become contaminated with Shigella bacteria if sewage runs into it, or if someone with shigellosis swims in or plays with it (especially in splash tables, untreated wading pools, or shallow play fountains used by daycare centers). Shigella infections can then be acquired by drinking, swimming in, or playing with the contaminated water.
Most people infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. The diarrhea is often bloody.
Shigellosis usually resolves in 5 to 7 days. Persons with shigellosis in the United States rarely require hospitalization.
A severe infection with high fever may be associated with seizures in children less than 2 years old. Some persons who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others.
Many different kinds of germs can cause diarrhea, so establishing the cause will help guide treatment.
Determining that Shigella is the cause of the illness depends on laboratory tests that identify Shigella in the stools of an infected person.
The laboratory can also do special tests to determine which antibiotics, if any, would be best to treat the infection.
Every year, about 14,000 cases of shigellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be twenty times greater.
Shigellosis is particularly common and causes recurrent problems in settings where hygiene is poor and can sometimes sweep through entire communities.
It is more common in summer than winter. Children, especially toddlers aged 2 to 4, are the most likely to get shigellosis. Many cases are related to the spread of illness in child-care settings, and many are the result of the spread of the illness in families with small children.
Persons with mild infections usually recover quickly without antibiotic treatment. However, appropriate antibiotic treatment kills Shigella bacteria, and may shorten the illness by a few days.
Some Shigella bacteria have become resistant to antibiotics. This means some antibiotics might not be effective for treatment. Using antibiotics to treat shigellosis can sometimes make the germs more resistant. Therefore, when many persons in a community are affected by shigellosis, antibiotics are sometimes used to treat only the most severe cases.
Antidiarrheal agents such as loperamide (Imodium®) or diphenoxylate with atropine (Lomotil®) can make the illness worse and should be avoided.
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal.
About 2% of persons who are infected with one type of Shigella, Shigella flexneri, later develop pains in their joints, irritation of the eyes, and painful urination. This is called post-infectious arthritis. It can last for months or years, and can lead to chronic arthritis. Post-infectious arthritis is caused by a reaction to Shigella infection that happens only in people who are genetically predisposed to it.
Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella
Currently, there is no vaccine to prevent shigellosis. However, frequent and careful hand washing (with soap) is important among all age groups.
Basic food safety precautions and disinfection of drinking water prevents shigellosis from food and water. However, people with shigellosis should not prepare food or drinks for others until they have been shown to no longer be carrying the Shigella bacterium, or if they have had no diarrhea for at least 2 days.
At swimming beaches, having enough bathrooms and hand washing stations with soap near the swimming area helps keep the water from becoming contaminated.
Informing the public health department about cases of shigellosis is vital. It is important for clinical laboratories to send isolates of Shigella to the City, County or State Public Health Laboratory so the specific type can be determined. If many cases occur at the same time, it may mean that a restaurant, food or water supply has a problem that needs correction by the public health department.
If a number of cases occur in a day-care center, the public health department may need to coordinate efforts to improve hand washing among the staff, children, and their families.
When a community-wide outbreak occurs, a community-wide approach to promote hand washing and basic hygiene among children can stop the outbreak.
Improvements in worker hygiene during vegetable and fruit picking and packing may prevent shigellosis caused by contaminated produce.
The spread of Shigella from an infected person to other persons can be stopped by frequent and careful hand washing with soap.