Shigella infection

Shigella infection is easily spread by faecal-oral contact or by contaminated water or food. It usually presents as a mild, self-limiting diarrhoeal illness.

S dysenteriae is more common in developing countries and causes a more severe illness with dysentery. S dysenteriae type 1 is a cause of haemolytic uraemic syndrome owing to its production of Shiga toxin.

Treatment is usually supportive in mild cases. Antibiotics may be useful to shorten the course of the illness and reduce shedding of the organism in stool.

Empirical antibiotics are recommended for children and adults with severe disease, for older adults, for malnourished or chronically ill patients, and to reduce spread (e.g., in institutions).

Prevention is paramount, including basic hygiene measures such as hand-washing, access to clean water, and cooking, especially in institutions and camps during natural disasters. Immunisations are in developmental stages.

Shigellosis is an important cause of diarrhoeal disease worldwide, most commonly affecting children <5 years old. However, about 40% of patients are adults.[1]Kotloff KL, Winickoff JP, Ivanoff B, et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ. 1999;77(8):651-66. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557719/pdf/10516787.pdf http://www.ncbi.nlm.nih.gov/pubmed/10516787?tool=bestpractice.com Shigella is a genus of the Enterobacteriaceae family, consisting of 4 species of aerobic, non-motile, non-lactose-fermenting gram-negative rods: S sonnei, S flexneri, S boydii, and S dysenteriae.

Shigellosis may spread from person to person (by faecal-oral contact), and via contaminated water and food. Outbreaks occur in institutions and in overcrowded areas where sanitation is poor. Although not equivalent, the term 'bloody diarrhoea' is sometimes used interchangeably by clinical practitioners.