Summary
Definition
History and exam
Key diagnostic factors
- diarrhea
- cramping abdominal pain
- fever
- features of hemolytic uremic syndrome
Other diagnostic factors
- tenesmus
- abdominal pain or tenderness
- signs of volume depletion
- increased bowel sounds
- vomiting
- meningismus
- febrile seizures
- delirium or somnolence
Risk factors
- exposure to contaminated water or food or direct fecal-oral contact
- age <5 years
- age >50 years
- malnutrition
- poor hygiene and cramped conditions
- chronic illness or immunocompromise
- travel to endemic areas
- men who have sex with men
Diagnostic investigations
1st investigations to order
- stool microscopy, culture, and sensitivity
- serum BUN and creatinine
- CBC
Investigations to consider
- Shigella serotyping
- peripheral blood smear
- abdominal x-ray
- flexible sigmoidoscopy
Treatment algorithm
suspected or confirmed shigellosis
Contributors
Authors
Ashley Barnabas, MRCP
Consultant Hepatologist and Gastroenterologist
St Mark's and Northwick Park Hospitals
Middlesex
UK
Disclosures
AB declares that he has no competing interests.
Acknowledgements
Dr Ashley Barnabas would like to gratefully acknowledge Dr Satish Keshav, Dr Gehanjali D.A. Amarasinghe, and Dr Richard Pollok, the previous contributors to this topic. Unfortunately, we have been made aware that Dr Satish Keshav has passed away.
Disclosures
GDAA and RP declare that they have no competing interests.
Peer reviewers
David Acheson, MD
Chief Medical Officer
Director of Food Safety and Security
US Food and Drug Administration
Rockville
MD
Disclosures
DA declares that he has no competing interests.
Franz Allerberger, MD, MPH
Professor of Clinical Microbiology
Austrian Agency for Health and Food Safety (AGES)
Vienna
Austria
Disclosures
FA declares that he has no competing interests.
Differentials
- Non-Shigella bacterial diarrhea
- Viral gastroenteritis
- Parasitic diarrhea
More DifferentialsGuidelines
- CDC health information for international travel (yellow book) - shigellosis
- Practice guidelines for the diagnosis and management of infectious diarrhea
More GuidelinesPatient leaflets
Diarrhea in adults
Diarrhea in children
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