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Shigella infection

Last reviewed: 10 Apr 2025
Last updated: 30 Jan 2024

Summary

Definition

History and exam

Key diagnostic factors

  • diarrhea
  • cramping abdominal pain
  • fever
  • tenesmus
  • abdominal pain or tenderness
  • features of hemolytic uremic syndrome
Full details

Other diagnostic factors

  • signs of volume depletion
  • increased bowel sounds
  • vomiting
  • meningismus or other signs of altered neurologic status
  • febrile seizures
  • somnolence
Full details

Risk factors

  • exposure to contaminated water or food or direct fecal-oral contact
  • age <5 years
  • malnutrition
  • poor hygiene and cramped conditions
  • travel to endemic areas
  • men who have sex with men
Full details

Diagnostic tests

1st tests to order

  • stool microscopy, culture, and sensitivity
  • serum BUN and creatinine
  • CBC
Full details

Tests to consider

  • Shigella serotyping
  • peripheral blood smear
  • abdominal x-ray
  • flexible sigmoidoscopy
Full details

Treatment algorithm

ACUTE

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 Gehanjali D.A. Amarasinghe, Dr Richard Pollok, and the late Dr Satish Keshav, the previous contributors to this topic.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1. 2005 [internet publication].Full text

King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003 Nov 21;52(RR-16):1-16.Full text  Abstract

Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016 May;111(5):602-22.Full text  Abstract

Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-80.Full text  Abstract

Murphy MS. Management of bloody diarrhoea in children in primary care. BMJ. 2008 May 3;336(7651):1010-5.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Shigella infection images
  • Differentials

    • Non-Shigella bacterial diarrhea
    • Viral gastroenteritis
    • Parasitic diarrhea
    More Differentials
  • Guidelines

    • CDC Yellow Book: health information for international travel - shigellosis
    • WHO model list of essential medicines for children - 9th list, 2023
    More Guidelines
  • Patient information

    Diarrhea in adults

    Diarrhea in children

    More Patient information
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