eMedicine Specialties > Gastroenterology > Colon

Shigellosis: Differential Diagnoses & Workup

Author: Joyann A Kroser, MD, Clinical Associate Professor of Medicine, Gastroenterology, and Hepatology, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Aug 22, 2008

Differential Diagnoses

Amebiasis
Gastroenteritis, Bacterial
Campylobacter Infections
Gastroenteritis, Viral
Cholera
Pseudomembranous Colitis
Clostridium Difficile Colitis
Salmonellosis
Colon Cancer, Adenocarcinoma
Ulcerative Colitis
Crohn Disease
Yersinia Enterocolitica
Cryptosporidiosis
Escherichia Coli Infections

Workup

Laboratory Studies

  • Fecal leukocytes and erythrocytes
  • Mildly elevated hematocrit, sodium, and urea nitrogen are indicative of volume depletion in cases of shigellosis.
  • Leukocytosis is rare.
  • Positive findings on stool culture of a fresh fecal specimen
  • In patients who are immunocompromised (eg, HIV), blood cultures are rarely helpful in cases of shigellosis.

Procedures

  • Sigmoidoscopy is not necessary in most cases of shigellosis.
  • If distinguishing between dysentery and the acute presentation of idiopathic ulcerative colitis is urgently necessary, a colonic biopsy may be useful if it is performed within 4 days of the onset of symptoms.

Histologic Findings

  • Intense neutrophilic and mononuclear cells infiltrating the lamina propria
  • Hemorrhage
  • Ulcers
  • Mucous depletion
  • Occasional crypt abscesses

More on Shigellosis

Overview: Shigellosis
Differential Diagnoses & Workup: Shigellosis
Treatment & Medication: Shigellosis
Follow-up: Shigellosis
References

References

  1. Al-Abri SS, Beeching NJ, Nye FJ. Traveller's diarrhoea. Lancet Infect Dis. Jun 2005;5(6):349-60. [Medline].

  2. Banerjee S, LaMont JT. Treatment of gastrointestinal infections. Gastroenterology. Feb 2000;118(2 Suppl 1):S48-67. [Medline].

  3. Dupont HL, Edelman R, Kimmey M. Infectious diarrhea: from E coli to Vibrio. Patient Care. 1990;30:18-43.

  4. Kroser JA, Metz DC. Evaluation of the adult patient with diarrhea. Prim Care. Sep 1996;23(3):629-47. [Medline].

  5. Murphy GS, Bodhidatta L, Echeverria P, et al. Ciprofloxacin and loperamide in the treatment of bacillary dysentery. Ann Intern Med. Apr 15 1993;118(8):582-6. [Medline].

  6. Policar M. Shigellosis. In: Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 2005:752-754.

  7. Sivapalasingam S, Nelson JM, Joyce K, et al. High prevalence of antimicrobial resistance among Shigella isolates in the United States tested by the National Antimicrobial Resistance Monitoring System from 1999 to 2002. Antimicrob Agents Chemother. Jan 2006;50(1):49-54. [Medline].

  8. Taneja N. Changing epidemiology of shigellosis and emergence of ciprofloxacin-resistant Shigellae in India. J Clin Microbiol. Feb 2007;45(2):678-9. [Medline].

  9. Wolf DC, Gianella RA. Invasive pathogens. Consultations in Gastroenterology. 1996;381-384.

Further Reading

Keywords

shigellosis, dysentery, bacillary dysentery, diarrhea, bacterial infection, intestinal infection, Shigella organisms, Shigella boydii, Shigella dysenteriae, Shigella sonnei, Shigella flexneri, S dysenteriae, S flexneri, S sonnei, S boydii

Contributor Information and Disclosures

Author

Joyann A Kroser, MD, Clinical Associate Professor of Medicine, Gastroenterology, and Hepatology, Drexel University College of Medicine
Joyann A Kroser, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Pennsylvania Medical Society, Phi Beta Kappa, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Ronnie Fass, MD, Director of GI Motility Laboratory, Tucson VA Medical Center, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of Arizona School of Medicine
Ronnie Fass, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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