eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Shigella Infection: Differential Diagnoses & Workup

Author: Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg), Registrar, Department of Pediatrics/Neonatology, Mid-Western Regional Hospital, Ireland
Coauthor(s): Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK; Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center; Ilyas Burny, MD, Staff Physician, Department of Pediatrics, Hurley Medical Center
Contributor Information and Disclosures

Updated: Jul 31, 2008

Differential Diagnoses

Campylobacter Infections
Crohn Disease
Escherichia Coli Infections
Salmonella Infection
Ulcerative Colitis
Yersinia Enterocolitica Infection

Other Problems to Be Considered

Clostridium difficile infection
Entameba histolytica infection

Workup

Laboratory Studies

  • Hematology
    • The total WBC count reveals no consistent findings. A shift to the left  (increased number of band cells) in the differential WBC count in a patient with diarrhea suggests bacillary dysentery. Leukopenia or leukemoid reactions are occasionally detected.
    • In HUS, anemia and thrombocytopenia occur.
    • Bacteremia is rare, even in severe disease, possibly due to the superficial nature of Shigella infection; the organism rarely penetrates beyond the mucosa.
  • Stool examination
    • Routine microscopy may reveal sheets of PMNs. Platelet counts are reduced.
    • In approximately 70% of patients with shigellosis, fecal blood or leukocytes (confirming colitis) are detectable in the stool. Fecal blood and leukocytes are present in 50% of patients.
  • Stool culture
    • A sample for stool culture should be obtained in all suspected cases of shigellosis.
    • The yield from stool cultures is greatest early in the course of disease. Guidelines for obtaining specimens to improve the yield are as follows:
      • Process specimens immediately after collection.
      • If processing is delayed, use a transport medium (eg, buffered glycerol saline).
      • Collect more than one stool or rectal (not anal) swab and inoculate them promptly on at least 2 different culture media.
      • Specimens should be plated lightly onto MacConkey, xylose-lysine-deoxycholate, Hektoen enteric, or Salmonella-Shigella, or eosin-methylene blue agars.
    • If processing is delayed, a rectal-swab sample can be placed in Cary-Blair transport medium or buffered glycerol saline.
    • After overnight incubation, colorless, nonlactose-fermenting colonies may be tested by means of latex agglutination to establish a preliminary identification of Shigella infection.
    • Antimicrobial susceptibility tests of all confirmed isolates should be performed by using the agar diffusion technique. The agar and broth-dilution methods are also widely used. The new Epsilometer strip method (E test) is used to accurately determine the minimum inhibitory concentration (MIC).
    • Despite meticulous care in obtaining and processing specimens from patients infected with Shigella species, approximately 20% may fail to yield Shigella organisms.
  • Enzyme immunoassay: An enzyme immunoassay for Stx is used to detect S dysenteriae type 1 in the stool.
  • Rapid techniques: With rapid techniques, gene probes or polymerase chain reaction (PCR) primers are directed toward virulence genes (invasion plasmid locus).

Other Tests

  • Additional diagnostic tools, such as gene probes, are being developed.

More on Shigella Infection

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

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  5. Basualdo W, Arbo A. Randomized comparison of azithromycin versus cefixime for treatment of shigellosis in children. Pediatr Infect Dis J. Apr 2003;22(4):374-7. [Medline].

  6. Bennish ML, Khan WA, Begum M, et al. Low risk of hemolytic uremic syndrome after early effective antimicrobial therapy for Shigella dysenteriae type 1 infection in Bangladesh. Clin Infect Dis. Feb 1 2006;42(3):356-62. [Medline].

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Further Reading

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Keywords

Shigella infection, shigellosis, Shigella dysenteriae, S dysenteriae, Shigella dysenteriae, S dysenteriae, Shigella sonnei, S sonnei, Shigella flexneri, S flexneri, Shigella boydii, S boydii, infectivity dose, ID, Shiga toxin, Stx, bacillary dysentery, Escherichia coli, diarrhea, hemolytic-uremic syndrome, dehydration, hypotension, abdominal tenderness, microangiopathic hemolytic anemia, thrombocytopenia, renal failure, septicemia, hypoglycemia, bronchopneumonia, disseminated intravascular coagulation, DIC, cholestatic hepatitis, arthritis, conjunctivitis, urethritis, myocarditis, rectal prolapse, cardiogenic shock, arrhythmias, heart block, bacteremia, rectal prolapse, toxic megacolon

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Contributor Information and Disclosures

Author

Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg), Registrar, Department of Pediatrics/Neonatology, Mid-Western Regional Hospital, Ireland
Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg) is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians and Surgeons of Glasgow, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Coauthor(s)

Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK
Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH is a member of the following medical societies: British Cardiac Society, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.

Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Ilyas Burny, MD, Staff Physician, Department of Pediatrics, Hurley Medical Center
Ilyas Burny, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

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