eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Shigella Infection: Follow-up

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

Follow-up

Deterrence/Prevention

  • For individuals who travel to highly endemic areas, recommend that all fruits and vegetables be washed, peeled, and cooked (see the CDC Web site).
  • In developed countries, person-to-person transmission is the most common source of infection. In developing countries, water contaminated with human waste is the most common source for infection.
  • Encourage prolonged breastfeeding in infants because the incidence of disease is markedly decreased in breastfed babies.
  • The following measures help prevent person-to-person transmission of Shigella species:
    • Education of families and child-care centre personnel in handwashing techniques, especially after toilet use
    • Avoidance of food preparation by personnel who change diapers in daycare centers
    • Exclusion of febrile children with diarrhea from daycare centers
    • Proper handling and refrigeration of food, even after cooking
    • Use of universal precautions and isolation of persons with diarrhea in institutions and hospitals
    • Exclusion of children with documented Shigella gastroenteritis from daycare centers until 2 stool culture findings are negative

Complications

  • Dehydration is the most common complication of shigellosis.
  • Other reported complications include the following:
    • CNS complications
      • Seizures were previously thought to be caused by the elaboration of Stx. The etiology is presently uncertain.
      • Syndrome of inappropriate secretion of antidiuretic hormone with profound hyponatremia may occur.
      • Lethargy, meningismus, delirium, seizures, and hypoglycemia may be observed.
      • Encephalopathy and meningitis are rare and may be lethal.
    • HUS associated with strains that produce Stx (eg, S dysenteriae serotype 1 and S flexneri 2a)
    • Septicemia and DIC, particularly in malnourished children
    • Arthritis
      • Postinfectious arthritis is a late complication of S flexneri infection, especially in persons with HLA-B27 marker.
      • Arthritis, conjunctivitis, urethritis syndrome is most common in adults with HLA-B27 marker (occurs 2-5 wk after enteritis).
    • GI complications
    • Other manifestations
      • Conjunctivitis, iritis, corneal ulcers, cystitis, myocarditis, and vaginitis are uncommon.
      • Ekiri syndrome is a rare syndrome that consists of extreme toxicity, seizures, hyperpyrexia, and headache; it can be rapidly fatal due to brain edema.

Prognosis

  • Most patients recover even without treatment, although illness is more prolonged and more severe if not treated.
    • The fever usually lessens within 24 hours.
    • Frequency of stool deceases within 2-3 days.
  • The overall mortality rate in developed countries is less than 1%. In the Far East and Middle East, the mortality rates for infections of S dysenteriae may be as high as 20-25%.
  • Severely malnourished children with shigellosis and hypoglycemia, hypothermia, altered consciousness, and/or bronchopneumonia are at high risk of dying.

Miscellaneous

Medicolegal Pitfalls

  • Shigella infections may be misdiagnosed as meningitis or meningoencephalitis.
  • Shigella infection may be misdiagnosed or not confirmed if specimens are not processed without delay and selective media are not used for culture. More than one stool culture or rectal swab should be obtained and promptly inoculated onto more than one type of culture medium.
 


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

  1. CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2007. MMWR Morb Mortal Wkly Rep. Apr 11 2008;57(14):366-70. [Medline]. [Full Text].

  2. Baer JT, Vugia DJ, Reingold AL, et al. HIV infection as a risk factor for shigellosis. Emerg Infect Dis. Nov-Dec 1999;5(6):820-3. [Medline].

  3. Khan WA, Dhar U, Salam MA, et al. Central nervous system manifestations of childhood shigellosis: prevalence, risk factors, and outcome. Pediatrics. Feb 1999;103(2):E18. [Medline].

  4. Rahman MJ, Sarkar P, Roy SK. Effect of zinc supplementation as adjunct therapy on the systemic immune response in shigellosis. Am J Clin Nutr. Feb, 2005;81(2):495-502. [Medline].

  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].

  7. Edwards BH. Salmonella and Shigella species. Clin Lab Med. Sep 1999;19(3):469-87, v. [Medline].

  8. Friedrich AW, Bielaszewska M, Zhang WL, et al. Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms. J Infect Dis. Jan 1 2002;185(1):74-84. [Medline].

  9. Gomez HF, Cleary TG. Shigella species. In: Principles and Practice of Pediatric Infectious Diseases. New York, NY: Churchill Livingstone; 1997:429-34.

  10. Gomez HF, Cleary TG. Shigella. In: Textbook of Pediatric Infectious Diseases. Philadelphia, PA: WB Saunders; 1998:1207-317.

  11. Huicho L, Sanchez D, Contreras M, et al. Occult blood and fecal leukocytes as screening tests in childhood infectious diarrhea: an old problem revisited. Pediatr Infect Dis J. Jun 1993;12(6):474-7. [Medline].

  12. Ingersoll MA, Zychlinsky A. ShiA abrogates the innate T-cell response to Shigella flexneri infection. Infect Immun. Apr 2006;74(4):2317-27. [Medline].

  13. Katz DE, Coster TS, Wolf MK, et al. Two studies evaluating the safety and immunogenicity of a live, attenuated Shigella flexneri 2a vaccine (SC602) and excretion of vaccine organisms in North American volunteers. Infect Immun. Feb 2004;72(2):923-30. [Medline].

  14. Keusch GT, Jacewicz M, Acheson DW, et al. Globotriaosylceramide, Gb3, is an alternative functional receptor for Shiga-like toxin 2e. Infect Immun. Mar 1995;63(3):1138-41. [Medline].

  15. Mitra AK, Alvarez JO, Wahed MA, et al. Predictors of serum retinol in children with shigellosis. Am J Clin Nutr. Nov 1998;68(5):1088-94. [Medline].

  16. Nataro JP. Treatment of bacterial enteritis. Pediatr Infect Dis J. May 1998;17(5):420-1. [Medline].

  17. Nathoo KJ, Porteous JE, Siziya S, et al. Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe. Cent Afr J Med. Nov 1998;44(11):272-6. [Medline].

  18. Navia MM, Gascon J, Vila J. Analysis of the mechanisms of resistance to several antimicrobial agents in Shigella spp. causing travellers' diarrhoea. Clin Microbiol Infect. Dec 2005;11(12):1044-7. [Medline].

  19. Niyogi SK. Shigellosis. J Microbiol. Apr 2005;43(2):133-43. [Medline].

  20. Oaks EV, Turbyfill KR. Development and evaluation of a Shigella flexneri 2a and S. sonnei bivalent invasin complex (Invaplex) vaccine. Vaccine. Mar 20 2006;24(13):2290-301. [Medline].

  21. Ochoa TJ, Cleary TG. Shigella. In: Kliegman, Behrman, Jenson, Stanton, eds. Nelson Textbook of Paediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007:1191-3.

  22. Pazhani GP, Ramamurthy T, Mitra U, et al. Species diversity and antimicrobial resistance of Shigella spp. isolated between 2001 and 2004 from hospitalized children with diarrhoea in Kolkata (Calcutta), India. Epidemiol Infect. Dec 2005;133(6):1089-95. [Medline].

  23. Plotz FB, Arets HG, Fleer A, et al. Lethal encephalopathy complicating childhood shigellosis. Eur J Pediatr. Jul 1999;158(7):550-2. [Medline].

  24. Richardson SE, Rotman TA, Jay V, et al. Experimental verocytotoxemia in rabbits. Infect Immun. Oct 1992;60(10):4154-67. [Medline].

  25. Tzipori S, Sheoran A, Akiyoshi D, et al. Antibody therapy in the management of shiga toxin-induced hemolytic uremic syndrome. Clin Microbiol Rev. Oct 2004;17(4):926-41, table of contents. [Medline].

  26. Wong CS, Jelacic S, Habeeb RL, et al. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. Jun 29 2000;342(26):1930-6. [Medline].

  27. Yang F, Yang J, Zhang X, et al. Genome dynamics and diversity of Shigella species, the etiologic agents of bacillary dysentery. Nucleic Acids Res. 2005;33(19):6445-58. [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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