Approach Considerations

Maintain hydration in patients with shigellosis to compensate for fluid losses from diarrhea.

Antibiotic treatment is indicated in most patients with a positive stool culture for Shigella. Treatment can reduce symptoms by 2 days.

Indications for treatment per Centers for Disease Control and Prevention (CDC) recommendations include persons who work in public setting (ie, food handlers, childcare providers, residents of nursing homes), have a immunocompromised state (including individuals with human immunodeficiency virus [HIV] infection), and patients with severe disease (those who require hospitalization or have complications). Patients infected with Shigella may shed the bacteria for up to 6 weeks, even after resolution of symptoms.^[3]

Avoid the use of antimotility agents, because they have the potential to worsen the symptoms and may predispose to toxic dilatation of the colon.

Clear liquids followed by a low residue, lactose-free diet are recommended until symptoms of shigellosis resolve.

Medical Care

General supportive care of patients with shigellosis includes the following^[42]:

Treat high fever in children.
Avoid narcotic-related antidiarrheals.
Antibiotic treatment is indicated in most patients.^[43]Note that antibiotic-resistant Shigella species have emerged^{[19, 20]}; thus, obtaining susceptibility testing and monitoring local shigellosis outbreaks is crucial.
Clear liquids followed by a low-residue, lactose-free diet is recommended until symptoms of shigellosis resolve.

As noted earlier, antimotility agents should be avoided, as they have the potential to worsen symptoms and may predispose to toxic dilatation of the colon.

For fluid and electrolyte supplementation, oral rehydration solutions are preferable.

Consultations

Consult a gastroenterologist or an infectious diseases expert if the Shigella infection is prolonged or if the patient experiences a severe course of shigellosis that is unresponsive to antibiotics.

Prevention

A vaccine for shigellosis is not currently available. Until a vaccine is available, the following measures can help prevent the dissemination of shigellosis:

Use of safe drinking water
Chlorination of unreliable water sources
Strict handwashing
Refrigeration and proper preparation and cooking of food. Food handlers must be treated with antibiotics and should not be involved in food preparation as long as stool cultures are positive for Shigella infection. At least 48 hours of antibiotic treatment are usually required.

Medication

Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM. Shigellosis. Lancet. 2018 Feb 24. 391(10122):801-12. [QxMD MEDLINE Link].
Sjolund Karlsson M, Bowen A, Reporter R, et al. Outbreak of infections caused by Shigella sonnei with reduced susceptibility to azithromycin in the United States. Antimicrob Agents Chemother. 2013 Mar. 57(3):1559-60. [QxMD MEDLINE Link]. [Full Text].
Centers for Disease Control and Prevention. Shigella -- shigellosis. Questions & answers. Available at https://www.cdc.gov/shigella/general-information.html. Updated: October 12, 2017; Accessed: December 21, 2017.
Mani S, Wierzba T, Walker RI. Status of vaccine research and development for Shigella. Vaccine. 2016 Jun 3. 34(26):2887-94. [QxMD MEDLINE Link]. [Full Text].
Baseer S, Ahmad S, Ranaghan KE, Azam SS. Towards a peptide-based vaccine against Shigella sonnei: a subtractive reverse vaccinology based approach. Biologicals. 2017 Nov. 50:87-99. [QxMD MEDLINE Link].
Yagnik B, Sharma D, Padh H, Desai P. Oral immunization with LacVax® OmpA induces protective immune response against Shigella flexneri 2a ATCC 12022 in a murine model. Vaccine. 2019 May 21. 37(23):3097-105. [QxMD MEDLINE Link].
Barel LA, Mulard LA. Classical and novel strategies to develop a Shigella glycoconjugate vaccine: from concept to efficacy in human. Hum Vaccin Immunother. 2019. 15(6):1338-56. [QxMD MEDLINE Link]. [Full Text].
Mellouk N, Enninga J. Cytosolic access of intracellular bacterial pathogens: the Shigella paradigm. Front Cell Infect Microbiol. 2016. 6:35. [QxMD MEDLINE Link].
Killackey SA, Sorbara MT, Girardin SE. Cellular aspects of Shigella pathogenesis: focus on the manipulation of host cell processes. Front Cell Infect Microbiol. 2016. 6:38. [QxMD MEDLINE Link].
Agaisse H. Molecular and cellular mechanisms of Shigella flexneri dissemination. Front Cell Infect Microbiol. 2016. 6:29. [QxMD MEDLINE Link].
Nuesch-Inderbinen M, Heini N, Zurfluh K, Althaus D, Hachler H, Stephan R. Shigella antimicrobial drug resistance mechanisms, 2004-2014. Emerg Infect Dis. 2016 Jun. 22(6):1083-5. [QxMD MEDLINE Link].
Dupont HL, Edelman R, Kimmey M. Infectious diarrhea: from E coli to Vibrio. Patient Care. 1991 May 30. 25(10):18-43.
Lapaquette P, Fritah S, Lhocine N, et al. Shigella entry unveils a calcium/calpain-dependent mechanism for inhibiting sumoylation. Elife. 2017 Dec 12. 6:[QxMD MEDLINE Link]. [Full Text].
Al-Abri SS, Beeching NJ, Nye FJ. Traveller's diarrhoea. Lancet Infect Dis. 2005 Jun. 5(6):349-60. [QxMD MEDLINE Link].
Hines JZ, Jagger MA, Jeanne TL, et al. Heavy precipitation as a risk factor for shigellosis among homeless persons during an outbreak - Oregon, 2015-2016. J Infect. 2018 Mar. 76(3):280-5. [QxMD MEDLINE Link].
Williamson D, Ingle D, Howden B. Extensively drug-resistant shigellosis in Australia among men who have sex with men. N Engl J Med. 2019 Dec 19. 381(25):2477-9. [QxMD MEDLINE Link]. [Full Text].
Ingle DJ, Easton M, Valcanis M, et al. Co-circulation of multidrug-resistant Shigella among men who have sex with men in Australia. Clin Infect Dis. 2019 Oct 15. 69(9):1535-44. [QxMD MEDLINE Link]. [Full Text].
Liang M, Ding X, Wu Y, Sun Y. Temperature and risk of infectious diarrhea: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2021 Jul 15. [QxMD MEDLINE Link].
Shad AA, Shad WA. Shigella sonnei: virulence and antibiotic resistance. Arch Microbiol. 2021 Jan. 203 (1):45-58. [QxMD MEDLINE Link]. [Full Text].
Puzari M, Sharma M, Chetia P. Emergence of antibiotic resistant Shigella species: A matter of concern. J Infect Public Health. 2018 Jul - Aug. 11(4):451-4. [QxMD MEDLINE Link]. [Full Text].
Arnold SLM. Target product profile and development path for shigellosis treatment with antibacterials. ACS Infect Dis. 2021 May 14. 7 (5):948-58. [QxMD MEDLINE Link].
Moralez EI, Lofland D. Shigellosis with resultant septic shock and renal failure. Clin Lab Sci. 2011 Summer. 24(3):147-52. [QxMD MEDLINE Link].
Khan WA, Griffiths JK, Bennish ML. Gastrointestinal and extra-intestinal manifestations of childhood shigellosis in a region where all four species of Shigella are endemic. PLoS One. 2013. 8(5):e64097. [QxMD MEDLINE Link]. [Full Text].
Bennish ML. Potentially lethal complications of shigellosis. Rev Infect Dis. 1991 Mar-Apr. 13(suppl 4):S319-24. [QxMD MEDLINE Link].
Bennish ML, Azad AK, Yousefzadeh D. Intestinal obstruction during shigellosis: incidence, clinical features, risk factors, and outcome. Gastroenterology. 1991 Sep. 101(3):626-34. [QxMD MEDLINE Link].
Azad MA, Islam M, Butler T. Colonic perforation in Shigella dysenteriae 1 infection. Pediatr Infect Dis. 1986 Jan-Feb. 5(1):103-4. [QxMD MEDLINE Link].
Martin T, Habbick BF, Nyssen J. Shigellosis with bacteremia: a report of two cases and a review of the literature. Pediatr Infect Dis. 1983 Jan-Feb. 2(1):21-6. [QxMD MEDLINE Link].
Struelens MJ, Patte D, Kabir I, Salam A, Nath SK, Butler T. Shigella septicemia: prevalence, presentation, risk factors, and outcome. J Infect Dis. 1985 Oct. 152(4):784-90. [QxMD MEDLINE Link].
Morduchowicz G, Huminer D, Siegman-Igra Y, Drucker M, Block CS, Pitlik SD. Shigella bacteremia in adults. A report of five cases and review of the literature. Arch Intern Med. 1987 Nov. 147(11):2034-7. [QxMD MEDLINE Link].
Keddy KH, Sooka A, Crowther-Gibson P, et al. Systemic shigellosis in South Africa. Clin Infect Dis. 2012 May. 54(10):1448-54. [QxMD MEDLINE Link].
Keusch GT, Bennish ML. Shigellosis: recent progress, persisting problems and research issues. Pediatr Infect Dis J. 1989 Oct. 8(10):713-9. [QxMD MEDLINE Link].
Butler T, Islam MR, Bardhan PK. The leukemoid reaction in shigellosis. Am J Dis Child. 1984 Feb. 138(2):162-5. [QxMD MEDLINE Link].
Khan WA, Dhar U, Salam MA, Griffiths JK, Rand W, Bennish ML. Central nervous system manifestations of childhood shigellosis: prevalence, risk factors, and outcome. Pediatrics. 1999 Feb. 103(2):E18. [QxMD MEDLINE Link].
Avital A, Maayan C, Goitein KJ. Incidence of convulsions and encephalopathy in childhood Shigella infections. Survey of 117 hospitalized patients. Clin Pediatr (Phila). 1982 Nov. 21(11):645-8. [QxMD MEDLINE Link].
Simon DG, Kaslow RA, Rosenbaum J, Kaye RL, Calin A. Reiter's syndrome following epidemic shigellosis. J Rheumatol. 1981 Nov-Dec. 8(6):969-73. [QxMD MEDLINE Link].
Siegler RL. The hemolytic uremic syndrome. Pediatr Clin North Am. 1995 Dec. 42(6):1505-29. [QxMD MEDLINE Link].
Murphy TV, Nelson JD. Shigella vaginitis: report of 38 patients and review of the literature. Pediatrics. 1979 Apr. 63(4):511-6. [QxMD MEDLINE Link].
Tobias JD, Starke JR, Tosi MF. Shigella keratitis: a report of two cases and a review of the literature. Pediatr Infect Dis J. 1987 Jan. 6(1):79-81. [QxMD MEDLINE Link].
Rubenstein JS, Noah ZL, Zales VR, Shulman ST. Acute myocarditis associated with Shigella sonnei gastroenteritis. J Pediatr. 1993 Jan. 122(1):82-4. [QxMD MEDLINE Link].
Kroser JA, Metz DC. Evaluation of the adult patient with diarrhea. Prim Care. 1996 Sep. 23(3):629-47. [QxMD MEDLINE Link].
Moreno-Mingorance A, Espinal P, Rodriguez V, et al. Circulation of multi-drug-resistant Shigella sonnei and Shigella flexneri among men who have sex with men in Barcelona, Spain, 2015-2019. Int J Antimicrob Agents. 2021 Sep. 58 (3):106378. [QxMD MEDLINE Link].
Banerjee S, LaMont JT. Treatment of gastrointestinal infections. Gastroenterology. 2000 Feb. 118(2 suppl 1):S48-67. [QxMD MEDLINE Link].
Murphy GS, Bodhidatta L, Echeverria P, et al. Ciprofloxacin and loperamide in the treatment of bacillary dysentery. Ann Intern Med. 1993 Apr 15. 118(8):582-6. [QxMD MEDLINE Link].
Baker KS, Campos J, Pichel M, et al. Whole genome sequencing of Shigella sonnei through PulseNet Latin America and Caribbean: advancing global surveillance of foodborne illnesses. Clin Microbiol Infect. 2017 Nov. 23(11):845-53. [QxMD MEDLINE Link]. [Full Text].
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. 2006 Jan. 50(1):49-54. [QxMD MEDLINE Link].
Klontz KC, Singh N. Treatment of drug-resistant Shigella infections. Expert Rev Anti Infect Ther. 2015 Jan. 13(1):69-80. [QxMD MEDLINE Link].
Medeiros PHQS, Lima AAM, Guedes MM, et al. Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil. Diagn Microbiol Infect Dis. 2018 Mar. 90(3):198-205. [QxMD MEDLINE Link].
Toro C, Arroyo A, Sarria A, et al. Shigellosis in subjects with traveler's diarrhea versus domestically acquired diarrhea: implications for antimicrobial therapy and human immunodeficiency virus surveillance. Am J Trop Med Hyg. 2015 Sep. 93(3):491-6. [QxMD MEDLINE Link].
Vinh H, Anh VT, Anh ND, et al. A multi-center randomized trial to assess the efficacy of gatifloxacin versus ciprofloxacin for the treatment of shigellosis in Vietnamese children. PLoS Negl Trop Dis. 2011 Aug. 5(8):e1264. [QxMD MEDLINE Link]. [Full Text].
Policar M. Shigellosis. In: Ferri FF, ed. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Mosby; 2005. 752-4.
Gu B, Ke X, Pan S, et al. Prevalence and trends of aminoglycoside resistance in Shigella worldwide, 1999-2010. J Biomed Res. 2013 Mar. 27(2):103-15. [QxMD MEDLINE Link]. [Full Text].
Wolf DC, Gianella RA. Invasive pathogens. Consultations in Gastroenterology. 1996. 381-4.
Taneja N. Changing epidemiology of shigellosis and emergence of ciprofloxacin-resistant Shigellae in India. J Clin Microbiol. 2007 Feb. 45(2):678-9. [QxMD MEDLINE Link].
Heiman KE, Karlsson M, Grass J, et al. Notes from the field: Shigella with decreased susceptibility to azithromycin among men who have sex with men - United States, 2002-2013. MMWR Morb Mortal Wkly Rep. 2014 Feb 14. 63(6):132-3. [QxMD MEDLINE Link].
Lewis R. Azithromycin not effective against all Shigella infections. Medscape Medical News from WebMD. February 13, 2014. Available at http://www.medscape.com/viewarticle/820607. Accessed: February 23, 2014.
Lubbert C. Antimicrobial therapy of acute diarrhoea: a clinical review. Expert Rev Anti Infect Ther. 2016. 14(2):193-206. [QxMD MEDLINE Link].
Li YL, Tewari D, Yealy CC, Fardig D, M'ikanatha NM. Surveillance for travel and domestically acquired multidrug-resistant human Shigella infections-Pennsylvania, 2006-2014. Health Secur. 2016 May-Jun. 14(3):143-51. [QxMD MEDLINE Link].
Piro AS, Hernandez D, Luoma S, et al. Detection of cytosolic Shigella flexneri via a C-terminal triple-arginine motif of GBP1 inhibits actin-based motility. MBio. 2017 Dec 12. 8(6):[QxMD MEDLINE Link]. [Full Text].
Pinaud L, Ferrari ML, Friedman R, et al. Identification of novel substrates of Shigella T3SA through analysis of its virulence plasmid-encoded secretome. PLoS One. 2017. 12(10):e0186920. [QxMD MEDLINE Link].
Brown JD, Willcox SJ, Franklin N, et al. Shigella species epidemiology and antimicrobial susceptibility: the implications of emerging azithromycin resistance for guiding treatment, guidelines and breakpoints. J Antimicrob Chemother. 2017 Nov 1. 72(11):3181-6. [QxMD MEDLINE Link].
Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis. 2011 Jan. 17(1):7-15. [QxMD MEDLINE Link]. [Full Text].
Ashkenazi S. Shigella infections in children: new insights. Semin Pediatr Infect Dis. 2004 Oct. 15(4):246-52. [QxMD MEDLINE Link].

Media Gallery

of 0

Shigellosis Treatment & Management

Approach Considerations

Medical Care

Consultations

Prevention

References

Tables

Contributor Information and Disclosures

What would you like to print?