Shigella Infection Follow-up

Updated: Apr 03, 2018
  • Author: Jaya Sureshbabu, MBBS, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg); Chief Editor: Russell W Steele, MD  more...
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Follow-up

Deterrence/Prevention

See the list below:

  • Meticulous hand hygiene is the single most important measure to decrease transmission. In situations where access to clean water or soap is limited, waterless hand sanitizers may be an effective option.

  • 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 center 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 from daycare centers of symptomatic children, attendees, and staff members with documented Shigella gastroenteritis until diarrhea has ceased and 2 stool culture tests are negative for Shigella

    • If a child in diapers has shigellosis, everyone who changes the child's diapers should be sure the diapers are disposed of properly in a closed-lid garbage can and should wash his or her hands and the child’s hands carefully with soap and warm water immediately after changing the diapers. After use, the diaper changing area should be wiped down with a disinfectant.

    • Exclusion of infected people as food handlers and measures to decrease contamination of food by house flies

    • People with diarrhea due to this waterborne pathogen should not use recreational water venues for 2 weeks after symptoms resolve.

    • Improvements in worker hygiene during vegetable and fruit picking and packing may prevent shigellosis caused by contaminated produce.

    • Appropriate case reporting to health authorities is essential to take effective measures to prevent further transmission.

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Complications

See the list below:

  • 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. [37]

      • 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) [38, 39]

    • 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. [37]

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Prognosis

See the list below:

  • 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 decreases within 2-3 days.

    • Carrier state usually ceases within 4 weeks of onset of illness even without antimicrobial treatment and chronic carrier state (>1 y) is rare.

  • 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.

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