Medical Care
The clinician should rapidly assess the patient's fluid and electrolyte status and institute parenteral or oral hydration along with antipyretics as needed. Prompt recognition and treatment of seizures and raised intracranial pressure are essential. Nutritional supplementation of vitamin A (200,000 IU) can hasten clinical resolution in malnourished children. [22, 23]
Zinc supplementation (20 mg elemental zinc for 14 d) has been shown to reduce the duration of diarrhea, improve weight gain during recovery, and result in better immune response to the Shigella along with decreased incidence of diarrheal illness in the subsequent 6 months in malnourished children. [21, 24, 25]
Methods to use bacteriophages to control bacterial infections are being developed and these include the combination of broad host range phages. Within the cocktails, the phages can alter their host range in situ and can be used to treat certain bacterial disease as well as decontaminate food handling premises. Interest in phage therapy has increased and well controlled, well designed blinded studies are on way which will eventually answer many of the questions derived from earlier studies. [26, 12, 27]
Surgical Care
Surgical care may be required for complications (eg, intestinal perforation).
Consultations
Consult a neurologist if seizures and altered sensorium predominate.
Consult a nephrologist if HUS is suspected (eg, for patients with anemia, thrombocytopenia, oliguria, and renal failure).
Diet and Activity
Diet
The diet may need to be restricted according to the severity of the disease.
Activity
No restrictions are necessary.
Prevention
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:
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Education of families and child-care center personnel in handwashing techniques, especially after toilet use
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Avoidance of food preparation by personnel who change diapers in daycare centers
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Exclusion of febrile children with diarrhea from daycare centers
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Proper handling and refrigeration of food, even after cooking
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Use of universal precautions and isolation of persons with diarrhea in institutions and hospitals
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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
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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.
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Exclusion of infected people as food handlers and measures to decrease contamination of food by house flies
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People with diarrhea due to this waterborne pathogen should not use recreational water venues for 2 weeks after symptoms resolve.
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Improvements in worker hygiene during vegetable and fruit picking and packing may prevent shigellosis caused by contaminated produce.
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Appropriate case reporting to health authorities is essential to take effective measures to prevent further transmission.
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This illustration depicts a three-dimensional (3D), computer-generated image of a number of rod-shaped, drug-resistant, Shigella sp. bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery. Note that the exterior of the Shigella bacteria is fimbriated, covered by numerous thin, hair-like projections, imparting a furry appearance. Courtesy of the Centers for Disease Control (CDC)/James Archer.
