Overview

Shigella infection (shigellosis) is an intestinal disease caused by a family of bacteria known as shigella. The main sign of shigella infection is diarrhea, which often is bloody.

Shigella can be passed through direct contact with the bacteria in the stool. For example, this can happen in a child care setting when staff members don't wash their hands well enough after changing diapers or helping toddlers with toilet training. Shigella bacteria also can be passed in contaminated food or by drinking or swimming in contaminated water.

Children between the ages of 2 and 4 are most likely to get shigella infection. A mild case usually clears up on its own within a week. When treatment is needed, doctors generally prescribe antibiotics.

Symptoms

Signs and symptoms of shigella infection usually begin a day or two after contact with shigella, but may take up to a week to develop. Signs and symptoms may include:

  • Diarrhea (often containing blood or mucus)
  • Abdominal pain or cramps
  • Fever

Although some people have no symptoms after they've been infected with shigella, their feces may still be contagious up to a few weeks.

When to see a doctor

Contact your doctor or seek urgent care if you or your child has bloody diarrhea or diarrhea severe enough to cause weight loss and dehydration. Also, contact your doctor if you or your child has diarrhea and a fever of 101 F (38 C) or higher.

Causes

Infection occurs when you accidentally swallow shigella bacteria. This can happen when you:

  • Touch your mouth. If you don't wash your hands well after changing the diaper of a child who has shigella infection, you may become infected yourself. Direct person-to-person contact is the most common way the disease is spread.
  • Eat contaminated food. Infected people who handle food can transmit the bacteria to people who eat the food. Food can also become contaminated if it grows in a field that contains sewage.
  • Swallow contaminated water. Water may become contaminated either from sewage or from a person with shigella infection swimming in it.

Risk factors

  • Being a toddler. Shigella infection is most common in children between the ages of 2 and 4.
  • Living in group housing or participating in group activities. Close contact with other people spreads the bacteria from person to person. Shigella outbreaks are more common in child care centers, community wading pools, nursing homes, jails and military barracks.
  • Living or traveling in areas that lack sanitation. People who live or travel in developing countries are more likely to contract shigella infection.
  • Being a sexually active gay male. Men who have sex with men are at higher risk because of direct or indirect oral-anal contact.

Complications

Shigella infection usually clears up without complications, although it may take weeks or months before your bowel habits return to normal.

Complications may include:

  • Dehydration. Persistent diarrhea can cause dehydration. Symptoms include lightheadedness, dizziness, lack of tears in children, sunken eyes and dry diapers. Severe dehydration can lead to shock and death.
  • Seizures. Some children who run high fevers with a shigella infection have seizures. It's not known whether the convulsions are a result of the fever or the shigella infection itself. If your child has a seizure, contact your doctor immediately.
  • Rectal prolapse. In this condition, straining during bowel movements may cause the mucous membrane or lining of the rectum to move out through the anus.
  • Hemolytic uremic syndrome. This rare complication of shigella, more commonly caused by bacteria called E. coli, can lead to a low red blood cell count (hemolytic anemia), low platelet count (thrombocytopenia) and acute kidney failure.
  • Toxic megacolon. This rare complication occurs when your colon becomes paralyzed, preventing you from having a bowel movement or passing gas. Signs and symptoms include abdominal pain and swelling, fever, and weakness. If you don't receive treatment for toxic megacolon, your colon may break open (rupture), causing peritonitis, a life-threatening infection requiring emergency surgery.
  • Reactive arthritis. Reactive arthritis develops in response to infection. Signs and symptoms include joint pain and inflammation, usually in the ankles, knees, feet and hips; redness, itching and discharge in one or both eyes (conjunctivitis); and painful urination (urethritis).

Prevention

Although the World Health Organization has been working on a shigella vaccine, nothing is available yet. To prevent the spread of shigella:

  • Wash hands frequently and thoroughly
  • Supervise small children when they wash their hands
  • Dispose of soiled diapers properly
  • Disinfect diaper-changing areas after use
  • Don't prepare food for others if you have diarrhea
  • Keep children with diarrhea home from child care, play groups or school
  • Avoid swallowing water from ponds, lakes or untreated pools
  • Avoid sexual activity with anyone who has diarrhea or who recently recovered from diarrhea
July 08, 2015
References
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  3. Marx JA, et al. Infectious diarrheal disease and dehydration. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Mosby Elsevier; 2014. http://www.clinicalkey.com. Accessed June 17, 2015.
  4. Bowen A, et al. The Yellow Book 2014: CDC health information for international travel. Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/shigellosis. Accessed June 17, 2015.
  5. Shigella – shigellosis. Centers for Disease Control and Prevention. http://www.cdc.gov/shigella/index.html. Accessed June 17, 2015.
  6. Shigella infections among gay & bisexual men. Centers for Disease Control and Prevention. http://www.cdc.gov/shigella/msm.html. Accessed June 17, 2015.