Shigella enteritis

Definition

Shigella enteritis is an acute infection of the lining of the intestines.

Alternative Names

Causes

Shigella enteritis is caused by the shigella bacteria. People infected with Shigella release the bacteria in their stool. The bacteria can spread from an infected person to contaminate water or food, or directly to another person. Getting just a little bit of the Shigella bacteria into your mouth is enough to cause disease.

Outbreaks of shigella enteritis are associated with poor sanitation, contaminated food and water, and crowded living conditions.

Shigella enteritis is common among travelers in developing countries and workers or residents of refugee camps. The time between exposure to the bacteria and symptoms is 1 to 7 days, with an average of 3 days.

Up to 40% of children with severe shigella enteritis develop febrile seizures or encephalopathy with headache, lethargy, confusion, and stiff neck (nuchal rigidity).

There are about 18,000 cases of shigella enteritis per year in the United States. The condition is most commonly seen in day care centers and similar places.

Symptoms

• Acute abdominal pain or cramping
• Tenesmus (crampy rectal pain)
• Watery diarrhea
• Nausea and vomiting
• Acute fever
• Blood, mucus, or pus in stool

Exams and Tests

• Dehydration with fast heart rate and low blood pressure
• Abdominal tenderness
• Elevated white blood cell count
• Stool culture
• White blood cells in stool

Treatment

The natural course of the disease is 2-7 days. The goal of treatment is to replace fluids and electrolytes (salt and minerals) lost in diarrhea.

Antidiarrheal medications are generally not given because they may prolong the course of the disease.

Self-care measures to avoid dehydration include drinking electrolyte solutions to replace the fluids lost by diarrhea. Several varieties of electrolyte solutions are now available over the counter.

Antibiotics can be used to shorten the length of the illness and to reduce spread to others in group living or day care situations. Antibiotics also may be indicated for patients with severe symptoms. Sulfamethoxazole-trimethoprim (Bactrim), ampicillin, ciprofloxacin (Cipro), or azithromycin are frequently used.

People with diarrhea who are unable to take fluids by mouth because of nausea may need medical attention and intravenous fluids, especially small children.

People taking diuretics should be cautious if they develop diarrhea, and may be told to stop taking the diuretic during acute shigella enteritis.

Outlook (Prognosis)

Often the infection is mild and goes away on its own. Most patients, except malnourished children and those with weakened immune systems, have an excellent outlook.

Possible Complications

• Severe dehydration
• Neurologic symptoms including seizures (in children)
• Hemolytic-uremic syndrome (HUS), a form of kidney failure with anemia and clotting problems
• Reiter's syndrome, which involves eye pain and redness, joint pain, and pain with urination

When to Contact a Medical Professional

Call your provider if diarrhea does not improve, if blood is noted in the stool, or if dehydration seems to be developing.

Go to the emergency room if seizures occur, or if confusion, lethargy, headache with stiff neck, or similar symptoms develop in a person with shigella enteritis (most common in children).

Prevention

Prevention involves the proper handling, storage, and preparation of food, in addition to good cleanliness. Hand washing is the most effective preventive measure. Avoid contaminated food and water.

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