Shigella
| Shigella infects the small and large bowel causing diarrhea fever (58%), nausea, cramps, tenesmus, and bloody stools (51%). Mucosal ulcers, intestinal microabscesses, and seizures (infants) are common. |
| Incubation Period: 1-3 days days |
| Fecal leukocytes are typical |
| Case Fatality Rate can be 20% in hospitalized cases of dysentery. Complications include toxic megacolon and hemolytic-uremic syndrome. Reiter Syndrome is associated with S. flexeneri |
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Isolation |
| Healthcare workers use Standard and Enteric Precautions. Food handling/preparation, child care or care or elderly or immunocompromised people is prohibited until two negative stools are documented. |
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Quarantine |
| Quarantine of case contacts not required. |
| The secondary attack rate in households is 40%. |
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Above: Salmonella invade bowel wall |
| Left Upper: Toxic megacolon |
| Left Lower: Fecal leukocytes |
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Treatment |
| Antibiotic resistance is common.
Antimotility drugs are contraindicated. Ciprofloxacin 500mg po bid for 3 days. TMP/SMX DS po bid for 3 days. Azithromycin 500mg po once then 250mg po bid for 4 days |
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Pediatric |
| TMP/SMX 5mg/kg of TMP q12h po for 3 days. Ceftriaxone 50-75mg/kg/d for 2-5 days Ciprofloxacin suspension 10mg/kg po bid for 5 days. |
| Breast-feeding is protective in infants. |
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