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Salem Health: Infectious Diseases & Conditions, 2nd Edition

Shigellosis

by Merrill Evans, , M.A.

Category: Diseases and conditions

Anatomy or system affected: Gastrointestinal system, intestines, stomach

Definition

The microscopic bacterium Shigella causes the infectious disease shigellosis. An acute bacterial infection attacks the lining of the intestines, resulting in diarrhea, fever, and stomach cramps.

Causes

Shigellosis is spread by fecal-oral contact. This can occur when people ingest food or water contaminated with Shigella. Shigellosis can spread when food grows in a field that contains contaminated water. Flies can spread shigellosis by breeding in infected feces. Shigellosis can also spread when people drink, swim in, or play in contaminated water. Transmission can be spread through sexual contact, particularly through anal and oral sex.

Shigellosis commonly occurs in developing countries with inadequate sanitation. It thrives in areas with overcrowding, poor handwashing technique, and lack of protocols for safe food and water. The disease also spreads easily in close quarters, such as day-care centers, refugee camps, and jails and prisons.

Risk Factors

About eighteen thousand cases of shigellosis are reported in the United States alone each year. Many milder cases are not diagnosed or reported; public health officials estimate the actual number of cases could be as high as 360,000 annually. The infection is most common in children age two to four years.

Shigellosis is the most common cause of diarrhea among visitors to developing countries. It infects hundreds of millions of people around the world each year, resulting in an estimated one million deaths, mostly among children in countries with inadequate medical resources.

Symptoms

The symptoms of watery diarrhea, fever, and stomach cramps begin from one to three days after a person comes into contact with the bacterium. In some cases, the incubation period is as short as twelve hours. Often, the diarrhea contains blood and mucus, and the infected person may develop fever. Some experience nausea, vomiting, anorexia, or a cramping rectal pain. The symptoms usually resolve within five to seven days, even without treatment, but the infected person may still be contagious for another week or two.

Some people do not experience symptoms at all, but while infected, they can pass Shigella to others. Sometimes, dehydration occurs, which can lead to the death of a person who has severe shigellosis.

In developing countries, infected persons may experience prolonged, acute diarrhea, lasting seven to thirteen days, or persistent diarrhea, lasting fourteen days or more; this leads to malnutrition. These long-term conditions have the potential to be life-threatening.

About 3 percent of persons with shigellosis develop Reiter’s syndrome, consisting of pain of the joints, irritation of the eyes, and painful urination. The syndrome can last for months or years, and it can lead to chronic, treatment-resistant arthritis. Another rare complication is hemolytic-uremic syndrome, a form of kidney failure that includes anemia and clotting problems.

Persons with high fever, confusion, headache with stiff neck, lethargy, or seizures should seek emergency care. These symptoms are most common in children.

Screening and Diagnosis

A stool culture identifies Shigella in the feces of an infected person. Because there are several different strains of Shigella, the stool culture will help to determine the correct treatment. A blood test also may be done if symptoms are severe, or to rule out other causes.

Treatment and Therapy

Persons with mild cases of shigellosis usually recover quickly, without treatment. However, antibiotics canshorten the course of the illness by a few days. Some Shigella bacteria have become resistant to antibiotics.

Infected persons should drink water and electrolyte solutions (such as Gatorade) to replace fluids lost by diarrhea and should follow their normal diet, as much as possible, to ensure nutrition. Doctors recommend that persons with shigellosis avoid foods that are high in fat and sugar, spicy foods, and alcohol and coffee until two days after all symptoms have disappeared.

Because shigellosis is particularly dangerous for children, research is ongoing into Shigella vaccines. A person who has recovered from shigellosis is unlikely to be infected with the same strain for several years. Antidiarrheal medicines such as loperamide (Imodium) and atropine (Lomotil) should not be taken by persons with shigellosis, as they can make the illness worse.

Prevention and Outcomes

Handwashing with soap can prevent the spread of shigellosis. Because of contagion, infected persons should be separated from those who are not infected. People with shigellosis should not prepare food or pour water for others. If a child in diapers is infected, all persons who change the diapers should observe strict sanitation and should dispose of the diapers properly. Precautions for food and water safety will prevent shigellosis. Travelers should drink only treated or boiled water and should eat cooked hot foods and self-peeled fruit.

Government agencies in the United States are working to prevent outbreaks of shigellosis. Shigella infections are monitored by the Centers for Disease Control and Prevention and by state and local health departments. These agencies investigate shigellosis, track how it is transmitted, and develop methods of controlling the disease. In addition, these agencies conduct research into ways to identify and treat shigella infection. The U.S. Food and Drug Administration checks imported foods and advocates for improved food-preparation techniques in restaurants and in food-processing plants. The U.S. Environmental Protection Agency checks the safety of drinking water.

Further Reading

1 

Alam, N. H. “Treatment of Infectious Diarrhea in Children.” Pediatric Drugs 5, no. 3 (2003): 151-165. Discusses three primary diarrheal diseases that impact childhood morbidity and death in developing countries, including shigellosis, and practices for treatment.

2 

Bain, W. B., et al. “Common-Source Outbreak of Waterborne Shigellosis at a Public School.” In AnIntroduction to Epidemiology, edited by Thomas C. Timmreck. 3d ed. Sudbury, Mass.: Jones and Bartlett, 2002. Includes a case study of a shigellosis outbreak at a public school in Stockport, Iowa.

3 

Bhattacharya, S. K. “An Evaluation of Current Shigellosis Treatment.” Expert Opinion on Pharmacotherapy 4, no. 8 (2003): 1315-1320. Surveys the use of antibiotics in the treatment of shigellosis and discusses personal hygiene practices.

4 

Moore, Sean R., Noelia L. Lima, Alberto M. Soares, et al. “Prolonged Episodes of Acute Diarrhea Reduce Growth and Increase Risk of Persistent Diarrhea in Children.” Gastroenterology 139 (2010): 1156-1164. This article discusses the consequences of prolonged episodes of acute diarrhea in children.

5 

Rebmann, Terri. “Spotlight on Shigellosis.” Nursing 39 (2009): 59-60. In addition to the standard information about shigellosis, this article includes details about taking a comprehensive patient history and the importance of patient teaching.

6 

Shannon, Joyce Brennfleck, ed. Contagious Diseases Sourcebook. Detroit: Omnigraphics, 2010. A chapter on shigellosis focuses on prevention and on public health considerations.

Web Sites of Interest

Centers for Disease Control and Prevention, Division of Foodborne, Bacterial, and Mycotic Diseases

http://www.cdc.gov/nczved/divisions/dfbmd

Neglected Tropical Diseases Coalition

http://www.neglectedtropicaldiseases.org

U.S. Department of Agriculture, Food Safety Information Center

http://foodsafety.nal.usda.gov

See also: Amebic dysentery; Bacterial infections; Children and infectious disease; Developing countries and infectious disease; Escherichia; Fecal-oral route of transmission; Flies and infectious disease; Food-borne illness and disease; Giardiasis; Intestinal and stomach infections; Salmonella; Shigella; Travelers’ diarrhea; Tropical medicine; Waterborne illness and disease.

Citation Types

Type
Format
MLA 9th
Evans, Merrill. "Shigellosis." Salem Health: Infectious Diseases & Conditions, 2nd Edition, edited by H. Bradford Hawley, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=Infect2e_0524.
APA 7th
Evans, M. (2020). Shigellosis. In H. B. Hawley (Ed.), Salem Health: Infectious Diseases & Conditions, 2nd Edition. Salem Press. online.salempress.com.
CMOS 17th
Evans, Merrill. "Shigellosis." Edited by H. Bradford Hawley. Salem Health: Infectious Diseases & Conditions, 2nd Edition. Hackensack: Salem Press, 2020. Accessed September 16, 2025. online.salempress.com.