Shigellosis - General Information Frequently Asked Questions
z What is shigellosis? z What sort of germ is Shigella? z How can Shigella infections be diagnosed? z How can Shigella infections be treated? z Are there long-term consequences to a Shigella infection? z How do people catch Shigella? z What can a person do to prevent this illness? z How common is shigellosis? z What else can be done to prevent shigellosis? z What is the government doing about shigellosis? z How can I learn more about this and other public health problems? z Some tips for preventing the spread of shigellosis
What is shigellosis?
Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most who are infected with Shigella develop diarrhea, fever, and stomach cramps
starting a day or two after they are exposed to the bacterium. The diarrhea is often bloody. Shigellosis usually resolves in 5 to 7 days. In some persons, especially
young children and the elderly, the diarrhea can be so severe that the patient needs to be hospitalized. A severe infection with high fever may also be
associated with seizures in children less than 2 years old. Some persons who are infected may have no symptoms at all, but may still pass the Shigella bacteria to
What sort of germ is Shigella?
The Shigella germ is actually a family of bacteria that can cause diarrhea in humans. They are microscopic living creatures that pass from person to person.
Shigella were discovered over 100 years ago by a Japanese scientist named Shiga, for whom they are named. There are several different kinds of Shigella
bacteria: Shigella sonnei, also known as "Group D" Shigella, accounts for over two-thirds of the shigellosis in the United States. A second type, Shigella flexneri,
or "group B" Shigella, accounts for almost all of the rest. Other types of Shigella
are rare in this country, though they continue to be important causes of disease in the developing world. One type found in the developing world, Shigella dysenteriae type 1, causes deadly epidemics there.
How can Shigella infections be diagnosed?
Many different kinds of diseases can cause diarrhea and bloody diarrhea, and the treatment depends on which germ is causing the diarrhea. Determining that
Shigella is the cause of the illness depends on laboratory tests that identify
Shigella in the stools of an infected person. These tests are sometimes not
performed unless the laboratory is instructed specifically to look for the organism. The laboratory can also do special tests to tell which type of Shigella
the person has and which antibiotics, if any, would be best to treat it.
How can Shigella infections be treated?
Shigellosis can usually be treated with antibiotics. The antibiotics commonly used for treatment are ampicillin, trimethoprim/sulfamethoxazole (also known as
Bactrim* or Septra*), nalidixic acid, or ciprofloxacin. Appropriate treatment kills the Shigella bacteria that might be present in the patient's stools, and shortens the
illness. Unfortunately, some Shigella bacteria have become resistant to antibiotics and using antibiotics to treat shigellosis can actually make the germs more
resistant in the future. Persons with mild infections will usually recover quickly without antibiotic treatment. Therefore, when many persons in a community are affected by shigellosis, antibiotics are sometimes used selectively to treat only the
more severe cases. Antidiarrheal agents such as loperamide (Imodium*) or diphenoxylate with atropine (Lomotil*) are likely to make the illness worse and
Are there long term consequences to a Shigella infection?
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. About 3% of persons who
are infected with one type of Shigella, Shigella flexneri, will later develop pains in their joints, irritation of the eyes, and painful urination. This is called Reiter's
syndrome. It can last for months or years, and can lead to chronic arthritis which is difficult to treat. Reiter's syndrome is caused by a reaction to Shigella infection
that happens only in people who are genetically predisposed to it.
Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella.
How do people catch Shigella?
The Shigella bacteria pass from one infected person to the next. Shigella are present in the diarrheal stools of infected persons while they are sick and for a
week or two afterwards. Most Shigella infections are the result of the bacterium passing from stools or soiled fingers of one person to the mouth of another
person. This happens when basic hygiene and handwashing habits are inadequate. It is particularly likely to occur among toddlers who are not fully toilet-trained. Family members and playmates of such children are at high risk of becoming
Shigella infections may be acquired from eating contaminated food. Contaminated food may look and smell normal. Food may become contaminated
by infected food handlers who forget to wash their hands with soap after using the bathroom. Vegetables can become contaminated if they are harvested from a
field with sewage in it. Flies can breed in infected feces and then contaminate food. Shigella infections can also be acquired by drinking or swimming in
contaminated water. Water may become contaminated if sewage runs into it, or if someone with shigellosis swims in it.
What can a person do to prevent this illness?
There is no vaccine to prevent shigellosis. However, the spread of Shigella from
an infected person to other persons can be stopped by frequent and careful handwashing with soap. Frequent and careful handwashing is important among
all age groups. Frequent, supervised handwashing of all children should be
followed in day care centers and in homes with children who are not completely
toilet-trained (including children in diapers). When possible, young children with
a Shigella infection who are still in diapers should not be in contact with uninfected children.
People who have shigellosis should not prepare food or pour water for others
until they have been shown to no longer be carrying the Shigella bacterium.
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 carefully with soap and warm water immediately after changing the diapers. After use, the diaper changing area should be wiped down with a disinfectant such as household bleach, Lysol* or
Basic food safety precautions and regular drinking water treatment prevents shigellosis. At swimming beaches, having enough bathrooms near the swimming
area helps keep the water from becoming contaminated.
Simple precautions taken while traveling to the developing world can prevent getting shigellosis. Drink only treated or boiled water, and eat only cooked hot foods or fruits you peel yourself. The same precautions prevent traveler's diarrhea
How common is shigellosis?
Every year, about 18,000 cases of shigellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be twenty times greater. Shigellosis is particularly common and
causes recurrent problems in settings where hygiene is poor and can sometimes sweep through entire communities. Shigellosis is more common in summer than
winter. Children, especially toddlers aged 2 to 4, are the most likely to get shigellosis. Many cases are related to the spread of illness in child-care settings,
and many more are the result of the spread of the illness in families with small children.
In the developing world, shigellosis is far more common and is present in most communities most of the time.
What else can be done to prevent shigellosis?
It is important for the public health department to know about cases of shigellosis. It is important for clinical laboratories to send isolates of Shigella to
the City, County or State Public Health Laboratory so the specific type can be determined and compared to other Shigella. If many cases occur at the same time,
it may mean that a restaurant, food or water supply has a problem which needs correction by the public health department. If a number of cases occur in a day-care center, the public health department may need to coordinate efforts to
improve handwashing among the staff, children, and their families. When a community-wide outbreak occurs, a community-wide approach to promote
handwashing and basic hygiene among children can stop the outbreak. Improvements in hygiene for vegetables and fruit picking and packing may
prevent shigellosis caused by contaminated produce.
Some prevention steps occur everyday, without you thinking about it. Making municipal water supplies safe and treating sewage are highly effective prevention measures that have been in place for many years.
What is the government doing about shigellosis?
The Centers for Disease Control and Prevention (CDC) monitors the frequency of
Shigella infections in the country, and assists local and State health departments
to investigate outbreaks, determine means of transmission and devise control measures. CDC also conducts research to better understand how to identify and
treat shigellosis. The Food and Drug Administration inspects imported foods, and promotes better food preparation techniques in restaurants and food processing plants. The Environmental Protection Agency regulates and monitors the safety
of our drinking water supplies. The government has also maintained active research into the development of a Shigella vaccine.
How can I learn more about this and other public health problems?
You can discuss any medical concerns you may have with your doctor or other
heath care provider. Your local city or county health department can provide more information about this and other public health problems that are occurring
in your area. General information about the public health of the nation is published every week in the "Morbidity and Mortality Weekly Report", by the
CDC in Atlanta, GA. Epidemiologists in your local and State Health Departments are tracking a number of important public health problems, investigating special
problems that arise, and helping to prevent them form occurring in the first place, or from spreading if they do occur.
Some tips for preventing the spread of shigellosis:
z wash hands with soap carefully and frequently, especially after going to the
bathroom, after changing diapers, and before preparing foods or beverages
z dispose of soiled diapers properly z disinfect diaper changing areas after using them z keep children with diarrhea out of child care settings z supervise handwashing of toddlers and small children after they use the
z persons with diarrheal illness should not prepare food for others z if you are traveling to the developing world, "boil it, cook it, peel it, or
This page last reviewed September 3, 2003
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