SHIGELLOSIS

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Experiencing a sharp cramp in your stomach and lower abdomen followed by frequent trips to the bathroom, sometimes up to 30 times a day, might signal you have shigellosis, a form of food poisoning.

Shigellosis, caused by a group of bacteria known as shigella, brings along symptoms like belly pain, fever, and either watery or bloody diarrhea.

This illness is commonly found among young children, often contracted in daycare or school settings. Additionally, travelers to developing countries where hygiene standards may be lower might also encounter shigellosis, known as traveler’s diarrhea.

Usually, shigellosis resolves within 5 to 7 days with proper rest and hydration. However, severe cases may require hospitalization.

In the United States alone, shigellosis affects around half a million people annually. However, its impact is far more severe in poorer nations, causing approximately 165 million cases and one million deaths worldwide each year.

So, how does shigellosis spread?

The shigella bacteria enter your system, multiply in the small intestines, and then move into the large intestines, triggering cramps and diarrhea. These bacteria exit the body through feces, and transmission occurs when the bacteria from an infected person’s stool reach the mouth of another individual.

Shigella spreads more easily than one might assume. Here are some common ways:

1. Touching Objects: For instance, changing the diaper of a child with shigellosis can leave behind bacteria on surfaces like changing tables, toys, and doorknobs if hands aren’t washed properly. Others touching these contaminated surfaces can become infected, especially if they touch their mouth or ingest something using their contaminated hands.
2. Food Contamination: Individuals handling or preparing food while infected with shigellosis can contaminate it. Without proper hand hygiene, food can become tainted. Even fruits and vegetables grown in fields contaminated with human feces can carry the bacteria.
3. Water Ingestion: Swallowing water while swimming in contaminated pools or ponds can introduce shigella into the body.
4. Sexual Contact: Engaging in sexual activities involving oral-anal contact can also expose individuals to shigellosis.

Symptoms Of Shigellosis

The primary symptom of shigellosis is diarrhea, often accompanied by blood or mucus. Additional symptoms may include:

• Nausea
• Vomiting
• Fever
• Stomach and abdominal cramping
• Tenesmus, which is the sensation of needing to use the bathroom even when your intestines are empty.

In mild cases, symptoms typically resolve without medication within a week. However, shigellosis can be more severe for certain groups, such as seniors, infants, or individuals with weakened immune systems due to chronic illnesses like HIV.

When Should You Seek Medical Help?

It’s important to contact your doctor if:

• Your diarrhea is severe, especially if it contains blood or mucus.
• You have a fever.
• You exhibit signs of dehydration, such as dry mouth, lips, or lightheadedness.

Even if you don’t experience symptoms, you can still spread the disease to others.

Complications

Although rare, shigella infections can lead to lingering issues, including:

• Dehydration: Characterized by symptoms like lightheadedness, dizziness, reduced tear production, and sunken eyes, particularly watchful for dry diapers in children.
• Post-infectious arthritis: Joint pain, often affecting the ankles, knees, feet, or hips, along with eye irritations and painful urination. This complication occurs in about 2% of people infected with shigella flexneri.
• Bloodstream infection: Damage to the intestinal lining during the illness can allow shigella or other bacteria from the gut to infect the bloodstream, more commonly observed in individuals with underlying conditions like HIV, cancer, or malnutrition.
• Hemolytic-uremic syndrome (HUS): This infection produces a toxin that destroys red blood cells, critical for oxygen transportation.
• Seizures: Particularly seen in young children, immediate medical attention is necessary if a child experiences a seizure.

Diagnosis

As there are various causes of diarrhea, a laboratory test may be necessary to determine if shigellosis is the culprit. Your doctor might request a stool sample to check for the presence of shigella bacteria. Additionally, the lab can conduct further tests to identify the most effective antibiotic treatment.

What’s the Treatment?

In most instances, recovery from shigellosis involves resting and replenishing lost fluids due to diarrhea. It’s crucial to avoid medications that halt diarrhea or slow down gut function, such as diphenoxylate with atropine (Lomotil) or loperamide (Imodium), as they can exacerbate the condition.

In severe cases, especially for seniors, infants, or individuals with underlying health conditions, antibiotics may be prescribed to shorten the duration of the illness. However, it’s important to note that some strains of shigella bacteria are resistant to antibiotics, which may render treatment ineffective. If prescribed antibiotics don’t improve symptoms after several days of use, it’s essential to inform your doctor.

Prevention

As there is currently no vaccine or cure for shigellosis, practicing good hygiene is paramount for prevention.

• Thoroughly wash your hands with warm water and soap, particularly after using the bathroom or changing diapers, and before handling food. Ensure young children also adhere to handwashing after using the bathroom.
• Additional preventive measures include keeping children with diarrhea out of daycare or school settings, avoiding drinking water from potentially contaminated sources like pools, lakes, or ponds, and consuming only boiled, cooked, or peeled food when traveling abroad.
• When traveling internationally, it’s advisable to increase handwashing frequency.
• Dispose of soiled diapers properly by wrapping them up and placing them in a trash receptacle.
• Refrain from engaging in sexual activity with someone who recently experienced diarrhea.

Sources:

1. Centers for Disease Control and Prevention
2. National Institute of Allergy and Infectious Diseases
3. Harvard Health Publications
4. Mayo Clinic: “Shigella Infection.”
5. FoodSafety.gov: “Shigella.”
6. California Department of Public Health: “Shigellosis.”
7. UpToDate: “Shigella infection: Treatment and prevention in adults,” “Shigella infection: Clinical manifestations and diagnosis.”